1
|
Oliveira Miranda D, Magalhães JN, Carvalho Sá D, Neves P, Gonçalves F. Pulmonary and Urologic Sarcoidosis as a Cause of Intermittent Fever of Unknown Origin. Cureus 2024; 16:e55709. [PMID: 38586756 PMCID: PMC10998438 DOI: 10.7759/cureus.55709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 04/09/2024] Open
Abstract
Diagnosing fever of unknown origin (FUO) presents a substantial challenge due to its potential association with various diseases affecting different organs. In 1961, Petersdorf and Beeson initially defined FUO as a condition characterized by a temperature exceeding 38.3 °C on at least three occasions over a minimum three-week period. Despite a week of inpatient investigation, a definitive diagnosis remains unclear. Sarcoidosis, a granulomatous disease impacting multiple systems, is among the causes of FUO. While the lungs are commonly affected, any organ can be involved, leading to diverse manifestations and clinical courses. Diagnosis relies on clinicopathologic findings and the exclusion of alternative causes of granulomatous disease. The hallmark of sarcoidosis is the development of granulomas in affected organs. Here, we present the case of a 61-year-old man with a history of recurrent spontaneous periurethral abscesses who underwent multiple urological interventions. He developed FUO during hospitalization following treatment for the infectious condition.
Collapse
Affiliation(s)
| | - José N Magalhães
- Department of Medicine, Unidade Local de Saúde de Santo António, Porto, PRT
| | - Diogo Carvalho Sá
- Department of Pathology, Unidade Local de Saúde de Santo António, Porto, PRT
| | - Patricia Neves
- Department of Medicine, Unidade Local de Saúde de Santo António, Porto, PRT
| | - Fabienne Gonçalves
- Department of Semiology, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, PRT
- Department of Medicine, Unidade Local de Saúde de Santo António, Porto, PRT
| |
Collapse
|
2
|
Ryan K. Fever of Unknown Origin. Med Clin North Am 2024; 108:79-92. [PMID: 37951657 DOI: 10.1016/j.mcna.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Fever of unknown origin in adolescents is a challenging disease state for which potential underlying etiology can include infectious, non-infectious inflammatory, and malignancy processes. Careful and thorough history (including exposure history), serial examination, and targeted laboratory and imaging testing is critical for these patients. In adolescents in which an etiology is discovered, infectious etiology remains the most prevalent, followed by non-infectious inflammatory diseases. In patients with non-diagnostic overall reassuring work up, the prognosis is typically self-limiting and favorable.
Collapse
Affiliation(s)
- Kathleen Ryan
- Infectious Disease, Department of Pediatric, Medical College of Wisconsin & Children's Hospital of Wisconsin, Suite C450, 999 North 92 nd Street, Wauwatosa, WI 53226, USA.
| |
Collapse
|
3
|
Krainer J, Hendling M, Siebenhandl S, Fuehner S, Kessel C, Verweyen E, Vierlinger K, Foell D, Schönthaler S, Weinhäusel A. Patients with Systemic Juvenile Idiopathic Arthritis (SJIA) Show Differences in Autoantibody Signatures Based on Disease Activity. Biomolecules 2023; 13:1392. [PMID: 37759792 PMCID: PMC10527260 DOI: 10.3390/biom13091392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/07/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
Systemic juvenile idiopathic arthritis (SJIA) is a severe rheumatic disease in children. It is a subgroup of juvenile idiopathic arthritis (JIA; MIM #604302), which is the most common rheumatic disease in children. The diagnosis of SJIA often comes with a significant delay, and the classification between autoinflammatory and autoimmune disease is still discussed. In this study, we analyzed the immunological responses of patients with SJIA, using human proteome arrays presenting immobilized recombinantly expressed human proteins, to analyze the involvement of autoantibodies in SJIA. Results from group comparisons show several differentially reactive antigens involved in inflammatory processes. Intriguingly, many of the identified antigens had a high reactivity against proteins involved in the NF-κB pathway, and it is also notable that many of the detected DIRAGs are described as dysregulated in rheumatoid arthritis. Our data highlight novel proteins and pathways potentially dysregulated in SJIA and offer a unique approach to unraveling the underlying disease pathogenesis in this chronic arthropathy.
Collapse
Affiliation(s)
- Julie Krainer
- Center for Health and Bioresources, Molecular Diagnostics, AIT Austrian Institute of Technology GmbH, Giefinggasse 4, 1210 Vienna, Austria; (M.H.); (K.V.); (S.S.)
| | - Michaela Hendling
- Center for Health and Bioresources, Molecular Diagnostics, AIT Austrian Institute of Technology GmbH, Giefinggasse 4, 1210 Vienna, Austria; (M.H.); (K.V.); (S.S.)
| | - Sandra Siebenhandl
- Center for Health and Bioresources, Molecular Diagnostics, AIT Austrian Institute of Technology GmbH, Giefinggasse 4, 1210 Vienna, Austria; (M.H.); (K.V.); (S.S.)
| | - Sabrina Fuehner
- Pediatric Rheumatology & Immunology, University Children’s Hospital, 48149 Münster, Germany; (S.F.); (C.K.); (E.V.); (D.F.)
| | - Christoph Kessel
- Pediatric Rheumatology & Immunology, University Children’s Hospital, 48149 Münster, Germany; (S.F.); (C.K.); (E.V.); (D.F.)
| | - Emely Verweyen
- Pediatric Rheumatology & Immunology, University Children’s Hospital, 48149 Münster, Germany; (S.F.); (C.K.); (E.V.); (D.F.)
| | - Klemens Vierlinger
- Center for Health and Bioresources, Molecular Diagnostics, AIT Austrian Institute of Technology GmbH, Giefinggasse 4, 1210 Vienna, Austria; (M.H.); (K.V.); (S.S.)
| | - Dirk Foell
- Pediatric Rheumatology & Immunology, University Children’s Hospital, 48149 Münster, Germany; (S.F.); (C.K.); (E.V.); (D.F.)
| | - Silvia Schönthaler
- Center for Health and Bioresources, Molecular Diagnostics, AIT Austrian Institute of Technology GmbH, Giefinggasse 4, 1210 Vienna, Austria; (M.H.); (K.V.); (S.S.)
| | - Andreas Weinhäusel
- Center for Health and Bioresources, Molecular Diagnostics, AIT Austrian Institute of Technology GmbH, Giefinggasse 4, 1210 Vienna, Austria; (M.H.); (K.V.); (S.S.)
| |
Collapse
|
4
|
Geßner D, Berisha M, Esser T, Schalk E. Tigecycline as salvage treatment of febrile neutropenia in patients with haematological malignancies-a retrospective single-centre analysis of 200 cases. Ann Hematol 2023; 102:2607-2616. [PMID: 37186157 PMCID: PMC10444688 DOI: 10.1007/s00277-023-05222-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/10/2023] [Indexed: 05/17/2023]
Abstract
Tigecycline has been used to treat patients with febrile neutropenia (FN). This study aims to analyse the effectiveness of tigecycline as salvage treatment of FN. Patients records from 09/2004 to 04/2019 were reviewed. Cases were eligible if fever persisted/recurred (p/r-FN) after 3 days of second-line treatment with a carbapenem, and were divided into three groups: switch to tigecycline (TGC group), switch to other antibiotics (OAB group), and no switch (W&W group). The primary endpoint was response rate (defervescence for ≥ 7 days or at least until discharge); the key secondary endpoint was 30-day mortality rate. Two hundred cases from 176 patients (median 59 years; 53.5% men) treated were included, mostly acute myeloid leukaemias (61.0%). 45.5% of cases were in the TGC group (in combination with an anti-pseudomonal antibiotic, mostly ceftazidime [95.6%]); 35.5% were in the OAB and 19.0% in the W&W group. There was no significant difference in response rates (TGC, 73.6%; OAB, 62.0%; W&W, 78.9%; p = 0.12) or 30-day mortality rates (TGC, 7.7%; OAB, 7.0%; W&W, 5.3%; p = 0.94). Tigecycline plus an anti-pseudomonal antibiotic does not improve response or 30-day mortality rate compared to other antibiotics in patients with p/r-FN. Also, in some cases, no switch in antibiotics may be necessary at all.
Collapse
Affiliation(s)
- Daniel Geßner
- Department of Haematology and Oncology, Otto-von-Guericke University Magdeburg, Medical Centre, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Mirjeta Berisha
- Department of Haematology and Oncology, Otto-von-Guericke University Magdeburg, Medical Centre, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Torben Esser
- Institute of Medical Microbiology and Hospital Hygiene, Otto-von-Guericke University Magdeburg, Medical Centre, Magdeburg, Germany
| | - Enrico Schalk
- Department of Haematology and Oncology, Otto-von-Guericke University Magdeburg, Medical Centre, Leipziger Str. 44, 39120, Magdeburg, Germany.
| |
Collapse
|
5
|
Palestro CJ, Brandon DC, Dibble EH, Keidar Z, Kwak JJ. FDG PET in Evaluation of Patients With Fever of Unknown Origin: AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2023; 221:151-162. [PMID: 36722759 DOI: 10.2214/ajr.22.28726] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Fever of unknown origin (FUO) is a diagnostic challenge, with its cause remaining undiagnosed in approximately half of patients. Nuclear medicine tests typically are performed after a negative or inconclusive initial workup. Gallium-67 citrate and labeled leukocytes were previous mainstays of radionuclide imaging for FUO, although they had limited diagnostic performance. FDG PET/CT has subsequently emerged as the nuclear medicine imaging test of choice, supported by a growing volume of evidence. A positive FDG PET/CT result contributes useful information by identifying potential causes of fever, localizing sites for further evaluation, and guiding further management; a negative result contributes useful information by excluding focal disease as the cause of fever and predicts a favorable prognosis. In 2021, CMS rescinded a prior national noncoverage determination for FDG PET for infection and inflammation, leading to increasing national utilization of FDG PET/CT for FUO workup. This article reviews the current status of the role of FDG PET/CT in the evaluation of patients with FUO. The literature reporting the diagnostic performance and yield of FDG PET/CT in FUO workup is summarized, with comparison with historically used nuclear medicine tests included. Attention is also given to the test's clinical impact; protocol, cost, and radiation considerations; and application in children.
Collapse
Affiliation(s)
- Christopher J Palestro
- Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
- Division of Nuclear Medicine & Molecular Imaging, Northwell Health, Long Island Jewish Medical Center, 270-05 76th Ave, New Hyde Park, NY 11040
| | - David C Brandon
- Department of Radiology, Division of Nuclear Medicine, Emory University School of Medicine, Atlanta VA Medical Center, Atlanta, GA
| | - Elizabeth H Dibble
- Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University/Rhode Island Hospital, Providence, RI
| | - Zohar Keidar
- Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel
| | - Jennifer J Kwak
- Department of Radiology, Division of Nuclear Medicine and Molecular Imaging, University of Colorado Anschutz Medical Campus, Aurora, CO
| |
Collapse
|
6
|
Chen H, Tang M, Yao L, Zhang D, Zhang Y, Zhao Y, Xia H, Chen T, Zheng J. Early application of metagenomics next-generation sequencing may significantly reduce unnecessary consumption of antibiotics in patients with fever of unknown origin. BMC Infect Dis 2023; 23:478. [PMID: 37464295 DOI: 10.1186/s12879-023-08417-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 06/22/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Metagenomic next-generation sequencing (mNGS) is a novel nucleic acid method for the detection of unknown and difficult pathogenic microorganisms, and its application in the etiological diagnosis of fever of unknown origin (FUO) is less reported. We aimed to comprehensively assess the value of mNGS in the etiologic diagnosis of FUO by the pathogen spectrum and diagnostic performance, and to investigate whether it is different in the time to diagnosis, length of hospitalization, antibiotic consumption and cost between FUO patients with and without early application of mNGS. METHODS A total of 149 FUO inpatients underwent both mNGS and routine pathogen detection was retrospectively analyzed. The diagnostic performance of mNGS, culture and CMTs for the final clinical diagnosis was evaluated by using sensitivity, specificity, positive predictive value, negative predictive value and total conforming rate. Patients were furtherly divided into two groups: the earlier mNGS detection group (sampling time: 0 to 3 days of the admission) and the later mNGS detection group (sampling time: after 3 days of the admission). The length of hospital stay, time spent on diagnosis, cost and consumption of antibiotics were compared between the two groups. RESULTS Compared with the conventional microbiological methods, mNGS detected much more species and had the higher negative predictive (67.6%) and total conforming rate (65.1%). Patients with mNGS sampled earlier had a significantly shorter time to diagnosis (6.05+/-6.23 vs. 10.5+/-6.4 days, P < 0.001) and days of hospital stay (13.7+/-20.0 vs. 30.3 +/-26.9, P < 0.001), as well as a significantly less consumption (13.3+/-7.8 vs. 19.5+/-8.0, P < 0.001) and cost (4543+/-7326 vs. 9873 +/- 9958 China Yuan [CNY], P = 0.001) of antibiotics compared with the patients sampled later. CONCLUSIONS mNGS could significantly improve the detected pathogen spectrum, clinical conforming rate of pathogens while having good negative predictive value for ruling out infections. Early mNGS detection may shorten the diagnosis time and hospitalization days and reduce unnecessary consumption of antibiotics.
