114 Cases Of Classic Fever Of Unknown Origin:Etiological Spectrum And Clinical Characteristics Analysis

Objective: To investigate the etiology and clinical characteristics of classic fever of unknown origin.Methods:We reviewed 114 inpatient clinical data which met classic fever of unknown origin(FUO)diagnostic criteria in the Infection ward of First Affiliated Hospital of Guangxi Medical University from January 2014 to December 2015.According to the diagnosis of discharge,five categories were identified: infectious diseases,connective tissue diseases,malignancies,miscellaneous diseases and undiagnosed.And analysis of its etiological spectrum,diagnostic methods and summarize the clinical features of infectious diseases,connective tissue disease and malignancies and identification points of infectious diseases and non-infectious diseases.Result:1.A diagnosis was established in 108 patients with 114 cases of classic FUO(94.7%).Infectious disease as the most important cause,a total of 68 cases(59.6%),followed by connective tissue disease(20,17.5%),malignancies(9,7.9%),miscellaneous diseases(11,9.7%),and undiagnosed was only 6 cases(5.3%).And In terms of specific disease,adult-onset Still's disease is the most common type of FUO disease(12,10.5%),followed by typhoid(7,6.1%)and lymphoma(7,6.1%).2.The diagnosis method included 42 patients with Empiric therapy(38.9%)(including empiric intravenous antibiotics treatment,diagnostic anti-tuberculosis treatment,empiric corticosteroids and / or NSAIDs treatment),Serological or etiological examination in 31 cases(28.7%),15 cases of Imaging examination(13.9%).Biopsy were 12 cases(11.1%),clinical observation in 8 cases(7.4%).The positive rate of bone marrow culture was low(4 / 73,5.5%),of which 3cases of bone marrow culture positive blood culture also cultured the same pathogens.3.Clinical characteristics of three types of causes of infectious diseases,connective tissue diseases and malignancies : Infectious diseases is more common in men,chills,headache patients(P <0.05);connective tissue disease is more common in people aged 20-40,and there were no significant differences in the proportion of male and female patients(P> 0.05),and the incidence of rash,joint pain and lymphadenopathy was higher(P> 0.05),and white blood cell count(WBC),serum ferritin(SF),high sensitivity C-reactive protein(hs-CRP)and erythrocyte sedimentation(ESR)were significantly higher than those of the other two types of etiology(P <0.05).Malignancies were more common in men over 40 years old,and more severe spleen,anemia,hypoproteinemia and lactate dehydrogenase(LDH),Alkaline phosphatase were significantly increased(P<0.05).4.Multivariate unconditional logistic regression analysis showed that SF was an independent predictor of infectious disease and was negatively correlated,suggesting that serum ferritin was lower in non-infectious disease than in non-infectious disease(P <0.05)(Hosmer-Lemeshow goodness Test,?2 = 5.354,P = 0.499),logistic regression equation: Logit P = 3.509-1.158x(x = SF).The area under the ROC curve of the SF is 0.763 and the 95% confidence interval is0.660-0.866.Conclusion:1.The most common cause of fever of unknown origin is infectious diseases,followed by connective tissue disease,miscellaneous diseases and malignancies.And In terms of specific disease,AOSD is the most common type of FUO disease,followed by typhoid and lymphoma.2.The positive rate of bone marrow culture in patients with classic FUO is low and the diagnostic value of bone marrow culture in patients with classic FUO is open to question.3.Infectious diseases,connective tissue disease and malignancy in classical FUO have their own clinical manifestations and laboratory tests,and combined with these characteristics contribute to the identification of classical FUO.4.Serum ferritin has a certain significance for the differential diagnosis of infectious and noninfectious diseases.