Study On The Distribution Of Etiology Of Fever Of Unknown Origin

Objective: The aim of this study is to retrospectively analyze the etiology,distribution,diagnosis and clinical characteristics of FUO in the 252 Hospital of PLA during the past 2 years.We summarized the distribution rule of FUO disease,the experience of clinical diagnosis and treatment,and guided the clinical work in order to improve the efficiency of diagnosis and save the cost of medical treatment.Method: Through the 252 Hospital of PLA medical record query system,retrieved all hospital departments(Pediatrics excepted)to find out the patients who were admitted to hospital with the initial diagnosis of "Fever of unknown origin",from January 2015 to December 2016,According to the FUO diagnostic standard proposed at the 1998 National Febrile Disease Symposium,187 patients with FUO diagnostic criteria were selected.Retrospective analysis of clinical data of 187 patients,according to the final diagnosis of each patient,divided them into five groups: infectious diseases,connective tissue diseases,tumor diseases and other diseases,of unknown origin.recorded the etiology,clinic department,Diagnosis method,age,gender,duration of fever,onset season of each patient.Used Spss22.0 software to compare the differences in the distribution of FUO patients,according to the type of disease,sex,age,onset season,duration of fever.Data are analyzed by SPSS22.0 statistical software.Results:1.Among 187 cases of adult FUO,155 cases were diagnosed clearly,the rate of diagnosis was 82.9%,including 107 cases of infectious diseases(57.2%),23 cases of connective tissue disease(12.3%),15 cases of neoplastic diseases(8%),10 cases of other diseases(5.3%),and 32 cases(17.1%)without diagnosis.There are about 50 diseases,the most common diseases are brucellosis,Mycobacterium tuberculosis infection,urinary tract infection,septicemia,adult Still disease,lymphoma and so on.2.FUO patients in our hospital,infectious disease patients were first treated in the Department of respiration,followed by neurology;patients with connective tissue disease first visits to the Department of Rheumatology,followed by Department of respiration;patients with neoplastic disease first treated in the Department of Hematology,followed by the Department of respiration;other kinds of disease patients first treated in the Department of respiration.3.Serology,secretions and body fluids and(or)the most important etiological detection method for diagnosis of FUO,accounting for 59.3%;followed by biopsy(including lymph node biopsy,bone marrow biopsy and other biopsy),accounting for 16.1%;followed by imaging,10.3%;diagnosis treatment or experimental treatment.Accounted for 14.2%.4.The female and male patients were 108 cases and 79 cases respectively.The proportion of women and men was 1.37:1,67 cases of infectious diseases were found in women,accounting for 35.8%,17 cases of connective tissue disease,9.1%,and 5 cases of tumor disease,accounting for 2.7%.There were 40 cases of infectious diseases in men,accounting for 21.4%,6 cases of connective tissue disease,3.2%,and 10 cases of tumor disease,accounting for 5.3%.The number of men and women with other diseases was the same,all of which were 5,and the proportion was 2.7%.The proportion of women in infectious and connective tissue diseases is higher than that of men.The proportion of men tumorous diseases is higher than that of women,however,The sex ratio of different disease groups was different(P=0.025 < 0.05),which was statistically significant.5.The incidence of infectious diseases in all age groups accounted for the first,and the proportion of infectious diseases in different age groups was equal.The prevalence rate of connective tissue disease was the highest in the age of 31-45 years,followed by the age of 46-60.The tumor is the second cause of the aged group(> 60 years old).6.The thermal process of infectious diseases is generally within 1 months.Connective tissue disease is the second cause of the 1-3 months thermal process group.In the >3 month thermal process group,connective tissue disease and tumor diseases become the first cause.The longer the fever time,the smaller the proportion of infectious diseases,the greater the possibility of non infectious diseases.7.The highest incidence of infectious diseases was from January to March(38.3%),followed by April to June(29.9%).Connective tissue diseases frequently occurred in April to June,and from June to september(the same is 30.4%30.4%),while the incidence of neoplastic diseases was high in theApril to June(53.3%).The distribution of etiological factors in different seasons was different(P=0.043<0.05).Conclusion:1.The main cause of FUO is infectious disease,followed by connective tissue disease,and then tumor.2.Infectious diseases are Still the main cause of FUO,Brucellosis is the primary cause of infectious diseases.Tuberculosis is the second cause of infection,and non pulmonary tuberculosis is the main cause.3.The most common diagnostic methods for FUO are serology,secretion and body fluid and(or)etiological detection.Then they are tissue biopsy,imaging,diagnostic treatment or experimental treatment.4.The distribution of FUO is different in different sex,age,thermal process and season.The diagnosis of FUO has certain rules.Most of them can be diagnosed through detailed medical history,careful physical examination,reasonable selection of auxiliary examination and diagnostic treatment.