Collapse
Affiliation(s)
- Hongmei Chen
- Department of Infectious Diseases, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Mingze Tang
- Department of Scientific Affairs, Hugobiotech Co., Ltd, Beijing, China
| | - Lemeng Yao
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Di Zhang
- Department of Pharmacy, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yubin Zhang
- Department of Clinical Laboratory, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yingren Zhao
- Department of Infectious Diseases, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Han Xia
- Department of Scientific Affairs, Hugobiotech Co., Ltd, Beijing, China.
| | - Tianyan Chen
- Department of Infectious Diseases, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
| | - Jie Zheng
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
| |
Collapse
|
7
|
Erdem H, Baymakova M, Alkan S, Letaief A, Yahia WB, Dayyab F, Kolovani E, Grgic S, Cosentino F, Hasanoglu I, Khedr R, Marino A, Pekok AU, Eser F, Arapovic J, Guner HR, Miftode IL, Poposki K, Sanlidag G, Tahmaz A, Sipahi OR, Miftode EG, Oncu S, Cagla-Sonmezer M, Addepalli SK, Darazam IA, Kumari HP, Koc MM, Kumar MR, Sayana SB, Wegdan AA, Amer F, Ceylan MR, El-Kholy A, Onder T, Tehrani HA, Hakamifard A, Kayaaslan B, Shehata G, Caskurlu H, El-Sayed NM, Mortazavi SE, Pourali M, Elbahr U, Kulzhanova S, Yetisyigit T, Saad SA, Cag Y, Eser-Karlidag G, Pshenichnaya N, Belitova M, Akhtar N, Al-Majid F, Ayhan M, Khan MA, Lanzafame M, Makek MJ, Nsutebu E, Cascio A, Dindar-Demiray EK, Evren EU, Kalas R, Kalem AK, Baljić R, Ikram A, Kaya S, Liskova A, Szabo BG, Rahimi BA, Mutlu-Yilmaz E, Sener A, Rello J. Classical fever of unknown origin in 21 countries with different economic development: an international ID-IRI study. Eur J Clin Microbiol Infect Dis 2023; 42:387-398. [PMID: 36790531 PMCID: PMC9930069 DOI: 10.1007/s10096-023-04561-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/03/2023] [Indexed: 02/16/2023]
Abstract
Fever of unknown origin (FUO) is a serious challenge for physicians. The aim of the present study was to consider epidemiology and dynamics of FUO in countries with different economic development. The data of FUO patients hospitalized/followed between 1st July 2016 and 1st July 2021 were collected retrospectively and submitted from referral centers in 21 countries through ID-IRI clinical research platform. The countries were categorized into developing (low-income (LI) and lower middle-income (LMI) economies) and developed countries (upper middle-income (UMI) and high-income (HI) economies). This research included 788 patients. FUO diagnoses were as follows: infections (51.6%; n = 407), neoplasms (11.4%, n = 90), collagen vascular disorders (9.3%, n = 73), undiagnosed (20.1%, n = 158), miscellaneous diseases (7.7%, n = 60). The most common infections were tuberculosis (n = 45, 5.7%), brucellosis (n = 39, 4.9%), rickettsiosis (n = 23, 2.9%), HIV infection (n = 20, 2.5%), and typhoid fever (n = 13, 1.6%). Cardiovascular infections (n = 56, 7.1%) were the most common infectious syndromes. Only collagen vascular disorders were reported significantly more from developed countries (RR = 2.00, 95% CI: 1.19-3.38). FUO had similar characteristics in LI/LMI and UMI/HI countries including the portion of undiagnosed cases (OR, 95% CI; 0.87 (0.65-1.15)), death attributed to FUO (RR = 0.87, 95% CI: 0.65-1.15, p-value = 0.3355), and the mean duration until diagnosis (p = 0.9663). Various aspects of FUO cannot be determined by the economic development solely. Other development indices can be considered in future analyses. Physicians in different countries should be equally prepared for FUO patients.
Collapse
Affiliation(s)
- Hakan Erdem
- Department of Infectious Diseases & Clinical Microbiology, Gulhane School of Medicine, Turkish Health Sciences University, Ankara, Turkey
| | - Magdalena Baymakova
- Department of Infectious Diseases, Military Medical Academy, Sofia, Bulgaria
| | - Sevil Alkan
- Department of Infectious Diseases and Clinical Microbiology, Onsekiz Mart University School of Medicine, Canakkale, Turkey
| | - Amel Letaief
- Department of Infectious Diseases, Farhat Hached University Hospital, Ibn El Jazzar Medical School, University of Sousse, Sousse, Tunisia
| | - Wissal Ben Yahia
- Department of Infectious Diseases, Farhat Hached University Hospital, Ibn El Jazzar Medical School, University of Sousse, Sousse, Tunisia
| | - Farouq Dayyab
- Department of Internal Medicine, King Hamad University Hospital, Al Sayh, Manama, Bahrain
| | - Entela Kolovani
- Infectious Disease Clinic, University Hospital Center 'Mother Theresa', Tirana, Albania
| | - Svjetlana Grgic
- Department of Infectious Diseases, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Federica Cosentino
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, ARNAS Garibaldi Hospital, University of Catania, Catania, Italy
| | - Imran Hasanoglu
- Department of Infectious Diseases & Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Reham Khedr
- Department of Pediatric Oncology, National Cancer Institute - Cairo University, Children Cancer Hospital Egypt, Cairo, Egypt
| | - Andrea Marino
- Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, ARNAS Garibaldi Hospital, University of Catania, Catania, Italy
| | | | - Fatma Eser
- Department of Infectious Diseases & Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | - Jurica Arapovic
- Department of Infectious Diseases, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
| | - Hatice Rahmet Guner
- Department of Infectious Diseases & Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | | | - Kostadin Poposki
- Faculty of Medicine, University Clinic for Infectious Diseases and Febrile Conditions, Skopje, Republic of North Macedonia
| | - Gamze Sanlidag
- Department of Infectious Diseases & Clinical Microbiology, Ege School of Medicine, Izmir, Turkey
| | - Alper Tahmaz
- Department of Infectious Diseases & Clinical Microbiology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Oguz Resat Sipahi
- Department of Infectious Diseases & Clinical Microbiology, Ege School of Medicine, Izmir, Turkey
| | | | - Serkan Oncu
- Department of Infectious Diseases & Clinical Microbiology, School of Medicine, Adnan Menderes University, Aydin, Turkey
| | - Meliha Cagla-Sonmezer
- Department of Infectious Diseases & Clinical Microbiology, Hacettepe School of Medicine, Hacettepe University, Ankara, Turkey
| | - Syam Kumar Addepalli
- Department of Pharmacology, GITAM Institute of Medical Sciences and Research, Visakhapatnam, Andhra Pradesh, India
| | - Ilad Alavi Darazam
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hema Prakash Kumari
- Department of Microbiology, GITAM Institute of Medical Sciences and Research, Visakhapatnam, Andhra Pradesh, India
| | - Meliha Meriç Koc
- Department of Infectious Diseases & Clinical Microbiology, School of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Meela Ranjith Kumar
- Department of Pharmacology, Government Medical College &, Government General Hospital, Suryapet, Telangana, India
| | - Suresh Babu Sayana
- Department of Pharmacology, Government Medical College, Suryapet, Telangana, India
| | - Ahmed Ashraf Wegdan
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
| | - Fatma Amer
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Mehmet Resat Ceylan
- Department of Infectious Diseases & Clinical Microbiology, School of Medicine, Harran University, Sanliurfa, Turkey
| | - Amani El-Kholy
- Department of Clinical Pathology, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Taylan Onder
- Department of Infectious Diseases and Clinical Microbiology, Onsekiz Mart University School of Medicine, Canakkale, Turkey
| | - Hamed Azhdari Tehrani
- Department of Hematology and Medical Oncology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atousa Hakamifard
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bircan Kayaaslan
- Department of Infectious Diseases & Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | | | - Hulya Caskurlu
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | | | - Seyed Erfan Mortazavi
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Pourali
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Umran Elbahr
- Department of Infectious Diseases, Bahrain Oncology Center, King Hamad University Hospital, Busaiteen, Bahrain
| | - Sholpan Kulzhanova
- Department of Infectious Diseases, Astana Medical University, Nur-Sultan, Kazakhstan
| | - Tarkan Yetisyigit
- Department of Oncology, Bahrain Oncology Center, King Hamad University Hospital, Busaiteen, Bahrain
| | - Sahar Ahmed Saad
- Department of Rheumatology, King Hamad Univesity Hospital, Al Sayh, Bahrain
| | - Yasemin Cag
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey.
| | - Gulden Eser-Karlidag
- Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Elazig Fethi Sekin City Hospital, Elazig, Turkey
| | | | | | - Nasim Akhtar
- Pakistan Institute of Medical Sciences, Islamabad, G-8/3, Pakistan
| | - Fahad Al-Majid
- Department of Medicine, Infectious Diseases Division, King Saud University, Riyadh, Saudi Arabia
| | - Muge Ayhan
- Department of Infectious Diseases & Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | | | | | | | - Emmanuel Nsutebu
- Tropical and Infectious Diseases Division, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Antonio Cascio
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) - Infectious Disease Unit, Policlinico 'P. Giaccone', University of Palermo, Palermo, Italy
| | | | - Emine Unal Evren
- Department of Infectious Diseases and Clinical Microbiology, School of Medicine, University of Kyrenia, Kyrenia, Cyprus
| | - Rama Kalas
- Internal Medicine Division, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Ayşe Kaya Kalem
- Department of Infectious Diseases & Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
| | | | - Aamer Ikram
- National Institutes of Health, Islamabad, Pakistan
| | - Selcuk Kaya
- Department of Infectious Diseases and Clinical Microbiology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Anna Liskova
- Hospital Nitra, St. Elisabeth University of Health Care and Social Work, Bratislava, Slovak Republic
| | - Balint Gergely Szabo
- South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
| | - Bilal Ahmad Rahimi
- Department of Infectious Diseases, Kandahar University Medical Faculty, Teaching Hospital, Kandahar, Afghanistan
| | - Esmeray Mutlu-Yilmaz
- Department of Infectious Diseases & Clinical Microbiology, Samsun Training and Research Hospital, Samsun, Turkey
| | - Alper Sener
- Department of Infectious Diseases and Clinical Microbiology, Onsekiz Mart University School of Medicine, Canakkale, Turkey
| | - Jordi Rello
- Clinical Research and Epidemiology in Pneumonia and Sepsis, Vall d'Hebron Institute of Research (VHIR), Barcelona, Spain
- Clinical Research, CHRU Nîmes, Nîmes, France
| |
Collapse
|
8
|
van Rijsewijk ND, IJpma FFA, Wouthuyzen-Bakker M, Glaudemans AWJM. Molecular Imaging of Fever of Unknown Origin: An Update. Semin Nucl Med 2023; 53:4-17. [PMID: 35902280 DOI: 10.1053/j.semnuclmed.2022.07.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 01/28/2023]
Abstract
18F-FDG PET/CT, 67Ga-citrate and white blood cell (WBC) scintigraphy are molecular imaging techniques currently used in the diagnostic workup of fever of unknown origin. However, it is unknown which technique fits which patient group best. A systematic literature search has been performed for original articles regarding the use of molecular imaging in fever of unknown origin. A total of 820 eligible studies were screened of which 63 articles evaluating 5094 patients met the inclusion criteria. 18F-FDG PET/CT provided good diagnostic accuracy (with a weighted mean sensitivity, specificity, positive predicting value, negative predictive value, accuracy and helpfulness of 84.4%, 61.8%, 80.7%, 67.8%, 76.3%, and 61.1%, respectively). Even within specific patient groups such as children, elderly, patients with connective tissue diseases, patients on renal replacement therapy, and HIV-infected patients, 18F-FDG PET/CT provided good diagnostic values. For 67Ga-citrate scintigraphy, the weighted mean sensitivity, specificity, positive predictive value, negative predictive value, and helpfulness were 42.2%, 80.3%, 82.4%, 41.9%, and 42.2%, respectively. WBC scintigraphy shows a weighted mean sensitivity, specificity, positive predictive value, negative predictive value and accuracy of 73.5%, 86.3%, 79.1%, 82.4%, and 79.5%, respectively. However, compared to 67Ga-citrate and WBC scintigraphy, significantly more research has been performed using 18F-FDG PET/CT and 18F-FDG PET/CT has the advantage of relatively short procedural duration; it is therefore the preferred molecular diagnostic imaging technique. 67Ga-citrate and WBC scintigraphy can only be considered if 18F-FDG PET/CT is not available.
