The Clinical Analysis Of 112 Cases Of Infectious Diseases Treated With Fever Of Unknown Origin

Objective:To explore the distribution,diagnostic methods and clinical features of infectious diseases treated with fever of unknown origin,to improve clinical physician infectious FUO in the diagnosis and treatment level.Methods:We reviewed 112 inpatient clinical data which met infectious FUO diagnostic criteria in the Infection ward of First Affiliated Hospital of Guangxi Medical University from January 2018 to December 2019.The etiological distribution,common diseases and diagnostic methods were analyzed retrospectively.According to discharge diagnosis,infectious FUO was divided into common bacterial infection group,special bacterial infection group(tuberculosis,leprosy,brucellosis),other pathogen infection group(fungus,virus,rickettsial,etc.)and unexplained infection group,and the differences in etiology distribution of patients with different ages,genders and heat courses were compared.Results:The causes of 112 cases of infectious FUO were followed by 53 cases of common bacterial infection(47.4%),31 cases of special bacterial infection(27.6%),12 cases of other pathogen infection(10.7%),and 16 cases of unexplained infection(14.3%).In terms of specific diseases,tuberculosis was the most common(21/112,18.7%),including 7 cases of tuberculosis and14 cases of extrapulmonary tuberculosis.It was followed by pulmonary infection(14/112,12.5%),bloodstream infection(13/112,11.6%),infective endocarditis(7/112,6.2%),brucellosis(7/112,6.2%),and urinary tract infection(6/112,5.4%).Other diseases were rare.In the distribution of infected foci,there were 32 cases of respiratory tract(28.6%),13 cases of blood(11.6%),10 cases of digestive system and lymphatic system(8.9%),7 cases of brain and endocardium(6.2%),6 cases of urinary tract(5.4%),5 cases of skin and soft tissue,5 cases of bone and joint(4.5%),1 case of testis(0.9%),and 16 cases of inability to identify the site of infection(14.3%).In the pathogen distribution,59 patients with infectious FUO were detected with pathogens,among which 3patients were detected with two different bacteria at the same time.Among the49 strains(49/62,79.0%)of bacteria,30 strains of bacillus(including 14 strains of enterobacter,7 strains of brucella,4 strains of mycobacterium tuberculosis,etc.)and 19 strains of coccus(including 11 strains of staphylococcus,6 strains of streptococcus cerevisiae,etc.)were detected.In addition,there were 5 fungal strains(5/62,8.1%),5 viral strains(5/62,8.1%).In the distribution of diagnostic methods,55 cases(49.1%)were detected by etiology,24 cases(21.4%)by empirical treatment,17 cases(15.1%)by clinical comprehensive analysis,8cases(7.2%)by imaging examination and histopathology.There were statistically significant differences in the diagnostic methods between different etiological groups(P<0.001).In the gender distribution,there were 63 males(56.3%)and 49 females(43.7%),with a male-to-female ratio of 1.29:1.There was no significant difference between the two groups in different etiology compositions(P>0.05).In the age distribution,the average age was 51.0±15.03 years old.Common bacterial infection was the main cause in the young,middle-aged and elderly groups,and the etiology composition of different age groups was not statistically significant(P>0.05).In the heat path distribution,33 patients(29.5%)had a heat path within 1 month,55 patients(49.1%)had a heat path between 1 and 3 months,and 24 patients(21.4%)had a heat path above 3 months.The etiology of the heat path in the three groups was not statistically significant(P>0.05).Conclusion:Among the causes of infectious FUO,common bacterial infection takes the first place,followed by mycobacterium tuberculosis.The most common lesions of infectious FUO were respiratory tract.The detection rate of infectious FUO pathogen is low,and the bacteria are mainly bacilli.The second coccus is more common.Among the diagnostic methods of infectious FUO,pathogen detection is the most important diagnostic method,and empirical treatment is an important method to diagnose tuberculosis and infectious FUO with unknown causes.