Zhou Guanyu, Zhou Ying, Zhong Cejun, Ye Hui, Liu Zhenzhen, Liu Yanbin, Tang Guangmin, Qu Junyan, Lv Xiaoju
Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China.
Ann Transl Med. 2020 Jun;8(11):690. doi: 10.21037/atm-20-3875.
Fever of unknown origin (FUO) is commonly defined as fever higher than 38.3 °C on several occasions during at least 3 weeks with uncertain diagnosis after a number of obligatory investigations. It is a special type of fever and a common disease in internal medicine. However, due to its complex etiology, lack of characteristic clinical manifestations, and insufficient laboratory examination indicators, it often baffles clinicians in diagnosis. We herein present a study of the etiological factors and clinical features of classic fever of unknown origin (FUO) to provide help for related clinical diagnosis and treatment.
A total of 1,641 cases of patients with classic FUO hospitalized in West China Hospital of Sichuan University between January 1, 2011 and December 31, 2017, were collected, and the etiological factors of classic FUO were analyzed. A special effort was made to explore and screen the laboratory indicators related to infectious diseases, and the above data were compared with the clinical features of tuberculosis and lymphoma, which are difficult to diagnose.
Among the 1,641 patients, 1,504 were finally diagnosed through various types of examination or diagnostic methods, and the diagnosis rate was 91.65%. Among all the causes of the 1,641 cases of FUO, 48.69% [799] were infectious diseases, of which tuberculosis was the most common, accounting for 19.50% [320]. Connective tissue diseases were responsible for 19.26% [316] of cases, of which adult-onset Still's disease (AOSD) was the most common, comprising 89 (5.42%) of the cases; 16.94% [278] were neoplastic diseases, and lymphoma (143, 8.71%) cases, was the most common malignant tumor; 6.76% [111] were other diseases; and in 8.35% [137] of cases, the cause was unclear. Through comparative analysis of tuberculosis and lymphoma, no significant differences were found between the symptoms, signs, and non-specific routine examination results of the two diseases. The diagnosis of these diseases was more dependent on tuberculosis-related examinations and pathological examinations.
Infectious diseases are the principal cause of classic FUO, in which tuberculosis accounts for a large proportion. Non-infectious diseases that cause FUO are mainly connective tissue diseases and malignant tumors. Of the various causes of classic FUO, tuberculosis and lymphoma are relatively difficult to diagnose. In most cases, the causes of classic FUO can be ascertained.
不明原因发热（FUO）通常被定义为在至少3周内多次体温高于38.3°C，经过多项必要检查后诊断仍不明确。它是一种特殊类型的发热，也是内科的常见疾病。然而，由于其病因复杂，缺乏特征性临床表现，实验室检查指标不足，常常使临床医生在诊断时感到困惑。我们在此呈现一项关于经典不明原因发热（FUO）的病因及临床特征的研究，以为相关临床诊断和治疗提供帮助。
收集了2011年1月1日至2017年12月31日期间在四川大学华西医院住院的1641例经典FUO患者，分析经典FUO的病因。特别致力于探索和筛选与传染病相关的实验室指标，并将上述数据与难以诊断的结核病和淋巴瘤的临床特征进行比较。
1641例患者中，最终通过各种检查或诊断方法确诊1504例，诊断率为91.65%。在1641例FUO的所有病因中，48.69%（799例）为传染病，其中结核病最为常见，占19.50%（320例）。结缔组织病占病例的19.26%（316例），其中成人斯蒂尔病（AOSD）最为常见，占89例（5.42%）；肿瘤性疾病占16.94%（278例），淋巴瘤（143例，8.71%）是最常见的恶性肿瘤；6.76%（111例）为其他疾病；8.35%（137例）病因不明。通过对结核病和淋巴瘤的对比分析，发现两种疾病的症状、体征及非特异性常规检查结果无显著差异。这些疾病的诊断更多地依赖于结核病相关检查和病理检查。
传染病是经典FUO的主要病因，其中结核病占很大比例。导致FUO的非传染病主要是结缔组织病和恶性肿瘤。在经典FUO的各种病因中，结核病和淋巴瘤相对难以诊断。在大多数情况下，经典FUO的病因可以确定。