Collapse
Affiliation(s)
- Nick D van Rijsewijk
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Frank F A IJpma
- Department of Trauma Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marjan Wouthuyzen-Bakker
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Andor W J M Glaudemans
- Medical Imaging Center, Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
9
|
Collercandy N, Thorey C, Diot E, Grammatico-Guillon L, Thillard EM, Bernard L, Maillot F, Lemaignen A. When to investigate for secondary hyperhidrosis: data from a retrospective cohort of all causes of recurrent sweating. Ann Med 2022; 54:2089-2101. [PMID: 35903938 PMCID: PMC9455328 DOI: 10.1080/07853890.2022.2102675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background: Identification of underlying diseases is crucial for secondary hyperhidrosis management, but data are lacking to guide appropriate investigation.Objective: To describe aetiologies of recurrent sweating in a hospital setting and the diagnostic performance parameters of their respective clinical/biological features.Patients and Methods: We performed a monocentric evaluative study in a tertiary care centre. Patients with recurrent generalised sweating were selected via the Clinical Data Warehouse (CDW) by screening all electronic hospital documents from the year 2018 using a keyword-based algorithm. All in and out-patients aged ≥ 18 years having reported recurrent sweating for at least 2 weeks in 2018 were included, with a minimum one-year follow-up after symptoms' onset.Results: A total of 420 patients were included. Over 130 different aetiologies were identified; 70 patients (16.7%) remained without diagnosis. Solid organ cancers (14.3% with 13 lung cancers), haematologic malignancies (14.0% with 35 non-Hodgkin's lymphomas) and Infectious Diseases (10.5% including 13 tuberculosis) were the most frequent diagnoses. Other aetiologies were gathered into inflammatory (16.9%) and non-inflammatory (27.6%) conditions. To distinguish non-inflammatory and undiagnosed hyperhidrosis from other causes, fever had a specificity of 94%, impaired general condition a sensitivity of 78%, and C-reactive protein (CRP) > 5.6 mg/l a positive predictive value of 0.86. Symptoms' duration over 1 year was in favour of non-infectious and non-malignant causes (94% specificity).Conclusions: We identified fever, impaired general condition, duration, and CRP as helpful orientation parameters to assess the need for complementary explorations for hyperhidrosis. The study provides a diagnostic algorithm for the investigation of recurrent sweating.KEY MESSAGESIn a hospital setting, malignancies and infections are the most frequently associated diseases, but 1/5 remain without diagnosis.Fever is a specific but not sensitive sign to distinguish inflammatory conditions.Over 1 year duration of symptoms significantly reduce the probability of malignancy or infection as the underlying diagnosis.
Collapse
Affiliation(s)
- Nived Collercandy
- Service de Médecine interne et Maladies infectieuses, Centre Hospitalier Universitaire de Tours, Tours, France.,Service de Médecine interne et Immunologie clinique, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Camille Thorey
- Service de Médecine interne et Maladies infectieuses, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Elisabeth Diot
- Service de Médecine interne et Immunologie clinique, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Leslie Grammatico-Guillon
- Service d'Information Médicale, Epidémiologie et Economie de la Santé (SIMEES, Centre de données cliniques), Centre Hospitalier Universitaire de Tours, Tours, France.,Université de Tours, Tours, France
| | - Eve Marie Thillard
- Centre Régional de Pharmacovigilance et d'Information sur le Médicament, Centre Val de Loire, Centre Hospitalier Universitaire de Tours, Tours, France
| | - Louis Bernard
- Service de Médecine interne et Maladies infectieuses, Centre Hospitalier Universitaire de Tours, Tours, France.,Université de Tours, Tours, France
| | - François Maillot
- Service de Médecine interne et Immunologie clinique, Centre Hospitalier Universitaire de Tours, Tours, France.,Université de Tours, Tours, France
| | - Adrien Lemaignen
- Service de Médecine interne et Maladies infectieuses, Centre Hospitalier Universitaire de Tours, Tours, France.,Université de Tours, Tours, France
| |
Collapse
|
10
|
Dong Y, Gao Y, Chai Y, Shou S. Use of Quantitative Metagenomics Next-Generation Sequencing to Confirm Fever of Unknown Origin and Infectious Disease. Front Microbiol 2022; 13:931058. [PMID: 35859749 PMCID: PMC9289621 DOI: 10.3389/fmicb.2022.931058] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/15/2022] [Indexed: 11/13/2022] Open
Abstract
A body temperature >38.3°C that lasts ≥3 weeks and lacks a clear diagnosis after 1 week of standard hospital examination and treatment is called "fever of unknown origin" (FUO). The main causes of FUO are infections, hematological diseases, autoimmune diseases, and other non-infectious inflammatory diseases. In recent years, quantitative metagenomics next-generation sequencing (Q-mNGS) has been used widely to detect pathogenic microorganisms, especially in the contribution of rare or new (e.g., severe acute respiratory syndrome-coronavirus-2) pathogens. This review addresses the undetermined cause of fever and its evaluation by Q-mNGS.
Collapse
Affiliation(s)
- Yuxin Dong
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Yulei Gao
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Yanfen Chai
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin, China
| | - Songtao Shou
- Department of Emergency Medicine, Tianjin Medical University General Hospital, Tianjin, China
| |
Collapse
|
11
|
Öğüt TS, Erbasan F, Terzioğlu ME, Tazegul G, Yazısız V. The Diagnostic Value of Fluoro-18 Fluorodeoxyglucose (F-18 FDG) PET/CT in Fever or Inflammation of Unknown Origin: A Retrospective Study at a Rheumatology Clinic. Cureus 2022; 14:e24192. [PMID: 35592192 PMCID: PMC9110075 DOI: 10.7759/cureus.24192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction Further diagnostic procedures are necessary for patients with fever of unknown origin (FUO) and unknown cause of inflammation (inflammation of unknown origin - IUO) for the identification of the definitive diagnosis. The aim of this study was to evaluate the contribution and roles of F-18 FDG PET/CT (fluoro-18 fluorodeoxyglucose-positron emission tomography/computed tomography) in the diagnostic process of patients with FUO/IUO. Methods The data of 58 patients who had F-18 FDG PET/CT scans for FUO/IUO were re-evaluated retrospectively. The relationships between definitive diagnosis and fluorodeoxyglucose uptake and SUVmax (maximum standardized uptake value) were examined. Results Rheumatic disease was diagnosed in 26 patients (44.5%), malignancy in 20 patients (34.5%), and infectious diseases in six patients (10.3%). The most prevalent rheumatic disease in patients with FUO/IUO was systemic vasculitis (n:10, 17.2%), especially large vessel vasculitis. There were 37 patients (63.7%) with clinically significant true positive fluorodeoxyglucose uptake. True positive fluorodeoxyglucose uptake was significantly higher in patients diagnosed with malignancy (85%, 17/20 patients) compared to other diagnoses. Fluorodeoxyglucose uptake above physiological levels was determined in 15 of the 26 patients (57.6%) diagnosed with rheumatic diseases. Conclusion The results of this study showed that F-18 FDG PET/CT is a useful imaging modality in FUO/IUO patients, who present a challenging diagnostic process for clinicians. In addition to malignancies, the presence of chronic inflammatory diseases, especially early period systemic vasculitis, were diagnosed in these patients.
Collapse
Affiliation(s)
| | | | | | - Gokhan Tazegul
- Internal Medicine, Ankara Polatlı Duatepe State Hospital, Ankara, TUR
| | | |
Collapse
|
12
|
Diagnostic value of F-18 FDG PET/CT in fever or inflammation of unknown origin in a large single-center retrospective study. Sci Rep 2022; 12:1883. [PMID: 35115619 PMCID: PMC8813902 DOI: 10.1038/s41598-022-05911-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 01/20/2022] [Indexed: 11/25/2022] Open
Abstract
Cause determination is challenging in fever or inflammation of unknown origin (FUO/IUO) despite today’s diagnostic modalities. We evaluated the value of F-18 FDG PET/CT in an unselected patient collective. This retrospective nonrandomized single-center study enrolled 300 male and female patients with FUO/IUO. PET/CT findings were compared with final clinical outcomes to determine the sensitivity, specificity, clinical significance, etiological distribution of final diagnoses, impact on treatment, role of white-blood cell count (WBC), and C-reactive protein (CRP). In 54.0% (162/300) PET/CT was the decisive exanimation for establishing the final diagnosis, in 13.3% (40/300) the findings were equivocal and indecisive, in 3.3% (10/300) PET/CT findings were false positive, while in 29.3% (88/300) a normal F-18 FDG pattern was present. Statistical analysis showed a sensitivity of 80.2% and a specificity of 89.8% for the contribution of PET/CT to the final diagnosis. CRP levels and WBC were not associated with PET/CT outcome. PET/CT let to new treatment in 24.0% (72/300), treatment change in 18.0% (54/300), no treatment change in 49.6% (149/300), and in 8.3% (25/300) no data was available. Our study demonstrates the utility of F-18 FDG PET/CT for source finding in FUO/IUO if other diagnostic tools fail.
Collapse
|
13
|
Aerospace Medicine Clinic. Aerosp Med Hum Perform 2022; 93:58-60. [PMID: 35063058 DOI: 10.3357/amhp.5917.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
14
|
Park C, Miranda-Garcia M, Berendes R, Horneff G, Kuemmerle-Deschner J, Ganser G, Huppertz HI, Minden K, Haas JP, Jansson AF, Borte M, Schuetz C, Oommen P, Frosch M, Schlueter B, Richter-Unruh A, Kessel C, Hinze C, Wittkowski H, Roth J, Foell D, Holzinger D. MRP8/14 serum levels as diagnostic markers for systemic juvenile idiopathic arthritis in children with prolonged fever. Rheumatology (Oxford) 2021; 61:3082-3092. [PMID: 34559193 DOI: 10.1093/rheumatology/keab729] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 09/22/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Differential diagnosis in children with prolonged fever is challenging. In particular, differentiating systemic-onset juvenile idiopathic arthritis (SJIA) from infectious diseases is difficult. Biomarkers are needed supporting the diagnostic work-up. The aim of this study was to validate the usefulness of MRP8/14 measurements in the diagnostic wok-up of febrile children and transfer it to clinical practice. METHODS Data of 1,110 paediatric patients were included and divided into two cohorts: (A) For validation of MRP8/14 test performance with 3 different testing systems: the experimental enzyme-linked immunosorbent sandwich assay (ELISA), commercial ELISA and an innovative (POCT) lateral flow immunoassay (LFIA); (B) to validate the diagnostic accuracy with the two latter assays. RESULTS In cohort A (n = 940), MRP8/14 was elevated in SJIA (12110±2650 ng/ml mean ± 95% CI) compared to other diagnoses (including infections and autoinflammatory diseases; 2980±510 ng/ml) irrespective of fever and anti-inflammatory treatment (p < 0.001). In untreated patients with fever (n = 195) MRP8/14 levels in SJIA (19740±5080 ng/ml) were even higher compared to other diagnoses (4590±1160 ng/ml) (p < 0.001, sensitivity 73%, specificity 90%). In cohort B1, the performance of the tests was confirmed in untreated patients with fever (n = 170): commercial ELISA (sensitivity 79%, specificity 89%) and LFIA (sensitivity 84%, specificity 81%). Compared with ferritin, IL-18, ESR, sIL2-R, and procalcitonin, MRP8/14 showed the best accuracy. CONCLUSION MRP8/14 serum analyses have been validated as a helpful tool supporting the diagnosis of SJIA in febrile children. The results could be confirmed with commercial ELISA and LFIA enabling a rapid diagnostic point-of-care screening test.
Collapse
Affiliation(s)
- Carolin Park
- Department of Pediatric Rheumatology and Immunology, University Hospital Childreńs Muenster, Muenster, Germany
| | - María Miranda-Garcia
- Department of Pediatric Rheumatology and Immunology, University Hospital Childreńs Muenster, Muenster, Germany
| | | | - Gerd Horneff
- Asklepios Clinic Sankt Augustin, Sankt Augustin, Germany
| | | | - Gerd Ganser
- St. Josef-Stift Sendenhorst Hospital, Sendenhorst, Germany
| | - Hans-Iko Huppertz
- Prof.-Hess Children's Hospital and Gesundheit Nord Klinikverbund Bremen, Bremen, Germany
| | - Kirsten Minden
- Charité University Medicine and Epidemiology Unit, German Rheumatism Research Centre, Berlin, Germany
| | - Johannes-Peter Haas
- German Center for Pediatric and Adolescent Rheumatology, Garmisch-Partenkirchen, Germany
| | - Annette F Jansson
- Department of Rheumatology and Immunology, Dr. von Hauner Children's Hospital, Ludwig-Maximilians-University, Munich, Germany
| | - Michael Borte
- Paediatric Rheumatology, Immunology and Infectiology, Hospital St. Georg, Leipzig, Germany
| | - Catharina Schuetz
- Department of Paediatrics, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Prasad Oommen
- Department of Pediatric Oncology, Hematology and Clinical Immunology, University Children's Hospital, Medical Faculty, Heinrich-Heine-University, Düsseldorf, Germany
| | - Michael Frosch
- German Pediatric Pain Centre, Children's and Adolescents' Hospital, Datteln, Germany
| | - Bernhard Schlueter
- Center for Laboratory Medicine, University Hospital Muenster, Muenster, Germany
| | | | - Christoph Kessel
- Department of Pediatric Rheumatology and Immunology, University Hospital Childreńs Muenster, Muenster, Germany
| | - Claas Hinze
- Department of Pediatric Rheumatology and Immunology, University Hospital Childreńs Muenster, Muenster, Germany
| | - Helmut Wittkowski
- Department of Pediatric Rheumatology and Immunology, University Hospital Childreńs Muenster, Muenster, Germany
| | - Johannes Roth
- Institute of Immunology, University of Muenster, Muenster, Germany
| | - Dirk Foell
- Department of Pediatric Rheumatology and Immunology, University Hospital Childreńs Muenster, Muenster, Germany
| | - Dirk Holzinger
- Department of Pediatric Hematology-Oncology University of Duisburg-Essen, Essen, Germany
| |
Collapse
|
15
|
An approach to the management of fever of unknown origin in the setting of acute spinal cord injury. Spinal Cord Ser Cases 2021; 7:19. [PMID: 33712553 PMCID: PMC7952824 DOI: 10.1038/s41394-021-00385-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Revised: 01/14/2021] [Accepted: 02/05/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction Discovering the source of a patient’s fever, in the absence of clinical localizing signs, can be a formidable undertaking. Without a clear symptom pattern to narrow the focus of a diagnostic workup, this task can require numerous noninvasive and invasive procedures, imaging studies, and laboratory tests to arrive at a conclusion. Identifying the source of a patient’s fever in the setting of an acute spinal cord injury can present a unique challenge because this population is at risk for many different conditions that can cause fever, some of which are rarely seen in the general population. Case presentation This case report describes a unique case and diagnostic workup of fever of unknown origin in a 51-year-old male with multiple medical comorbidities who presented to an inpatient rehabilitation service following an acute traumatic cervical spinal cord injury. Ultimately, it was determined that the patient had several different factors that were causing him to have intermittent fevers over a 5-week period. Discussion This case demonstrates the importance of obtaining serial medical histories and physical examinations during the investigation for fever of unknown origin. It also supports why additional workup of a patient’s fever may need to be considered even after a potential source is found. Finally, it demonstrates the need for increased awareness of quadriplegic fever so that this condition can be more effectively recognized, prevented, and managed in the future.
