Cases Of Fever Of Unknown Origin Research Articles

Carcinoma of Colon Presenting as Fever of Unknown Origin

Fever of unknown origin (FUO) is defined as fever of more than 38.3 degrees C, the cause of which remains elusive after 1 week of intensive investigation. Most cases of FUO are restricted to infections, malignancies, and inflammatory diseases. FUO was previously reported as the presenting symptom of a few solid tumors such as lymphoma, renal cell carcinoma, and hepatocellular carcinoma. Colon carcinoma manifesting as FUO has been rarely reported. We describe three female patients who presented with classical FUO and microcytic anemia. As a control, we retrospectively evaluated 28 matched patients with carcinoma of colon and no fever. The evaluation included review of patient files, clinical and laboratory data, and pathologic specimens. In the three patients (mean age, 58 years) who presented with FUO and had left-sided colon carcinoma and microcytic anemia, pathologic evaluation of the tumor tissues demonstrated a severe organized inflammatory process forming abscesses in the pericolic fat. The 28 control matched patients showed no such histopathologic changes. In patients presenting with FUO, especially those who present with microcytic anemia, even with no bowel disturbances or elevated carcinoembryonic antigen levels, diagnostic workup should include a search for occult colorectal carcinoma. In our three cases, it appears that microabscesses in the pericolic fat are the cause of fever.

Pyrexia of unknown origin

<h2>Abstract</h2> Fever of unknown origin (FUO) is now often defined as a fever higher than 38.3°C on several occasions during at least 3 weeks with uncertain diagnosis after several obligatory tests. Infection accounts for about one-third of cases of FUO, followed by neoplasm and non-infectious inflammatory diseases. No diagnosis is reached in 25–35% of cases. In patients with periodic fever, this percentage is higher. A diagnostic algorithm is proposed in which the most important steps are history-taking, physical examination and obligatory investigations in a search for potentially diagnostic clues (PDCs). First, factitious fever and drug fever should be excluded. Further diagnostic procedures should be guided by a list of most probable diagnoses. In patients without useful PDCs, certain diagnostic procedures, divided into first-stage and second-stage investigations, should be performed. If no diagnosis is reached and the clinical condition is stable, waiting for new PDCs is recommended. In patients with recurrent fever, diagnosis should comprise only a search for PDCs matching known recurrent syndromes. Scintigraphic methods such as gallium-67 citrate-labelled leucocytes and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) are often used in patients with FUO. Because of the favourable characteristics of FDG-PET, conventional scintigraphic techniques may be replaced by FDG-PET in institutions where it is available. If undiagnosed fever persists, supportive treatment with non-steroidal anti-inflammatory drugs can be helpful. Most patients with undiagnosed FUO have benign self-limiting or recurrent fever. Other therapeutic trials should be considered only in patients who deteriorate.

Application of serum PSA to identify acute bacterial prostatitis in patients with fever of unknown origin or symptoms of acute pyelonephritis.

Exclusion of prostatitis in screening for prostate cancer (Cap) is a matter of concern in the prostate-specific antigen (PSA) era. Yet, the identification of acute bacterial prostatitis (ABP), intentionally utilizing PSA in patients with pyrexia has been scarcely reported. In total, 39 men, who presented at our department with a fever higher than 38.3 degrees C, were randomly selected. We investigated the fraction of patients who had serum PSA levels higher than 4.0 ng/ml and categorized them according to an initial diagnosis of pyelonephritis, ABP, other urogenital infections, and fever of unknown origin (FUO). Six of nine cases initially diagnosed as pyelonephritis, presented with elevated PSA levels between 9.5 and 75.1 ng/ml. All six cases of clinically diagnosed prostatitis had PSA elevated between 4.1 and 13.6 ng/ml. In 8 of 18 FUO cases, PSA was elevated between 5.1 and 77.0 ng/ml. PSA levels significantly correlated with age (P < 0.005). All 20 patients with elevated PSA received antibiotics, and serum PSA was significantly reduced in all cases (P < 0.001) together with the alleviation of fever and normalization of CRP. PSA is a prompt and steady diagnostic tool for identifying ABP that might be missed or misdiagnosed. We recommend the measurement of PSA in cases not only with urologic infection but also puzzling pyrexia.

Fiebre recurrente como primera manifestación del cáncer de colon

Fever of unknown origin (FUO) has been rarely associated with colonic cancer. In less than 1% of cases of FUO a colonic cancer is found as the main cause of fever. The authors reviewed 4 cases of colonic cancer whose first manifestation was FUO. Recurrent episodes of brief, self-limited fever, without a characteristic pattern, may be the first symptom of colonic cancer. On occassions, E. coli bacteremia may be the herald of an occult colonic malignancy.

