Knobel H, Supevía A, Salvadó M, Gimeno J L, López-Colomes J L, Saballs P, Drobnic L, Díez A
Servicio de Medicina Interna. Enfermedades Infecciosas, Hospital del Mar, Barcelona.
Rev Clin Esp. 1996 Jun;196(6):349-53.
Fever of unknown origin (FUO) has been insufficiently studied in patients infected with HIV. The aim of this study was to determine the incidence, mean hospital stay, etiology, diagnostic methods and clinical course in patients infected with HIV and FUO.
Descriptive prospective study of patients infected with HIV and with FUO for a period of 24 months (February 1993-February 1995). Out of a total of 1,202 admissions, 100 were prompted by FUO in 95 patients (61 males, 34 women). Sixty-six per cent were parenteral drug abusers or had been so and the mean T CD4+ lymphocyte count was 0.061 x 10(9)/1 +/- 0.075 x 10(9)/1.
The incidence of FUO was 8.3 every 100 patients/year. The mean hospital stay was 31.3 +/- 17.8 days, compared with an overall mean stay for HIV-positive patients of 14.6 +/- 8 days (p < 0.001). An etiologic diagnosis was achieved in 90% of cases. Pulmonary or extrapulmonary tuberculosis accounted for approximately 50% of cases, whereas non tuberculous mycobacteria (MAI and M. kansasii) for 20%. The other etiologies (CMV, visceral leishmaniasis, PCP, toxoplasmosis, cryptococcosis, lymphoma) accounted each for less than 5% of diagnoses. In 14 occasions there were two concomitant diagnoses. Mortality rate was 22%, which was higher when two simultaneous diagnosis were present [RR: 3.17 (1.5-6.6)]. In 45% of fatal cases one of the diagnoses went undiagnosed premortem. The highest diagnostic yield was obtained with sputum culture (34.2% of diagnosis) and blood culture (21.5%).
FUO in common in patients infected with HIV, with important health resources consumption associated. The obtention of diagnosis was possible in a high percentage of patients. It is associated with a high hospital mortality rate. The most common diagnoses were tuberculosis and infections by other mycobacteria. It is possible to obtain the diagnosis with non-invasive procedures in 75% of cases.
不明原因发热（FUO）在HIV感染患者中的研究尚不充分。本研究旨在确定HIV感染合并FUO患者的发病率、平均住院时间、病因、诊断方法及临床病程。
对HIV感染合并FUO患者进行为期24个月（1993年2月至1995年2月）的描述性前瞻性研究。在总共1202例入院患者中，95例患者（61例男性，34例女性）因FUO入院。66%为静脉注射吸毒者或曾经是静脉注射吸毒者，T CD4+淋巴细胞平均计数为0.061×10⁹/L±0.075×10⁹/L。
FUO的发病率为每100例患者每年8.3例。平均住院时间为31.3±17.8天，而HIV阳性患者的总体平均住院时间为14.6±8天（p<0.001）。90%的病例获得了病因诊断。肺或肺外结核约占病例的50%，而非结核分枝杆菌（鸟分枝杆菌和堪萨斯分枝杆菌）占20%。其他病因（巨细胞病毒、内脏利什曼病、肺孢子菌肺炎、弓形虫病、隐球菌病、淋巴瘤）各占诊断的比例不到5%。有14例存在两种并存诊断。死亡率为22%，当存在两种同时诊断时死亡率更高[相对危险度：3.17（1.5 - 6.6）]。在45%的致命病例中，有一种诊断在死前未被诊断出来。痰培养（34.2%的诊断）和血培养（21.5%）的诊断阳性率最高。
FUO在HIV感染患者中很常见，且消耗大量医疗资源。大部分患者能够获得诊断。它与较高的医院死亡率相关。最常见的诊断是结核和其他分枝杆菌感染。75%的病例可以通过非侵入性检查获得诊断。