Collapse
|
16
|
Housin A, Pusztaszeri MP, Tamilia M. Fever of unknown origin as the major manifestation of subacute thyroiditis. Endocrinol Diabetes Metab Case Rep 2021. [PMCID: PMC7983513 DOI: 10.1530/edm-20-0179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Fever of unknown origin is a commonly encountered medical problem. Most common causes include infections, malignancy, and connective tissue diseases. Endocrine causes are rare but are well documented. While fever is common in some endocrine disorders, fever of unknown origin as the sole presenting feature is very rare. We describe a case report of a 63-year-old male who presents with fever of unknown origin. Imaging and biopsy results confirmed the diagnosis of subacute thyroiditis. He was started on prednisone with a good response. We conclude that subacute thyroiditis should be considered in the work up of fever of unknown origin even in the absence of classical signs and symptoms.
Collapse
Affiliation(s)
- Ahmad Housin
- 1Division of EndocrinologyDepartment of Medicine
| | - Marc P Pusztaszeri
- 2Department of PathologyJewish General Hospital, McGill University, Montreal, Quebec, Canada
| | | |
Collapse
|
17
|
Kubota K, Tanaka N, Miyata Y, Ohtsu H, Nakahara T, Sakamoto S, Kudo T, Nishiyama Y, Tateishi U, Murakami K, Nakamoto Y, Taki Y, Kaneta T, Kawabe J, Nagamachi S, Kawano T, Hatazawa J, Mizutani Y, Baba S, Kirii K, Yokoyama K, Okamura T, Kameyama M, Minamimoto R, Kunimatsu J, Kato O, Yamashita H, Kaneko H, Kutsuna S, Ohmagari N, Hagiwara A, Kikuchi Y, Kobayakawa M. Comparison of 18F-FDG PET/CT and 67Ga-SPECT for the diagnosis of fever of unknown origin: a multicenter prospective study in Japan. Ann Nucl Med 2021; 35:31-46. [PMID: 33037581 DOI: 10.1007/s12149-020-01533-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 09/18/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aim of this multicenter prospective study was to compare the sensitivity of 18F-fluorodeoxyglucose (FDG)-positron emission tomography/computed tomography (PET/CT) with that of 67Ga single photon emission computed tomography (SPECT) for the identification of the site of greatest importance for the final diagnosis of the cause of fever of unknown origin (FUO). METHODS The study participants consisted of patients with an axillary temperature ≥ 38.0 °C on ≥ 2 occasions within 1 week, with repeated episodes for ≥ 2 weeks prior to providing consent, and whose final diagnosis after undergoing specific examinations, including a chest-to-abdomen CT scan, was uncertain. All the patients underwent FDG-PET/CT imaging first, followed by 67Ga-SPECT imaging within 3 days. The results of the FDG-PET/CT and 67Ga-SPECT examinations were reviewed by the central image interpretation committee (CIIC), which was blinded to all other clinical information. The sensitivities of FDG-PET/CT and 67Ga-SPECT were then evaluated with regard to identifying the site of greatest importance for a final diagnosis of the cause of the fever as decided by the patient's attending physician. The clinical impacts (four grades) of FDG-PET/CT and 67Ga-SPECT on the final diagnosis were evaluated. RESULTS A total of 149 subjects were enrolled in this study between October 2014 and September 2017. No adverse events were identified among the enrolled subjects. Twenty-one subjects were excluded from the study because of deviations from the study protocol. Among the 128 remaining subjects, a final diagnosis of the disease leading to the appearance of FUO was made for 92 (71.9%) subjects. The final diagnoses in these 92 cases were classified into four groups: noninfectious inflammatory disease (52 cases); infectious disease (31 cases), malignancy (six cases); and other (three cases). These 92 subjects were eligible for inclusion in the study's analysis, but one case did not meet the PET/CT image acquisition criteria; thus, PET/CT results were analyzed for 91 cases. According to the patient-based assessments, the sensitivity of FDG-PET/CT (45%, 95% CI 33.1-58.2%) was significantly higher than that for 67Ga-SPECT (25%, 95% CI 15.5-37.5%) (P = 0.0029). The clinical impact of FDG-PET/CT (91%) was also significantly higher than that for 67Ga-SPECT (57%, P < 0.001). CONCLUSIONS FDG-PET/CT showed a superior sensitivity to 67Ga-SPECT for the identification of the site of greatest importance for the final diagnosis of the cause of FUO.
Collapse
Affiliation(s)
- Kazuo Kubota
- Division of Nuclear Medicine, National Center for Global Health and Medicine, Tokyo, Japan.
- Department of Radiology, Southern TOHOKU General Hospital, Koriyama City, 7-115 Yatsuyamada, Fukushima, 963-8563, Japan.
| | - Noriko Tanaka
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yoko Miyata
- Division of Nuclear Medicine, National Center for Global Health and Medicine, Tokyo, Japan
- Department of Radiology, Kohnodai Hospital, National Center for Global Health and Medicine, Chiba, Japan
| | - Hiroshi Ohtsu
- Clinical Epidemiology/JCRAC Data Center, Department of Data Science National Center for Global Health and Medicine Center for Clinical Sciences, Tokyo, Japan
| | - Tadaki Nakahara
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Setsu Sakamoto
- PET Center, Dokkyo Medical University Hospital, Tochigi, Japan
- Department of Diagnostic Radiology, Hyogo Cancer Center, Hyogo, Japan
| | - Takashi Kudo
- Department of Radioisotope Medicine, Atomic Bomb Disease Institute, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Yoshihiro Nishiyama
- Department of Radiology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Ukihide Tateishi
- Department of Diagnostic Radiology and Nuclear Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Koji Murakami
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Yuji Nakamoto
- Department of Diagnostic Imaging and Nuclear Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasuyuki Taki
- Department of Nuclear Medicine and Radiology, Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan
| | - Tomohiro Kaneta
- Department of Radiology, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Joji Kawabe
- Department of Nuclear Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shigeki Nagamachi
- Department of Radiology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Tsuyoshi Kawano
- Department of Radiology, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - Jun Hatazawa
- Department of Nuclear Medicine and Tracer Kinetics, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Youichi Mizutani
- Department of Radiology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Shingo Baba
- Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazukuni Kirii
- Department of Diagnostic Radiology, Yamagata University, Faculty of Medicine, Yamagata, Japan
| | - Kunihiko Yokoyama
- Department of Thyroidology, Public Central Hospital of Matto Ishikawa, Ishikawa, Japan
| | - Terue Okamura
- PET Center, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Masashi Kameyama
- Department of Diagnostic Radiology, Tokyo Metropolitan Geriatric Hospital and Institute of Gerontology, Tokyo, Japan
| | - Ryogo Minamimoto
- Division of Nuclear Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Junwa Kunimatsu
- Department of General Internal Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - On Kato
- Department of General Internal Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hiroyuki Yamashita
- Division of Rheumatic Diseases, National Center for Global Health and Medicine, Tokyo, Japan
| | - Hiroshi Kaneko
- Division of Rheumatic Diseases, National Center for Global Health and Medicine, Tokyo, Japan
| | - Satoshi Kutsuna
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Norio Ohmagari
- Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Akiyoshi Hagiwara
- Department of Emergency Medicine and Critical Care, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yoshimi Kikuchi
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masao Kobayakawa
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
- Medical Research Center, Fukushima Medical University, Fukushima, Japan
| |
Collapse
|
18
|
Depetri F, Tarsia P, Donato MF, Invernizzi F, Cugno M. A 5-month history of fever and dry cough in a 67-year-old man. Intern Emerg Med 2020; 15:1057-1060. [PMID: 31214884 DOI: 10.1007/s11739-019-02132-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 06/12/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Federica Depetri
- Medicina Interna, Dipartimento Di Fisiopatologia Medico-Chirurgica E Dei Trapianti, Università Degli Studi Di Milano, IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Via Pace, 9, 20122, Milano, Italy
| | - Paolo Tarsia
- Dipartimento Di Pneumologia, Ospedale Maggiore Policlinico, Fondazione IRCCS Ca' Granda, Milano, Italy
| | - Maria Francesca Donato
- Unità Di Epatologia Dei Trapianti, Divisione Di Gastroenterologia Ed Epatologia, Ospedale Maggiore Policlinico, Fondazione IRCCS Ca' Granda, Milano, Italy
- Centro Per Lo Studio Delle Malattie del Fegato "A. M. E A. Migliavacca", Università Degli Studi Di Milano, Milano, Italy
| | - Federica Invernizzi
- Unità Di Epatologia Dei Trapianti, Divisione Di Gastroenterologia Ed Epatologia, Ospedale Maggiore Policlinico, Fondazione IRCCS Ca' Granda, Milano, Italy
- Centro Per Lo Studio Delle Malattie del Fegato "A. M. E A. Migliavacca", Università Degli Studi Di Milano, Milano, Italy
| | - Massimo Cugno
- Medicina Interna, Dipartimento Di Fisiopatologia Medico-Chirurgica E Dei Trapianti, Università Degli Studi Di Milano, IRCCS Fondazione Cà Granda Ospedale Maggiore Policlinico, Via Pace, 9, 20122, Milano, Italy.
| |
Collapse
|
19
|
Tavakoli AA, Reichert M, Blank T, Dinter D, Weckbach S, Buchheidt D, Schoenberg SO, Attenberger U. Findings in whole body MRI and conventional imaging in patients with fever of unknown origin-a retrospective study. BMC Med Imaging 2020; 20:94. [PMID: 32767967 PMCID: PMC7412796 DOI: 10.1186/s12880-020-00493-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 07/30/2020] [Indexed: 11/10/2022] Open
Abstract
Background To analyse the influence of whole body (wb)-MRI on patient management compared to routine diagnostic tests in patients with fever of unknown origin (FUO). Methods Twenty-four patients with FUO, defined as illness of more than three weeks with fever greater than 38.3 °C, underwent wb-MRI at a 1.5 T MR-system. The MR-protocol consisted of the following sequences: axial T1 VIBE, coronal T2-TIRM and a coronal echoplanar diffusion weighted sequence (overall acquisition time 29:39 min:s). Furthermore, laboratory findings, chest-x-ray, abdominal ultrasound, CT-scans and/or PET-CT scans were evaluated and compared to the wb-MRI findings in regard to treatment changes. Results Wb-MRI yielded a correct diagnosis in 70% of the patients. In 46% the inflammatory focus was exclusively detected by wb-MRI. Focus detection by wb-MRI led to a subsequent change of the clinical management in 92% of the patients. In 6 patients both a wb-MRI and a PET-CT were performed yielding the correct diagnosis in the same 4 of 6 patients for both imaging modalities. Conclusions Wb-MRI appears to be of value in the evaluation of FUO patients, allowing for optimized treatment by increasing diagnostic certainty. Due to its lack of nephrotoxicity and ionizing radiation it may be preferred over standard imaging techniques and PET-CT in the future. However, given the low number of patients in our trial, further prospective studies have to be performed to confirm our results.
Collapse
Affiliation(s)
- Anoshirwan Andrej Tavakoli
- Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Mannheim, Germany. .,Department of Radiology, German Cancer Research Center (Dkfz), Heidelberg, Germany.
| | - Miriam Reichert
- Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Mannheim, Germany
| | - Tanja Blank
- Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Mannheim, Germany
| | - Dietmar Dinter
- Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Mannheim, Germany.,Radiologie Schwetzingen, Schwetzingen, Germany
| | - Sabine Weckbach
- Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Mannheim, Germany.,Department of Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Dieter Buchheidt
- Department of Hematology and Oncology, University Medical Center Mannheim, Mannheim, Germany
| | - Stefan Oswald Schoenberg
- Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Mannheim, Germany
| | | |
Collapse
|
20
|
Khan D, Saddique MU, Jamshaid MB, Yousaf Z, Yassin MA. Non-Conforming Still's Disease With Low Ferritin and No Skin Rash: A Case Report. Cureus 2020; 12:e9168. [PMID: 32802605 PMCID: PMC7423497 DOI: 10.7759/cureus.9168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/13/2020] [Indexed: 11/05/2022] Open
Abstract
Adult Still's disease (ASD) is an inflammatory disorder with an unclear etiology. It is a rare disease that was first described more than a century ago. Its common characteristics are daily fevers, arthritis, and skin rash. ASD is diagnosed after excluding infections, malignancies, and connective tissue diseases. It has a female predominance. Classic skin rash and high serum ferritin levels are commonly associated with this condition and help in the diagnosis. Due to a lack of pathognomic clinical and laboratory features, a valid diagnostic criterion, the Yamaguchi criteria, is generally used for the diagnosis. The disease has a good prognosis with appropriate treatment. We present the case of a young gentleman who presented with fever, anemia, and leucocytosis; however, his serum ferritin levels were normal, and there was no typical salmon-colored skin rash. Hyperferritinemia developed later in the disease course, leading to a diagnosis of ASD.
