[Fever of unknown origin. Fever caused by bacteria].
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Eighteen patients with fever of unknown origin in whom other diagnostic procedures had failed, underwent exploratory laparotomy with splenectomy, hepatic biopsies and biopsies of lymph nodes, muscle and bone, while bile, urine and intestinal content were cultured. In all patients, inspection and palpation of abdominal cavity doesn't give any diagnostic orientation. With histologic examination and cultures, precise diagnosis was made in 13 cases (72 per cent). Predominant diagnosis was Hodgkin's disease. One patient died with complications of surgery.
Fever of unknown origin (FUO) is a frequent disorder in pediatric age. FUO is defined as the presence of fever over 38.4 centigrades in a patient for more than three weeks in which the etiology remains undetermined. From 30.736 consecutive admittances into our hospital, 180 patients with FUO were detected, and studied in a systematized way and according to a predetermined protocol. FUO was commonly found in children under six years of age. Our patients presented fever from three weeks to six and a half years of evolution; however, in the vast majority of the cases (n = 115) fever had a three weeks course. Several symptoms and physical manifestations other than fever were observed in our patients but they were widely variable and nonspecific. Infectious diseases were the commonest etiological factor encountered; among them, thyroid fever, and urinary tract infections were the most frequent infectious disorder found; in four children fever was associated to ampicillin administration; in 19 patients, fever was no demonstrated. A large number of laboratory investigations were done in the diagnosis of neoplastic diseases. We think that the study of a patient with FUO requires of a systematized approach.
A patient with a yearlong fever of unknown origin responded to trimethoprim-sulfamethoxazole and was discovered to have culture-proved Nocardia asteroides sinusitis, with absence of detectable disease in other organs. An inhalational route is postulated as the mode of entry of the organism, with localization in the maxillary sinus.
Fever of unknown origin strictly defined by Petersdorf in 1961 may be caused by a whole array of conditions. A rational approach should be based upon the relative frequencies of the different causes and their importance for the health and life of the patient. Risks, discomfort and, to a limited degree, costs must be taken into consideration. The investigation protocol we propose takes into account all these factors and is mainly based upon an extensive literature survey and our personal experience with a series of 199 patients studied in the 1980 s.
The evaluation of the condition of a patient with fever of unknown origin requires a knowledge of those disorders that produce this syndrome, an awareness of the potential significance of subtle findings in the history and physical examination, and an appreciation of the value in this clinical setting of specific diagnostic procedures. In this report, we review these aspects of fever of unknown origin and outline a diagnostic approach to the persistently febrile patient.
Lymphography has been performed in 21 patients with fever of unknown origin. In 8 of the patients, lymphography was positive, demonstrating retroperitoneal lymphoma. The value of lymphography before planning a laparotomy is stressed.
A patient with a dissecting aneurysm of the ascending aorta had fever of unknown origin. Although his clinical picture included a number of classical features of his disorder, these were initially misinterpreted, largely because fever was the patient's chief complaint. Polymorphonuclear leukocytes sequestered within the aortic hemagen as they disintegrated. This case emphasizes the protean nature of the dissecting aortic aneurysm, adding yet another distinct clinical manifestation, fever of unknown origin, with which it may be associated.
This review summarizes the different causes of fever of unknown origin reported in the internationally indexed literature from 1961 till 1990. In 1961 Petersdorf published his landmark report that, for the first time, proposed criteria that cases have to meet to be considered as fever of unknown origin. We only retained cases and series that met these criteria. We meticulously compared the reported case series and tried to explain the differences between these series.
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A 68-year-old man with intermittent fever of unknown origin was found to have a systemic Saccharomyces infection, probably as a result of daily oral ingestion of the organism as brewer's yeast, a nutritional supplement. The case illustrates the potential dangers that may occur secondary to the oral ingestion of viable microorganisms, and the disease-producing potential of Saccharomyces is reaffirmed. Once again, a thorough and complete medical history was the key to resolving an unusual fever of unknown origin.
A patient with a one-year history of fever of unknown origin is presented. Extensive work-up failed to reveal the source of the fever. Treatment of periodontal infection resulted in complete cure, suggesting a cause-effect relationship. A possible role of Interleukin 1 (IL-1), universal pyrogen, in periodontal disease is suggested.
Two patients with long-standing fever and weight loss underwent extensive diagnostic procedures before peritoneal tuberculosis was diagnosed by explorative laparatomy. By that time they had developed signs of intestinal obstruction. Both recovered after treatment, but one developed serious neurological complications, which could not be explained. Peritoneal tuberculosis is a manifestation of tuberculosis that is often difficult to diagnose. It should be borne in mind when diagnosing patients with fever of unknown origin, especially if they are originally from countries with a high prevalence of tuberculosis.
OBJECTIVE: To determine the relative proportions of the diagnostic categories in patients with fever of unknown origin who were examined in the 1980s. STUDY DESIGN: Prospective case series. SETTING: General Internal Medicine Service based at University Hospital, Leuven, Belgium. PATIENTS: One hundred ninety-nine consecutive patients meeting the classic criteria of fever of unknown origin who were treated in the 1980s. MAIN OUTCOME MEASUREMENT: The final diagnosis established at discharge or during follow-up. RESULTS: Infections were found in 45 patients (22.6%), tumors were found in 14 (7%), multisystem diseases were found in 42 (21.5%), drug-related fever was found in six (3%), factitious fever was found in seven (3.5%), habitual hyperthermia was found in five (2.5%), miscellaneous diseases were found in 29 (14.5%), and no diagnosis was reached in 51 (25.6%). CONCLUSIONS: Tumors were a less important cause of fever of unknown origin in the 1980s. The same holds true for some infectious diseases, such as abscesses and hepatobiliary disorders. Multisystem diseases were more frequently found, and the number of undiagnosed cases increased. Although these shifts in the disease spectrum in fever of unknown origin most probably resulted from a constellation of factors, we suspect that these changes are mainly due to easy and early diagnosis by new diagnostic modalities, such as ultrasonography and computed tomography, of previously common causes of fever of unknown origin.
Tuberculosis is the most frequent cause of fever from unknown etiology. On the other hand, mediastinal tuberculous adenopathy (TBM), without associated pulmonary affection is a rare form of presentation among adults, generally evolving with sustained fever until a thoracic radiology is performed showing mediastinal enlargement. We present a case which started as fever from unknown etiology (FUE), given that, according to the thoracic radiology performed one month after the onset of fever, no mediastinal affection was observed.
We report a patient with a jejunal leiomyosarcoma who presented with fever of unknown origin. Resection of the tumour resulted in resolution of his symptoms.