A Study Of Distribution Of Disease Categories And Diagnostic Strategy In Fever Of Unknown Origin

Objective1. To investigate distribution of disease categories in FUO2. To formulate a diagnostic strategy of FUO3. To evaluate the clinical value of18F-FDG PET/CT for the diagnosis of FUOMethods1. Between January2009and February2010, patients with FUO were identified byreview of patient records of the Department of Fever Related Diseases in ChinesePLA general hospital, and their clinical data were analyzed retrospectively.2. We formulated a structured diagnostic protocol of FUO, and performed aprospective study of inhospitable patients with FUO in the Department of FeverRelated Diseases in Chinese PLA general hospital from November2011toNovember2012.3. Between January and December in2012, the clinical data of patients with FUO whounderwent18F-FDG PET/CT were analyzed retrospectively in the Department ofFever Related Diseases in Chinese PLA general hospital.Results1.215cases with classic type of FUO were enrolled. The cause distribution of FUOwas infective diseases (42.3%), connective tissue diseases (32.1%), malignant tumor(6.5%) and miscellaneous diseases (10.7%). The most frequent diseases wereadult-onset Still’s disease (17.2%), tuberculosis (7.2%), lymphoma (2.8%) andnecrotic lymphadenitis (1.9%).2. The accurate rate of the structured diagnostic protocol of FUO was88.3%, the meantime of diagnosis was11.7days and the mean medical expense￥14,700.61.5%of infective diseases,64.7%of connective tissue diseases and44.4%of miscellaneousdiseases were diagnosed after the initial investigations.46.7%of malignant tumorand44.4%of miscellaneous diseases were diagnosed by special examinations, andthe proportions rise to80%and55.5%respectively if including18F-FDG PET/CT.3. The accurate rate, sensitivity, specificity, positive predictive value and negativepredictive value of18F-FDG PET/CT for the diagnosis of FUO were75.6%,100%,44.1%,69.8%and100%respectively.Conclusion1. The most cause of FUO was infective diseases, followed by connective tissuediseases, malignant tumor and miscellaneous diseases.2. The structured diagnostic protocol of FUO was helpful with high accurate rate.Initial investigations were more important for infective diseases and connectivetissue diseases, but special examinations for malignant tumor and miscellaneousdiseases.3. The high sensitivity and negative predictive value of18F-FDG PET/CT for thediagnosis of FUO were helpful and recommended.