Collapse
Affiliation(s)
- Dawlat Khan
- Internal Medicine, Hamad Medical Corporation, Doha, QAT
| | | | | | - Zohaib Yousaf
- Internal Medicine, Hamad Medical Corporation, Doha, QAT
- Clinical Research, Dresden International University, Dresden, DEU
| | | |
Collapse
|
21
|
Pijl JP, Kwee TC, Legger GE, Peters HJH, Armbrust W, Schölvinck EH, Glaudemans AWJM. Role of FDG-PET/CT in children with fever of unknown origin. Eur J Nucl Med Mol Imaging 2020; 47:1596-1604. [PMID: 32030452 PMCID: PMC7188721 DOI: 10.1007/s00259-020-04707-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 01/22/2020] [Indexed: 12/11/2022]
Abstract
PURPOSE To determine the role of 18F-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET)/computed tomography (CT) in children with fever of unknown origin (FUO). METHODS This retrospective single-center study included 110 children (0-18 years) with FUO who underwent FDG-PET/CT between 2010 and 2019. The diagnostic value of FDG-PET/CT for identifying cause of fever was calculated, treatment modifications after FDG-PET/CT were assessed, and logistic regression analyses were performed to identify clinical and biochemical factors associated with FDG-PET/CT outcome. RESULTS In 53 out of 110 patients (48%), FDG-PET/CT identified a (true positive) cause of fever. Endocarditis (11%), systemic juvenile idiopathic arthritis (5%), and inflammatory bowel disorder (5%) were the most common causes of FUO. In 42 patients (38%), no cause of fever was found on FDG-PET/CT. In 58 out of 110 patients (53%), treatment modifications were made after FDG-PET/CT. FDG-PET/CT achieved a sensitivity of 85.5%, specificity of 79.2%, positive predictive value of 84.1%, and negative predictive value of 80.9%. On multivariate logistic regression, C-reactive protein was positively associated with finding a true positive focus of fever on FDG-PET/CT (OR = 1.01 (95% CI 1.00-1.02) per mg/L increase in CRP), while leukocyte count was negatively associated with finding a true positive focus of fever (OR = 0.91 (95% CI 0.85-0.97) per 109 leukocytes/L increase). CONCLUSION FDG-PET/CT is a valuable diagnostic tool in the evaluation of children with FUO, since it may detect a true underlying cause in almost half (48%) of all cases where none was found otherwise. It allows full-body evaluation in patients without disease-specific symptoms on one examination. CRP and leukocyte count were significantly associated with FDG-PET/CT results, which may contribute to a priori assessment on the outcome of FDG-PET/CT. Future research could be aimed at evaluating more patient-specific factors to prospectively estimate the added value of FDG-PET/CT in children with FUO.
Collapse
Affiliation(s)
- Jordy P Pijl
- Medical Imaging Center, Department of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Thomas C Kwee
- Medical Imaging Center, Department of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - G E Legger
- Beatrix Children's Hospital, Department of Pediatric Rheumatology and Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Helja J H Peters
- Beatrix Children's Hospital, Department of Pediatric Rheumatology and Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Wineke Armbrust
- Beatrix Children's Hospital, Department of Pediatric Rheumatology and Immunology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - E H Schölvinck
- Beatrix Children's Hospital, Department of Pediatric Infectious Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Andor W J M Glaudemans
- Medical Imaging Center, Department of Radiology, Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
22
|
Methods of Granulocyte Isolation from Human Blood and Labeling with Multimodal Superparamagnetic Iron Oxide Nanoparticles. Molecules 2020; 25:molecules25040765. [PMID: 32053865 PMCID: PMC7070653 DOI: 10.3390/molecules25040765] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 01/17/2020] [Accepted: 02/02/2020] [Indexed: 02/08/2023] Open
Abstract
This in vitro study aimed to find the best method of granulocyte isolation for subsequent labeling with multimodal nanoparticles (magnetic and fluorescent properties) to enable detection by optical and magnetic resonance imaging (MRI) techniques. The granulocytes were obtained from venous blood samples from 12 healthy volunteers. To achieve high purity and yield, four different methods of granulocyte isolation were evaluated. The isolated granulocytes were labeled with multimodal superparamagnetic iron oxide nanoparticles (M-SPIONs) coated with dextran, and the iron load was evaluated qualitatively and quantitatively by MRI, near-infrared fluorescence (NIRF) and inductively coupled plasma mass spectrometry (ICP-MS). The best method of granulocyte isolation was Percoll with Ficoll, which showed 95.92% purity and 94% viability. After labeling with M-SPIONs, the granulocytes showed 98.0% purity with a yield of 3.5 × 106 cells/mL and more than 98.6% viability. The iron-loading value in the labeled granulocytes, as obtained by MRI, was 6.40 ± 0.18 pg/cell. Similar values were found with the ICP-MS and NIRF imaging techniques. Therefore, our study shows that it is possible to isolate granulocytes with high purity and yield and labeling with M-SPIONs provides a high internalized iron load and low toxicity to cells. Therefore, these M-SPION-labeled granulocytes could be a promising candidate for future use in inflammation/infection detection by optical and MRI techniques.
Collapse
|
23
|
Wang WX, Cheng ZT, Zhu JL, Xing MY, Zheng CF, Wang SJ, Xie NN, XianYu ZQ, Song JX. Combined clinical parameters improve the diagnostic efficacy of 18F-FDG PET/CT in patients with fever of unknown origin (FUO) and inflammation of unknown origin (IUO): A prospective study in China. Int J Infect Dis 2020; 93:77-83. [PMID: 31982625 DOI: 10.1016/j.ijid.2020.01.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/21/2019] [Accepted: 01/16/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To improve the diagnostic efficacy of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for Chinese patients with fever of unknown origin (FUO) and inflammation of unknown origin (IUO), with combined clinical parameters. MATERIALS AND METHODS FUO/IUO patients who underwent a standard diagnostic work-up and 18F-FDG PET/CT scanning were enrolled and divided into a local uptake lesion subgroup and a non-specific abnormal uptake subgroup. Beneficial clinical parameters for improving the diagnostic efficacy of PET/CT were identified. RESULTS From January 2014 to January 2019, 253 FUO/IUO patients were studied. In total, 147 patients had local uptake lesions and 106 patients had non-specific abnormal uptake. In the local uptake lesion group, the positioning accuracy of PET/CT was 37.2% in grades 1 and 2, and 66.3% in grades 3 and 4. With the following combination of clinical parameters, the positioning accuracy increased to 75.0% and 90.0%, respectively: time from admission to performing PET/CT scanning <6.5 days and C-reactive protein level >95 mg/l. In the non-specific abnormal uptake group, the combination of sex (male), bicytopenia, and lactic dehydrogenase improved the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for diagnosing malignancy from 64.3%, 69%, 60%, and 72.7%, respectively, to 83.3%, 81%, 81.4%, and 82.9%, respectively. With the combination of sex (male), white blood count, serum ferritin level, and hepatosplenomegaly, the infection prediction model had a sensitivity, specificity, PPV, and NPV of 78%, 76.2%, 76.6%, and 77.6%, respectively. CONCLUSIONS Combined clinical parameters improved the localization diagnostic value of 18F-FDG PET/CT in the local uptake lesion subgroup and the etiological diagnostic value in the non-specific abnormal uptake subgroup.
Collapse
Affiliation(s)
- Wen-Xia Wang
- Department of Infectious Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, 430030, Wuhan, China
| | - Zhao-Ting Cheng
- Department of Nuclear Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, 430030 Wuhan, China
| | - Ji-Ling Zhu
- Department of Infectious Diseases, Renmin Hospital of Wuhan University, 238 Jiefang Road, 430030, Wuhan, China
| | - Ming-You Xing
- Department of Infectious Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, 430030, Wuhan, China
| | - Cai-Feng Zheng
- Department of Infectious Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, 430030, Wuhan, China
| | - Si-Jun Wang
- Department of Infectious Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, 430030, Wuhan, China
| | - Na-Na Xie
- Department of Infectious Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, 430030, Wuhan, China
| | - Zhi-Qun XianYu
- Department of Nuclear Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, 430030 Wuhan, China
| | - Jian-Xin Song
- Department of Infectious Diseases, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Avenue, 430030, Wuhan, China.
| |
Collapse
|
24
|
Ingestible sensors correlate closely with peripheral temperature measurements in febrile patients. J Infect 2019; 80:161-166. [PMID: 31734342 PMCID: PMC7112658 DOI: 10.1016/j.jinf.2019.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 11/02/2019] [Indexed: 12/31/2022]
Abstract
BACKGROUNDS Reliable non-invasive methods for measuring body temperature are essential for the diagnosis and monitoring of infectious disease. METHODS This study used Intraclass Correlation Coefficients (ICC) and the Bland- Altman plot to analyse the agreement between temperature measurements using an ingestible capsule sensor, a skin sensor and two non-invasive peripheral temperature measurements (axillary and infrared non-contact), collected from a population of febrile patient admitted for infectious disease. RESULTS Of the 77 febrile patients screened, 26 patients were enrolled. The ICC between axillary temperature measurements (Taxi) vs. non-contact measurements (Tno-c) were 0.34 [-0.18; 0.63], 0.87 [0.55; 0.94] between Taxi vs. ingestible capsule measurements (Tcap) and 0.12 [-0.09; 0.37] between Taxi vs. Tetac. The mean difference between Taxi vs Tno-c was -1.18 °C with limits of agreement (LoA) from -2.96 to 0.58 °C. The mean difference between Taxi vs Tcap was 0.48 °C, with LoA from -0.60 to 1.56 °C. The mean difference between Taxi vs Tetac was -4.23 °C with LoA from -7.22 to -1.23 °C. CONCLUSIONS Ingestible capsule measurements are reliable enough to adequately estimate the core body temperature in clinical practice. Its non-invasiveness, and the real-time remote control offer new opportunities for future research into fever during infectious diseases.
Collapse
|
25
|
Abstract
Fever is a common clinical sign encountered in hospitalized patients and often represents the cardinal sign of infectious processes. However, a number of noninfectious etiologies causing fever should be considered prior to initiating broad-spectrum antibiotic therapy. Reducing unnecessary antibiotic use is crucial in an era of increasing resistance.
Collapse
|
26
|
Abstract
Unexplained fever is one of the most common and difficult diagnostic problems faced daily by clinicians. This study evaluated the differences in health service utilization, health care expenditures, and quality of care provided to patients with unexplained fever before and after global budget (GB) implementation in Taiwan.The National Health Insurance Research Database was used for analyzing the health care expenditures and quality of care before and after implementation of the GB system. Patients diagnosed as having unexplained fever during 2000-2001 were recruited; their 2000-2001 and 2004-2005 data were considered baseline and postintervention data, respectively.Data of 259 patients with unexplained fever were analyzed. The mean lengths of stay (LOSs) before and after GB system implementation were 4.22 ± 0.35 days and 5.29 ± 0.70 days, respectively. The mean costs of different health care expenditures before and after implementation of the GB system were as follows: the mean diagnostic, drug, therapy, and total costs increased respectively from New Taiwan Dollar (NT$) 1440.05 ± NT$97.43, NT$3249.90 ± NT$1108.27, NT$421.03 ± NT$100.03, and NT$13,866.77 ± NT$2,114.95 before GB system implementation to NT$2224.34 ± NT$238.36, NT$4272.31 ± NT$1466.90, NT$2217.03 ± NT$672.20, and NT$22,856.41 ± NT$4,196.28 after implementation. The mean rates of revisiting the emergency department within 3 days and readmission within 14 days increased respectively from 10.5% ± 2.7% and 8.3% ± 2.4% before implementation to 6.3% ± 2.2% and 4.0% ± 1.7% after implementation.GB significantly increased LOS and incremental total costs for patients with unexplained fever; but improved the quality of care.
Collapse
Affiliation(s)
- Keh-Sen Liu
- Department of Infectious Diseases, Show Chwan Memorial Hospital, Changhua
| | - Tsung-Fu Yu
- Institute of Biomedical Sciences, Academia Sinica, Nankang District, Taipei
| | - Hsing-Ju Wu
- Research Assistant Center, Show Chwan Memorial Hospital, Changhua
- Department of Medical Research, Chang Bing Show Chwan Memorial Hospital, Lukang Town, Changhua County
| | - Chun-Yi Lin
- Department of Nursing, DaYeh University, Dacun, Changhua
- Department of Nuclear Medicine, Show Chwan Memorial Hospital, Changhua
- Department of Nuclear Medicine, Chang Bing Show Chwan Memorial Hospital, Lukang Town, Changhua County, Taiwan
| |
Collapse
|
27
|
Arnon-Sheleg E, Israel O, Keidar Z. PET/CT Imaging in Soft Tissue Infection and Inflammation-An Update. Semin Nucl Med 2019; 50:35-49. [PMID: 31843060 DOI: 10.1053/j.semnuclmed.2019.07.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Nuclear medicine procedures, including Ga-67 and labeled leucocyte SPECT/CT as well as PET/CT using 18F-FDG and recently Ga-68 tracers, have found extensive applications in the assessment of infectious and inflammatory processes in general and in soft tissues in particular. Recent published data focus on summarizing the available imaging information with the purpose of providing the referring clinicians with optimized evidence based results. Guidelines and/or recommendations of clinical societies have incorporated nuclear medicine tests (using both labeled leucocytes and FDG) in their suggested work-up for evaluation of infective endocarditis and in certain patients with suspected vascular graft infections. Joint guidelines of the European and American nuclear medicine societies include fever of unknown origin, sarcoidosis, and vasculitis among the major clinical indications that will benefit from nuclear medicine procedures, specifically from FDG PET/CT. Limitations and pitfalls for the use of radiotracers in assessment of infection and inflammation can be related to patient conditions (eg, diabetes mellitus), or to the biodistribution of a specific radiopharmaceutical. Limited presently available data on the use of functional and/or metabolic monitoring of response to infectious and inflammatory processes to treatment and with respect to the effect of drugs such as antibiotics and glucocorticoids on the imaging patterns of these patients need further confirmation.
