Fukuhara H, Tamaki K, Nakamura H, Kanesima H, Irabu Y, Shimozi K, Kitsukawa K, Shigeno Y, Kyinjou F, Saito A
First Department of Internal Medicine, Faculty of Medicine, University of the Ryukyus.
Kansenshogaku Zasshi. 1990 Mar;64(3):335-41. doi: 10.11150/kansenshogakuzasshi1970.64.335.
We analysed retrospectively 48 hospitalized patients with fever of unknown origin (FUO) from 1982 through 1988. The criteria of FUO were (1) temperature of more than 38.3 degrees C documented on several occasions (2) overall duration of illness more than three weeks, (3) uncertain diagnosis till one week after hospitalization. Of this group of FUO, 25 patients (52.1%) were found to have infections, 8 patients (16.7%) had collagen disorders, 7 patients (14.6%) had neoplastic disorders, 3 patients (6.3%) were crohn disease and 5 patients (10.4%) were undiagnosed. Among infectious diseases, chronic tonsillitis was the most frequent (5 patients: 20%) and they were diagnosed by the provocative examination. Non bacterial meningitis and cervical lymphadenitis were diagnosed in all 3 patients (12% in all), Adult Still's disease was found in 3 patients (37.5%) and systemic lupus erythematosus (SLE) in 2 patients (25%) in collagen disease. Immunoblastic lymphadenopathy was diagnosed in 3 patients (42.9%) of malignant diseases. Three cases of Crohn disease were revealed in all the patients of the miscellaneous group. Duration of fever was relatively short in infection diseases compared to malignant and Crohn diseases. The most common laboratory abnormality is an elevated erythrocyte sedimentation rate (89.6%). As the final diagnosis of FUO are changing with the development of diagnostic techniques, a new criteria of FUO is necessary.
我们回顾性分析了1982年至1988年间48例不明原因发热(FUO)的住院患者。FUO的标准为:(1)多次记录体温超过38.3摄氏度;(2)疾病总病程超过三周;(3)住院一周后诊断仍不明确。在这组FUO患者中,25例(52.1%)被发现患有感染性疾病,8例(16.7%)患有胶原病,7例(14.6%)患有肿瘤性疾病,3例(6.3%)为克罗恩病,5例(10.4%)未确诊。在感染性疾病中,慢性扁桃体炎最为常见(5例:20%),通过激发试验确诊。3例患者均被诊断为非细菌性脑膜炎和颈部淋巴结炎(共占12%),胶原病中3例患者(37.5%)为成人斯蒂尔病,2例患者(25%)为系统性红斑狼疮(SLE)。恶性疾病中有3例患者(42.9%)被诊断为免疫母细胞性淋巴结病。在所有其他组患者中发现3例克罗恩病。与恶性疾病和克罗恩病相比,感染性疾病的发热持续时间相对较短。最常见的实验室异常是红细胞沉降率升高(89.6%)。由于随着诊断技术的发展,FUO的最终诊断在不断变化,因此需要制定新的FUO标准。