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[Fever of unknown origin in internal medicine. The experience of Spanish authors over 20 years]
J M Ramos Rincón1, R Ramos Guevara, F Herrero Huerta
1Servicio de Medicina Interna, Hospital General Universitario Morales Meseguer, Murcia.
Abstract:
The diseases responsible of fever of unknown origin (FUO) have changed in the last years. With the object of study the etiologic spectrum and diagnostic attitude in the FUO in a national level in the last 25 years, we has revised 14 articles of FUO realized in Internal Medicine published from 1970 to 1995, without aids patients. We use MEDLINE and Indice Médico Español to search the publications about FUO. In 14 articles, 914 cases of FUO was evaluated, the infection was the principal cause (41.2%), followed by tumor (19.2%) and collagenoses/vasculitis (13.7%). In the infection group, the disease more frequent was the tuberculosis (134/377) (35.5%) follow by brucellosis (15.6%) y abscesses (11.6%). Half of malignancy group was due to lymphoma. Systemic lupus erythematous, polyarteritis nodosa and temporal arteritis were caused of FUO in 28.8%, 21.6% y 20% of collagenoses/vasculitis group. In the miscellaneous group emphasized granulomatous diseases (38.8%) (including sarcoidosis, idiopathic granulomatous hepatitis and chronic granulomatous disease). The improve of diagnostic procedures has conditioned a change of spectrum of the diseases, with a decrease of infectious causes (as brucellosis or salmonellosis) and increase or neoplasia and collagenoses/vasculitis (except lupus).
Insights
The causes of fever of unknown origin (FUO) have shifted over 25 years. Infections remain common, but neoplastic and collagen vascular diseases are increasingly identified as key etiologies.
Area of Science:
- Internal Medicine
- Clinical Epidemiology
Context:
- Fever of unknown origin (FUO) presents diagnostic challenges.
- Etiologic spectrum of FUO has evolved over time.
- Understanding these shifts is crucial for effective diagnosis.
Purpose:
- To analyze the etiologic spectrum of FUO.
- To evaluate diagnostic approaches for FUO.
- To assess changes in FUO causes over a 25-year period (1970-1995).
Summary:
- A review of 14 Internal Medicine articles encompassing 914 FUO cases from 1970-1995.
- Infections were the leading cause (41.2%), notably tuberculosis, brucellosis, and abscesses.
- Neoplasms (19.2%) and collagen vascular diseases (13.7%) were also significant, with lymphoma and systemic lupus erythematosus being prominent.
Impact:
- Improved diagnostic procedures have altered the FUO landscape.
- A decrease in infectious causes like brucellosis is observed.
- An increase in neoplastic and collagen vascular diseases (excluding lupus) as FUO etiologies is evident.