Collapse
Affiliation(s)
- Elite Arnon-Sheleg
- Department of Nuclear Medicine, Galilee Medical Center, Naharia, Israel; Department of Diagnostic Radiology, Galilee Medical Center, Naharia, Israel.
| | - Ora Israel
- Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel; The B. Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Zohar Keidar
- Department of Nuclear Medicine, Rambam Health Care Campus, Haifa, Israel; The B. Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| |
Collapse
|
28
|
Kan Y, Wang W, Liu J, Yang J, Wang Z. Contribution of 18F-FDG PET/CT in a case-mix of fever of unknown origin and inflammation of unknown origin: a meta-analysis. Acta Radiol 2019; 60:716-725. [PMID: 30205705 DOI: 10.1177/0284185118799512] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Fever of unknown origin (FUO) and inflammation of unknown origin (IUO) are challenging medical problems. Previous studies have shown that 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) plays an important role in the diagnosis of FUO, but few studies have explored this diagnostic technique in relation to IUO. PURPOSE To systematically review and perform a meta-analysis of published data on the diagnostic performance of PET/CT in the diagnosis of FUO and IUO. MATERIAL AND METHODS A comprehensive literature search was performed in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines published in March 2018. Meta-analysis of diagnostic performance was performed using STATA 12.0 software. Subgroup analysis was performed by stratification based on study design, number of patients, geographic area, and final diagnosis based on 18F-FDG PET/CT. Meta-regression analyses were performed to recognize heterogeneity. RESULTS Our meta-analysis included 23 studies, comprising a total sample size of 1927 patients. The pooled diagnosis performance was calculated with a per-patient-based analysis: sensitivity = 0.84 (95% confidence interval [CI] = 0.79-0.89), specificity = 0.63 (95% CI = 0.49-0.75), positive likelihood ratio = 2.3 (95% CI = 1.5-3.4), negative likelihood ratio = 0.25 (95% CI = 0.16-0.38), diagnostic odds ratio = 9 (95% CI = 4.0-20), and AUC = 0.84 (95% CI = 0.81-0.87). CONCLUSION In patients with non-specific symptoms and signs, 18F-FDG PET/CT is very helpful for recognizing and excluding diseases, directing further diagnostic decisions, and avoiding unnecessary invasive examinations. We recommend that 18F-FDG PET/CT should be considered among the first-line diagnostic tools for patients with FUO and IUO.
Collapse
Affiliation(s)
- Ying Kan
- Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China
| | - Wei Wang
- Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China
| | - Jie Liu
- Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China
| | - Jigang Yang
- Department of Nuclear Medicine, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, PR China
| |
Collapse
|
29
|
Sai SK, Padhi S, Varghese RGB, Kanungo R, Basheer A, Iqbal N. Diagnostic utility of bone marrow examination in evaluation of fever: a descriptive study on 98 immunocompetent adults from a tertiary care institute in south India. Trop Doct 2019; 49:88-96. [PMID: 30614411 DOI: 10.1177/0049475518822844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Five-year clinico-laboratory data from 99 (one HIV seropositive) adults (mean age = 41.3 ± 20.4 years) who underwent bone marrow examination for fever persisting for ≥ 1 week were analysed and correlated with microbiological characteristics. Infections, reactive marrow changes and haematolymphoid malignancies were most commonly associated with fever. A high concordance rate of 71% was noted between aspiration and trephine biopsies. Bone marrow granulomas (BMG) were seen exclusively on sections and were most commonly of tubercular and typhoidal in origin (two Salmonella Typhi, one Salmonella Paratyphi A). The common aetiologies associated with fever and cytopenia(s) were BMG, acute leukaemia and haemophagocytic lymphohistiocytosis (HLH; n = 3). The yield from bone marrow culture was inferior compared to other body fluids. In conclusion, bone marrow histology is superior to smears in the evaluation of prolonged fever. Marrow culture may not be useful in immunocompetent individuals other than if Salmonellosis is suspected.
Collapse
Affiliation(s)
- Sri Krishna Sai
- 1 Junior Resident, Department of Pathology, Pondicherry Institute of Medical Sciences, Pondicherry, India
| | - Somanath Padhi
- 2 Associate Professor, Department of Pathology, Pondicherry Institute of Medical Sciences, Pondicherry, India
| | - Renu G Boy Varghese
- 3 Professor and Head, Department of Pathology, Pondicherry Institute of Medical Sciences, Pondicherry, India
| | - Reba Kanungo
- 4 Professor and Head, Department of Microbiology, Pondicherry Institute of Medical Sciences, Pondicherry, India
| | - Aneesh Basheer
- 5 Associate Professor, Department of General Medicine, Pondicherry Institute of Medical Sciences, Pondicherry, India
| | - Nayyar Iqbal
- 5 Associate Professor, Department of General Medicine, Pondicherry Institute of Medical Sciences, Pondicherry, India
| |
Collapse
|
30
|
Okamoto N, Yokota S, Takei S, Okura Y, Kubota T, Shimizu M, Nozawa T, Iwata N, Umebayashi H, Kinjo N, Kunishima T, Yasumura J, Mori M. Clinical practice guidance for juvenile idiopathic arthritis (JIA) 2018. Mod Rheumatol 2018; 29:41-59. [PMID: 30126298 DOI: 10.1080/14397595.2018.1514724] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Juvenile idiopathic arthritis (JIA) is the most common disease in pediatric rheumatism. There is no specific symptom or examination finding for JIA, and the diagnosis is made by exclusion and differentiation. Because non-pediatric rheumatologists are sometimes involved in medical care, 'proposal for JIA guidance on diagnosis and treatment for primary care pediatricians and non-pediatric rheumatologists' was first published in 2007. In these 10 years, a number of new findings on pathophysiology and treatment of JIA have been published; therefore, we propose this guidance of 2018th edition aiming at updating and standardization of JIA medical care in Japan. This edition included the management of uveitis, macrophage activation syndrome, infectious diseases before and during treatment. Moreover, details of biologics are also described. Although this guidance is tailored to adaptation of examinations and drugs, we do not purpose to limit the physicians' discretion in clinical practice. This guidance should be viewed as recommendations and be individualized according to the condition of the patient. We hope that medical care for JIA will advance and more patients will get benefit based on this guidance. Then, further revisions are needed due to changes in future conditions.
Collapse
Affiliation(s)
- Nami Okamoto
- a Department of Pediatrics, Faculty of Medicine , Osaka Medical College , Takatsuki , Japan
| | - Shumpei Yokota
- b Laboratory of Pediatric Research , Institute of Tokyo Medical School , Tokyo , Japan
| | - Syuji Takei
- c Department of Pediatrics, Graduate School of Medical and Dental Sciences , Kagoshima University , Kagoshima , Japan
| | - Yuka Okura
- d Department of Pediatrics , KKR Sapporo Medical Center , Sapporo , Japan
| | - Tomohiro Kubota
- c Department of Pediatrics, Graduate School of Medical and Dental Sciences , Kagoshima University , Kagoshima , Japan
| | - Masaki Shimizu
- e Department of Pediatrics, Graduate School of Medical Sciences , Kanazawa University , Kanazawa , Japan
| | - Tomo Nozawa
- f Department of Pediatrics , Yokohama City University Graduate School of Medicine , Yokohama , Japan
| | - Naomi Iwata
- g Department of Infection and Immunology , Aichi Children's Health and Medical Center , Obu , Japan
| | - Hiroaki Umebayashi
- h Department of General Pediatrics , Miyagi Children's Hospital , Sendai , Japan
| | - Noriko Kinjo
- i Department of Child Health and Welfare (Pediatrics), Graduate School of Medicine , University of the Ryukyus , Nishihara , Japan
| | - Tomoko Kunishima
- i Department of Child Health and Welfare (Pediatrics), Graduate School of Medicine , University of the Ryukyus , Nishihara , Japan
| | - Junko Yasumura
- j Department of Pediatrics , Hiroshima University Graduate School of Biomedical & Health Sciences , Hiroshima , Japan
| | - Masaaki Mori
- k Department of Lifetime Clinical Immunology, Graduate School of Medical and Dental Sciences , Tokyo Medical and Dental University , Tokyo , Japan
| |
Collapse
|
31
|
Holzinger D, Foell D, Kessel C. The role of S100 proteins in the pathogenesis and monitoring of autoinflammatory diseases. Mol Cell Pediatr 2018; 5:7. [PMID: 30255357 PMCID: PMC6156694 DOI: 10.1186/s40348-018-0085-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 04/27/2018] [Indexed: 01/09/2023] Open
Abstract
S100A8/A9 and S100A12 are released from activated monocytes and granulocytes and act as proinflammatory endogenous toll-like receptor (TLR)4-ligands. S100 serum concentrations correlate with disease activity, both during local and systemic inflammatory processes. In some autoinflammatory diseases such as familial Mediterranean fever (FMF) or systemic juvenile idiopathic arthritis (SJIA), dysregulation of S100 release may be involved in the pathogenesis. Moreover, S100 serum levels are a valuable supportive tool in the diagnosis of SJIA in fever of unknown origin. Furthermore, S100 levels can be used to monitor disease activity to subclinical level, as their serum concentrations decrease with successful treatment.
Collapse
Affiliation(s)
- Dirk Holzinger
- Department of Pediatric Hematology-Oncology, University of Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany.
| | - Dirk Foell
- Department of Pediatric Rheumatology and Immunology, University Children's Hospital Muenster, Domagkstr. 3, 48149, Muenster, Germany
| | - Christoph Kessel
- Department of Pediatric Rheumatology and Immunology, University Children's Hospital Muenster, Domagkstr. 3, 48149, Muenster, Germany
| |
Collapse
|
32
|
Kim JH, Kim ES, Jun KI, Jung HG, Bang JH, Choe PG, Park WB, Song KH, Kim HB, Kim NJ, Oh MD, Park SW. Delayed diagnosis of extrapulmonary tuberculosis presenting as fever of unknown origin in an intermediate-burden country. BMC Infect Dis 2018; 18:426. [PMID: 30153813 PMCID: PMC6114835 DOI: 10.1186/s12879-018-3349-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 08/21/2018] [Indexed: 11/14/2022] Open
Abstract
Background Tuberculosis (TB), especially extrapulmonary tuberculosis (EPTB), is an important cause of fever of unknown origin (FUO) in TB-burdened areas. Little information is known about patients with EPTB with clinical features presenting as FUO and about the factor of delaying the diagnosis. Methods We retrospectively analyzed EPTB patients who were referred with FUO at 3 university-affiliated hospitals over 8 years (2010–2017). The subjects were assigned to groups of early diagnosis and delayed diagnosis within 3 days of an initial comprehensive evaluation from the referral. Clinical and laboratory variables were compared between the groups. Results A total of 95 patients with febrile EPTB were included. Localizing symptoms and/or signs suggestive of anatomy were identified in 62.1% of the patients. Concurrent lung involvement by TB was presented by 49.5% (47/95) of the patients, and only 23.4% of them showed typical findings of pulmonary TB on simple chest X-ray. Most of the patients showed abnormal lesions on cross-sectional CT (98.9%) and MRI (100%). The clinical variables and blood test results of patients were not significantly different between the two groups. The less typical imaging finding of EPTB on CT (38.5% vs. 79.0%) and MRI (37.5% vs. 79.0%) in the delayed diagnosis group was a risk factor for delayed diagnosis. Conclusion Febrile EPTB referred as FUO showed nonspecific clinical manifestations. The active application of cross-sectional imaging tests according to clinical clues or randomly in the absence of local manifestations, combined with invasive diagnostic approaches even for atypical presentations may lead to an earlier diagnosis of febrile EPTB.
Collapse
Affiliation(s)
- Jeong-Han Kim
- Department of Internal Medicine, Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, South Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kang-Il Jun
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyun Gul Jung
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ji Hwan Bang
- Department of Internal Medicine, Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, South Korea.,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Pyeong Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyoung-Ho Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Myoung-Don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sang-Won Park
- Department of Internal Medicine, Boramae Medical Center, 20, Boramae-ro 5-gil, Dongjak-gu, Seoul, 07061, South Korea. .,Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
| |
Collapse
|
33
|
Reactivation and Dissemination of Tuberculosis to Extrapulmonary Sites in Patients With Hematologic Malignancies. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2018. [DOI: 10.1097/ipc.0000000000000576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
34
|
Liu W, Jiang H, Jing H, Mao B. An unusual cause of fever of unknown origin with enlarged lymph nodes-relapsing polychondritis: A case report. Medicine (Baltimore) 2017; 96:e8734. [PMID: 29145318 PMCID: PMC5704863 DOI: 10.1097/md.0000000000008734] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
INTRODUCTION Fever of unknown origin (FUO) is a common initial presentation leading to a diagnostic challenge. PATIENT CONCERNS A 3-month history of moderate-to-high fever was reported in an otherwise healthy 54-year-old man. Enhanced computed tomography (CT) scans of his chest showed a remarkable progressive enlargement of bilateral cervical, supraclavicular, hilar, and mediastinal lymph nodes within 2 weeks. Bronchofibroscopy manifested obvious luminal stenosis with swelling, thick pale mucosa, and disappearing of structures of trachea cricoid cartilage, followed by a 18F-fluorodeoxyglucose positron-emission tomography-computed tomography (18F-FDG PET/CT) with intense symmetric FDG uptake in larynx, tracheobronchial tree, and hilar, mediastinal, and axillary lymph nodes being demonstrated. DIAGNOSIS A diagnosis of relapsing polychondritis (RP) was finally reached. INTERVENTIONS The patient received methylprednisolone 40 mg daily with a gradual tapering in a 4-month follow-up. OUTCOMES The patient experienced no relapse of fever and lymph nodes enlargement in the 4-month follow-up. LESSONS Even though long-term fever with multiple lymphadenectasis usually lead to a diagnosis of lymphoma, the bronchoscopic features and evidence from 18F-FDG PET/CT in this case were much more approximate to RP, indicating an importance of a sensible differential diagnosis of RP in patients who present with nonspecific features such as FUO and lymph nodes enlargement. Keeping a high index of clinical suspicion in these patients can help recognize uncommon of RP and promote diagnosis and treatment. Our case highlights the significance of 18F-FDG PET/CT in helping reaching the diagnosis of RP in this condition. This report provides new data regarding the diagnostic difficulties of this rare type of autoimmune disease, and further investigations are needed as cases accumulate.
Collapse
|
35
|
Schönau V, Vogel K, Englbrecht M, Wacker J, Schmidt D, Manger B, Kuwert T, Schett G. The value of 18F-FDG-PET/CT in identifying the cause of fever of unknown origin (FUO) and inflammation of unknown origin (IUO): data from a prospective study. Ann Rheum Dis 2017; 77:70-77. [PMID: 28928271 DOI: 10.1136/annrheumdis-2017-211687] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 08/24/2017] [Accepted: 09/08/2017] [Indexed: 11/03/2022]
Abstract
BACKGROUND Fever of unknown origin (FUO) and inflammation of unknown origin (IUO) are diagnostically challenging conditions. Diagnosis of underlying disease may be improved by 18F-fluorodesoxyglucose positron emission tomography (18F-FDG-PET). METHODS Prospective study to test diagnostic utility of 18F-FDG-PET/CT in a large cohort of patients with FUO or IUO and to define parameters that increase the likelihood of diagnostic 18F-FDG-PET/CT. Patients with FUO or IUO received 18F-FDG-PET/CT scanning in addition to standard diagnostic work-up. 18F-FDG-PET/CT results were classified as helpful or non-helpful in establishing final diagnosis. Binary logistic regression was used to identify clinical parameters associated with a diagnostic 18F-FDG-PET/CT. RESULTS 240 patients were enrolled, 72 with FUO, 142 with IUO and 26 had FUO or IUO previously (exFUO/IUO). Diagnosis was established in 190 patients (79.2%). The leading diagnoses were adult-onset Still's disease (15.3%) in the FUO group, large vessel vasculitis (21.1%) and polymyalgia rheumatica (18.3%) in the IUO group and IgG4-related disease (15.4%) in the exFUO/IUO group. In 136 patients (56.7% of all patients and 71.6% of patients with a diagnosis), 18F-FDG-PET/CT was positive and helpful in finding the diagnosis. Predictive markers for a diagnostic 18F-FDG-PET/CT were age over 50 years (p=0.019), C-reactive protein (CRP) level over 30 mg/L (p=0.002) and absence of fever (p=0.001). CONCLUSION 18F-FDG-PET/CT scanning is helpful in ascertaining the correct diagnosis in more than 50% of the cases presenting with FUO and IUO. Absence of intermittent fever, higher age and elevated CRP level increase the likelihood for a diagnostic 18F-FDG-PET/CT.
Collapse
Affiliation(s)
- Verena Schönau
- Department of Internal Medicine 3, Institute for Clinical Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum, Erlangen, Germany
| | - Kristin Vogel
- Department of Internal Medicine 3, Institute for Clinical Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum, Erlangen, Germany
| | - Matthias Englbrecht
- Department of Internal Medicine 3, Institute for Clinical Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum, Erlangen, Germany
| | - Jochen Wacker
- Department of Internal Medicine 3, Institute for Clinical Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum, Erlangen, Germany
| | - Daniela Schmidt
- Clinic of Nuclear Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum, Erlangen, Germany
| | - Bernhard Manger
- Department of Internal Medicine 3, Institute for Clinical Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum, Erlangen, Germany
| | - Torsten Kuwert
- Clinic of Nuclear Medicine, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum, Erlangen, Germany
| | - Georg Schett
- Department of Internal Medicine 3, Institute for Clinical Immunology, Friedrich-Alexander-University Erlangen-Nürnberg (FAU) and Universitätsklinikum, Erlangen, Germany
| |
Collapse
|
36
|
Yi J, Kim KH, Ko MK, Lee EY, Choi SJ, Oh MD. Human Granulocytic Anaplasmosis as a Cause of Febrile Illness in Korea Since at Least 2006. Am J Trop Med Hyg 2017; 96:777-782. [PMID: 28093540 DOI: 10.4269/ajtmh.16-0309] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
AbstractHuman granulocytic anaplasmosis (HGA) is a tick-borne rickettsial zoonosis with fever, thrombocytopenia, and leukopenia. HGA has been reported in Korea in 2013 but it is uncertain how long it has existed. A retrospective study was conducted on patients who underwent bone marrow examination due to fever and cytopenia, with no clear hematologic or microbiologic causes, from 2003 through 2012. Laboratory diagnosis was made by detecting 16S rRNA genes of Anaplasma phagocytophilum from the stored blood samples. Among the 70 patients, five (7.1%) HGA cases were found, and the earliest case dated back to 2006. Two cases met the diagnostic criteria of hemophagocytic lymphohistiocytosis (HLH) and were fatal. Although HGA has been prevalent in Korea since at least 2006, it is not always diagnosed and has posed a possible lethal health risk to the people in Korea. HGA should be considered as a cause of fever with cytopenia or HLH.
Collapse
Affiliation(s)
- Jongyoun Yi
- Department of Laboratory Medicine, Pusan National University School of Medicine, Busan, South Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Kye-Hyung Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, South Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Mee Kyung Ko
- Department of Laboratory Medicine, Pusan National University School of Medicine, Busan, South Korea.,Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Eun Yup Lee
- Department of Laboratory Medicine, Pusan National University School of Medicine, Busan, South Korea
| | - Su Jin Choi
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Myoung-Don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| |
Collapse
|
37
|
Lung Lesions During Fever of Unknown Origin. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1022:35-43. [DOI: 10.1007/5584_2017_37] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
38
|
Cunha CB, Cunha BA. Fever of Unknown Origin (FUO). Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00068-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
39
|
Unger M, Karanikas G, Kerschbaumer A, Winkler S, Aletaha D. Fever of unknown origin (FUO) revised. Wien Klin Wochenschr 2016; 128:796-801. [PMID: 27670857 PMCID: PMC5104815 DOI: 10.1007/s00508-016-1083-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 08/18/2016] [Indexed: 12/16/2022]
Abstract
Fever of unknown origin (FUO) was originally characterised in 1961 by Petersdorf and Beeson as a disease condition of temperature exceeding 38.3 °C on at least three occasions over a period of at least three weeks, with no diagnosis made despite one week of inpatient investigation. However, since underlying diseases are often reported for classical FUO, these presentations may not be considered to be of “unknown origin”. Rather, the aetiology of prolonged fever may resolve, or not resolve. The definition of fever with unresolved cause (true FUO) is difficult, as it is a moving target, given the constant advancement of imaging and biomarker analysis. Therefore, the prevalence of fever with unresolved cause (FUO) is unknown. In this review, we report such a case of prolonged fever, which initially has presented as classical FUO, and discuss current literature. Furthermore, we will give an outlook, how a prospective study on FUO will allow to solve outstanding issues like the utility of different diagnostic investigations, and the types and prevalence of various underlying diseases.
Collapse
Affiliation(s)
- Manuel Unger
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Georgios Karanikas
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Andreas Kerschbaumer
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Stefan Winkler
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine 1, Medical University of Vienna, Vienna, Austria
| | - Daniel Aletaha
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| |
Collapse
|
40
|
Westra SJ, Karmazyn BK, Alazraki AL, Dempsey ME, Dillman JR, Garber M, Moore SG, Raske ME, Rice HE, Rigsby CK, Safdar N, Simoneaux SF, Strouse PJ, Trout AT, Wootton-Gorges SL, Coley BD. ACR Appropriateness Criteria Fever Without Source or Unknown Origin—Child. J Am Coll Radiol 2016; 13:922-30. [DOI: 10.1016/j.jacr.2016.04.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 04/27/2016] [Indexed: 11/16/2022]
|
41
|
Contribution of (18)F-FDG PET in the diagnostic assessment of fever of unknown origin (FUO): a stratification-based meta-analysis. Eur J Nucl Med Mol Imaging 2016; 43:1887-95. [PMID: 27037917 DOI: 10.1007/s00259-016-3377-6] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Accepted: 03/17/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of this study was to quantify the contribution of FDG PET to the diagnostic assessment of fever of unknown origin (FUO), taking into account the diagnostic limitations resulting from the composite nature of this entity. METHODS The PubMed/MEDLINE database was searched from 2000 to September 2015. Original articles fulfilling the following criteria were included: (1) FUO as the initial diagnosis, (2) no immunosuppressed or nosocomial condition, (3) final diagnosis not based on PET, (4) a follow-up period specified, (5) adult population, and (6) availability of adapted data for calculation of odds ratios (ORs). ORs were computed for each study and then pooled using a random effects model. Stratification-based sensitivity analyses were finally performed using the following prespecified criteria: (a) study design, (b) PET device, (c) geographic area, and (d) follow-up period. RESULTS A meta-analysis of the 14 included studies showed that normal PET findings led to an increase in the absolute final diagnostic rate of 36 % abnormal PET findings to an increase of 83 %, corresponding to a pooled OR of 8.94 (95 % CI 4.18 - 19.12, Z = 5.65; p < 0.00001). The design of the studies influenced the results (OR 2.92, 95 % CI 1.00 - 8.53 for prospective studies; OR 18,57, 95 % CI 7.57 - 45.59 for retrospective studies; p = 0.01), whereas devices (dedicated or hybrid), geographic area and follow-up period did not. CONCLUSION Abnormal PET findings are associated with a substantially increased final diagnostic rate in FUO. Consequently, FDG PET could be considered for inclusion in the first-line diagnostic work-up of FUO. Further randomized prospective studies with standardized FDG PET procedures are warranted to confirm this first-line position.
Collapse
|
42
|
Cunha BA, Lortholary O, Cunha CB. Fever of unknown origin: a clinical approach. Am J Med 2015; 128:1138.e1-1138.e15. [PMID: 26093175 DOI: 10.1016/j.amjmed.2015.06.001] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 06/03/2015] [Accepted: 06/03/2015] [Indexed: 11/22/2022]
Abstract
Fevers of unknown origin remain one of the most difficult diagnostic challenges in medicine. Because fever of unknown origin may be caused by over 200 malignant/neoplastic, infectious, rheumatic/inflammatory, and miscellaneous disorders, clinicians often order non-clue-based imaging and specific testing early in the fever of unknown origin work-up, which may be inefficient/misleading. Unlike most other fever-of-unknown-origin reviews, this article presents a clinical approach. Characteristic history and physical examination findings together with key nonspecific test abnormalities are the basis for a focused clue-directed fever of unknown origin work-up.
Collapse
Affiliation(s)
- Burke A Cunha
- Infectious Disease Division, Winthrop-University Hospital, Mineola, NY; State University of New York, School of Medicine, Stony Brook.
| | - Olivier Lortholary
- Hôpital Necker-Enfants Malades, Service des Maladies Infectieuses et Tropicales, Centre d'Infectiologie Necker-Pasteur, IHU Imagine, Paris, France; Université Paris Descartes, Paris, France
| | - Cheston B Cunha
- Infectious Disease Division, Rhode Island Hospital and The Miriam Hospital, Providence, RI; Brown University Alpert School of Medicine, Providence, RI
| |
Collapse
|
43
|
Masotti M, Bergamaschi G, Formagnana P, Corazza GR. A case of fever of unknown origin? Intern Emerg Med 2015; 10:603-5. [PMID: 25931300 DOI: 10.1007/s11739-015-1240-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 04/07/2015] [Indexed: 11/24/2022]
|
44
|
Abstract
Fever of unknown origin (FUO) remains a challenging clinical problem despite recent advances in diagnostic tools and techniques. Because primary care physicians are often the first ones to encounter a case of FUO, it is important that they be familiar with the best strategy and steps for confronting this problem initially. Here, Drs Amin and Kauffman review the major causes of FUO in adults and describe an in-depth approach to laboratory and radiologic tests that help establish a diagnosis.
Collapse
Affiliation(s)
- Kamal Amin
- Infectious Diseases Division, University of Michigan Medical Center, Ann Arbor, MI, USA
| | | |
Collapse
|
45
|
PET Index of Bone Glucose Metabolism (PIBGM) Classification of PET/CT Data for Fever of Unknown Origin Diagnosis. PLoS One 2015; 10:e0130173. [PMID: 26076139 PMCID: PMC4468245 DOI: 10.1371/journal.pone.0130173] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 05/17/2015] [Indexed: 11/19/2022] Open
Abstract
Objectives Fever of unknown origin (FUO) remains a challenge in clinical practice. Fluorine-18 fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) is helpful in diagnosing the etiology of FUO. This paper aims to develop a completely automatic classification method based on PET/CT data for the computer-assisted diagnosis of FUO. Methods We retrospectively analyzed the FDG PET/CT scan of 175 FUO patients, 79 males and 96 females. The final diagnosis of all FUO patients was achieved through pathology or clinical evaluation, including 108 normal patients and 67 FUO patients. CT anatomic information was used to acquire bone functional information from PET images. The skeletal system of FUO patients was classified by analyzing the standardized uptake value (SUV) and the PET index of bone glucose metabolism (PIBGM). The SUV distributions in the bone marrow and the bone cortex were also studied in detail. Results The SUV and PIBGM of the bone marrow only slightly differed between the FUO patients and normal people, whereas the SUV of whole bone structures and the PIBGM of the bone cortex significantly differed between the normal people and FUO patients. The method detected 43 patients from 67 FUO patients, with sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 64.18%, 95%, 93.48%, 72.73%, and 83.33%, respectively. Conclusion The experimental results demonstrate that the study can achieve automatic classification of FUO patients by the proposed novel biomarker of PIBGM, which has the potential to be utilized in clinical practice.
Collapse
|
46
|
Gafter-Gvili A, Raibman S, Grossman A, Avni T, Paul M, Leibovici L, Tadmor B, Groshar D, Bernstine H. [18F]FDG-PET/CT for the diagnosis of patients with fever of unknown origin. QJM 2015; 108:289-98. [PMID: 25208896 DOI: 10.1093/qjmed/hcu193] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND AND AIMS The diagnosis of patients with fever of unknown origin (FUO) remains a challenging medical problem. We aimed to assess the diagnostic contribution of 18-fluoro-2-deoxy-d-glucose positron emission tomography (FDG-PET)/computed tomography (CT) for the evaluation of FUO. METHODS We performed a 4-year retrospective single-center study of all hospitalized patients that underwent FDG-PET/CT for evaluation of FUO. The final diagnosis of the febrile disease was based on clinical, microbiological, radiological and pathological data available at the final follow-up. Predictors for a contributory exam were sought. RESULTS One hundred and twelve patients underwent FDG-PET/CT for the investigation of FUO in the years 2008-2012 and were included in the study. A final diagnosis was determined in 83 patients (74%) and included: infectious disease in 49 patients (43%), non-infectious inflammatory disease in 17 patients (16%), malignancies in 15 patients (14%), other diagnoses in 2 patients (1.7%), FUO resolved with no diagnosis and no evidence of disease during a 6-month follow-up in 23 patients (20%), and death with fever and with no diagnosis in 6 patients (5%). Seventy-four FDG-PET/CT studies (66%) were considered clinically helpful and contributory to diagnosis (46% positive contributory value and 20.5% contributory to exclusion of diagnosis). PET/CT had a sensitivity of 72.2%, a specificity of 57.5%, a positive predictive value (PPV) of 74.2% and a negative predictive value (NPV) of 53.5%. On multivariable analysis, significant predictors of a positive PET/CT contributory to diagnosis were a short duration of fever and male gender. CONCLUSIONS PET/CT is an important diagnostic tool for patients with FUO.
Collapse
Affiliation(s)
- A Gafter-Gvili
- From the Department of Medicine E, Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel and Infectious Disease Unit, Department of Nuclear Medicine, Beilinson Hospital, Rabin Medical Center, Petah-Tikva From the Department of Medicine E, Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel and Infectious Disease Unit, Department of Nuclear Medicine, Beilinson Hospital, Rabin Medical Center, Petah-Tikva From the Department of Medicine E, Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel and Infectious Disease Unit, Department of Nuclear Medicine, Beilinson Hospital, Rabin Medical Center, Petah-Tikva
| | - S Raibman
- From the Department of Medicine E, Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel and Infectious Disease Unit, Department of Nuclear Medicine, Beilinson Hospital, Rabin Medical Center, Petah-Tikva From the Department of Medicine E, Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel and Infectious Disease Unit, Department of Nuclear Medicine, Beilinson Hospital, Rabin Medical Center, Petah-Tikva
| | - A Grossman
- From the Department of Medicine E, Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel and Infectious Disease Unit, Department of Nuclear Medicine, Beilinson Hospital, Rabin Medical Center, Petah-Tikva From the Department of Medicine E, Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel and Infectious Disease Unit, Department of Nuclear Medicine, Beilinson Hospital, Rabin Medical Center, Petah-Tikva
| | - T Avni
- From the Department of Medicine E, Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel and Infectious Disease Unit, Department of Nuclear Medicine, Beilinson Hospital, Rabin Medical Center, Petah-Tikva From the Department of Medicine E, Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel and Infectious Disease Unit, Department of Nuclear Medicine, Beilinson Hospital, Rabin Medical Center, Petah-Tikva
| | - M Paul
- From the Department of Medicine E, Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel and Infectious Disease Unit, Department of Nuclear Medicine, Beilinson Hospital, Rabin Medical Center, Petah-Tikva From the Department of Medicine E, Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel and Infectious Disease Unit, Department of Nuclear Medicine, Beilinson Hospital, Rabin Medical Center, Petah-Tikva
| | - L Leibovici
- From the Department of Medicine E, Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel and Infectious Disease Unit, Department of Nuclear Medicine, Beilinson Hospital, Rabin Medical Center, Petah-Tikva From the Department of Medicine E, Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel and Infectious Disease Unit, Department of Nuclear Medicine, Beilinson Hospital, Rabin Medical Center, Petah-Tikva
| | - B Tadmor
- From the Department of Medicine E, Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel and Infectious Disease Unit, Department of Nuclear Medicine, Beilinson Hospital, Rabin Medical Center, Petah-Tikva
| | - D Groshar
- From the Department of Medicine E, Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel and Infectious Disease Unit, Department of Nuclear Medicine, Beilinson Hospital, Rabin Medical Center, Petah-Tikva From the Department of Medicine E, Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel and Infectious Disease Unit, Department of Nuclear Medicine, Beilinson Hospital, Rabin Medical Center, Petah-Tikva
| | - H Bernstine
- From the Department of Medicine E, Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel and Infectious Disease Unit, Department of Nuclear Medicine, Beilinson Hospital, Rabin Medical Center, Petah-Tikva From the Department of Medicine E, Institute of Hematology, Davidoff Cancer Center, Rabin Medical Center, Petah-Tikva; Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel and Infectious Disease Unit, Department of Nuclear Medicine, Beilinson Hospital, Rabin Medical Center, Petah-Tikva
| |
Collapse
|
47
|
Cho CY, Lai CC, Lee ML, Hsu CL, Chen CJ, Chang LY, Lo CW, Chiang SF, Wu KG. Clinical analysis of fever of unknown origin in children: A 10-year experience in a northern Taiwan medical center. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2015; 50:40-45. [PMID: 25735796 DOI: 10.1016/j.jmii.2015.01.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2014] [Revised: 11/27/2014] [Accepted: 01/19/2015] [Indexed: 11/25/2022]
Abstract
BACKGROUND Fever of unknown origin (FUO) was first described in 1961 as fever >38.3°C for at least 3 weeks with no apparent source after 1 week of investigations in the hospital. Infectious disease comprises the majority of cases (40-60%). There is no related research on FUO in children in Taiwan. The aim of this study is to determine the etiologies of FUO in children in Taiwan and to evaluate the relationship between the diagnosis and patient's demography and laboratory data. METHODS Children under 18 years old with fever >38.3°C for >2 weeks without apparent source after preliminary investigations at Taipei Veterans General Hospital during 2002-2012 were included. Fever duration, symptoms and signs, laboratory examinations, and final diagnosis were recorded. The distribution of etiologies and age, fever duration, laboratory examinations, and associated symptoms and signs were analyzed. RESULTS A total of 126 children were enrolled; 60 were girls and 66 were boys. The mean age was 6.7 years old. Infection accounted for 27.0% of cases, followed by undiagnosed cases (23.8%), miscellaneous etiologies (19.8%), malignancies (16.6%), and autoimmune disorders (12.7%). Epstein-Barr virus (EBV) and cytomegalovirus (CMV) were the most commonly found pathogens for infectious disease, and Kawasaki disease (KD) was the top cause of miscellaneous diagnosis. CONCLUSIONS Infectious disease remains the most common etiology. Careful history taking and physical examination are most crucial for making the diagnosis. Conservative treatment may be enough for most children with FUO, except for those suffering from malignancies.
Collapse
Affiliation(s)
- Ching-Yi Cho
- Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chou-Cheng Lai
- Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, ROC; Division of Infectious Diseases, Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, ROC
| | - Ming-Luen Lee
- Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, ROC; Division of Infectious Diseases, Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chien-Lun Hsu
- Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, ROC; Division of Infectious Diseases, Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chun-Jen Chen
- Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, ROC; Division of Infectious Diseases, Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, ROC
| | - Lo-Yi Chang
- Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, ROC; Division of Infectious Diseases, Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chiao-Wei Lo
- Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, ROC; Division of Infectious Diseases, Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, ROC
| | - Sheng-Fong Chiang
- Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, ROC; Division of Infectious Diseases, Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, ROC
| | - Keh-Gong Wu
- Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, ROC; Division of Infectious Diseases, Department of Pediatrics, Taipei Veterans General Hospital and National Yang-Ming University, Taipei, Taiwan, ROC.
| |
Collapse
|
48
|
Ulcerative Colitis Presented as Fever and Bloody Diarrhea at Initiation of Dialysis in an Elderly Patient with End-Stage Kidney Disease. Case Rep Med 2015; 2015:725205. [PMID: 26617642 PMCID: PMC4649069 DOI: 10.1155/2015/725205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2015] [Revised: 10/18/2015] [Accepted: 10/18/2015] [Indexed: 11/29/2022] Open
Abstract
Ulcerative colitis (UC) is a chronic inflammatory bowel disorder that mainly affects the colon and rectum. Immunological derangements are associated with the pathogenesis of UC. Many patients with UC also have chronic kidney disease, associated with immunological disorders and/or pharmacotherapy for UC. Some patients with UC may develop end-stage renal disease (ESRD) and require renal replacement therapy. However, little is known clinically about ESRD patients who develop UC or about patients with UC who develop ESRD. This report describes an elderly patient with ESRD who presented with fever and bloody diarrhea and was finally diagnosed as UC (pancolitis type) at dialysis initiation. The patient was successfully treated with a series of immunosuppressive agents. This report highlights the importance of considering UC as a potential cause of bloody stool and fever in patients with ESRD.
Collapse
|
49
|
A rare case of central nervous system tuberculosis. Case Rep Infect Dis 2014; 2014:186030. [PMID: 25478256 PMCID: PMC4248556 DOI: 10.1155/2014/186030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Revised: 10/10/2014] [Accepted: 10/28/2014] [Indexed: 11/17/2022] Open
Abstract
Intracranial abscess is an extremely rare form of central nervous system (CNS) tuberculosis (TB). We describe a case of central nervous system tuberculous abscess in absence of human immunodeficiency virus (HIV) infection. A 82-year-old Middle Eastern male from Yemen was initially brought to the emergency room due to altered mental status and acute renal failure. Cross-sectional imaging revealed multiple ring enhancing lesions located in the left cerebellum and in bilateral frontal lobe as well as in the inferior parietal lobe on the left. The patient was placed on an empiric antibiotic regimen. Preliminary testing for infectious causes was negative. Chest radiography and CT of chest showed no positive findings. He was not on any immunosuppressive medications and human immunodeficiency virus (HIV) enzyme immunoassay (EIA) test was negative. A subsequent MRI one month later showed profound worsening of the lesions with increasing vasogenic edema and newly found mass effect impinging on the fourth ventricle. Brain biopsy showed focal exudative cerebellitis and inflamed granulation tissue consistent with formation of abscesses. The diagnosis of CNS TB was finally confirmed by positive acid-fast bacilli (AFB) cultures. The patient was started on standard tuberculosis therapy but expired due to renal failure and cardiac arrest.
Collapse
|
50
|
Li S, Huang DJ, Gong K, Xu YW. Combined transcatheter managements of a huge spontaneous iliac pseudoaneurysm presenting with fever of unknown origin: a case report. J Med Case Rep 2014; 8:118. [PMID: 24708630 PMCID: PMC4234985 DOI: 10.1186/1752-1947-8-118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 02/11/2014] [Indexed: 12/03/2022] Open
Abstract
Introduction We present a successful combined endovascular repair of a rare huge spontaneous pseudoaneurysm in a patient troubled solely with fever of unknown origin. Case presentation A 79-year-old Chinese man complained of repeated episodes of fever for 10 days. His medical history, physical examination and laboratory tests were not significant. Routine antibiotics were given for suspected sepsis lasting 4 weeks without clinical improvement. Finally, an 81.9×61.6mm iliac pseudoaneurysm was found. The pseudoaneurysm originated from his left iliac arteries and covered the bifurcation of the left common iliac artery and proximal ends of both internal and external iliac arteries. A combination of endovascular repair with coil embolization and stent graft implantation was successfully performed. He underwent an uneventful recovery. Conclusions Spontaneous pseudoaneurysm with fever of unknown origin should not be ignored, especially for patients with a high risk for atherosclerosis. Combined transcatheter managements might be an alternative approach to deal with complex pseudoaneurysms, effectively and safely.
Collapse
|