Aetiology and Management of Children With Acute Fever of Unknown Origin

This is part I of a 2-part paper on fever of unknown origin (FUO) in children. FUO is best defined as fever without obvious source on initial clinical examination and then classified into acute (illness of < or =1 week's duration) and prolonged (>7 to 10 days' duration). Aetiologically, there is a marked overlap between acute and prolonged FUO, and infections are major players in both. Age, climate, local epidemiology and host factors are the major aetiological factors that should be considered in the choice of definitive tests. Depending on age, serious bacterial infections (including bacteraemia, meningitis and urinary tract infection) occur in 3 to 20% of cases of acute FUO. Prevention of mortality and sequelae from these infections, particularly bacteraemia and meningitis, is of particular concern in acute FUO. An individualised approach, based on clinical evaluation supplemented with screening and definitive laboratory tests to determine the need for empiric antibiotic therapy and hospitalisation, seems to be the best approach to acute FUO (although this may be less applicable to neonates and infants younger than 90 days, particularly those aged 0 to 7 days). The place of laboratory tests, empiric antibiotic therapy and hospitalisation are important issues that are likely to remain so for some time.

Management of children with prolonged fever of unknown origin and difficulties in the management of fever of unknown origin in children in developing countries.

This is Part II of a 2-part paper on fever of unknown origin (FUO) in children. It examines the aetiology and management of prolonged FUO in children and the difficulties in the management of FUO in children in developing countries. Part I of this paper discussed acute FUO in children and was published in the March 2001 issue of Paediatric Drugs. Prolonged FUO is documented fever of more than 7 to 10 days which has no apparent source and no apparent diagnosis after 1 week of clinical investigations. About 34% of cases of prolonged FUO are caused by infections, with bacterial meningitis and urinary tract infection accounting for about 6.5 and 11.4%, respectively, of cases attributable to infections. Chronic infections, particularly tuberculosis and 'old' disorders such as Kawasaki disease, cat-scratch disease and Epstein-Barr virus infection presenting with 'new' manifestations, collagen-vascular diseases and neoplastic disorders are the other issues of major concern in prolonged FUO. Overall, however, there is a trend towards an increased number of undiagnosed cases. This is due to advancements in diagnostic techniques, such that illnesses which were previously common among the causes of prolonged FUO are now diagnosed earlier, before the presentation becomes that of prolonged FUO. Clinical examination supplemented with laboratory tests to screen for serious bacterial infections should be the mainstay of initial evaluation of children with prolonged FUO. Use of scanning techniques (such as computerised tomography and ultrasound) as additional supplements to this clinical examination may allow for the earlier diagnosis of causes of prolonged FUO in children such as 'occult' abdominal tumours. A common error in management of children with prolonged FUO is the failure to perform a complete history and physical examination; repeated clinical examination and continued observation are of paramount importance in the diagnosis of difficult cases. Major difficulties in the management of FUO in children in developing countries include constraints in the availability and reliability of laboratory tests, cost, misuse of antibiotics and difficulties encountered in the diagnosis of malaria and typhoid fever. Malaria and typhoid fever are major aetiological considerations in both acute and prolonged FUO in children in developing countries. The newer quinolones may hold great promise for the treatment of serious bacterial infections, including meningitis, which are associated with prolonged FUO in developing countries.

Fever of unknown origin responding to steroid therapy.

It is not uncommon to find cases of fever of unknown origin (FUO) in which no final diagnosis is made ever after various examinations. We investigated such cases of undiagnosed FUO, with fever persisting for a long periods and responding to steroid therapy. Among 4,596 patients who were hospitalized over 3-year period from September 1991, 25 met Petersdorf's definition of FUO. Among these 25 patient, six cases were steroid-responsive undiagnosed FUO (SR-FUO). Patients with SR-FUO had the following characteristics: marked inflammatory findings and severe illness; without a definite underlying disease being found despite various examinations; no findings which indicated any known diseases such as adult-onset Still's disease, polymyalgia rheumatica, or other collagen diseases; elderly onset, at 58 to 77 years of age (mean age: 67 years); no improvement with antibiotics, antituberculous agents, or antimycotic drugs; significant improvement of symptoms and signs with steroid therapy; and a relatively good prognosis. SR-FUO, which is not caused by any known disease and is highly responsive to steroids, is included among the FUO cases which we have difficulty in diagnosing and treating.

Fever of unknown origin: a prospective study.

Fever of unknown origin (FUO) is a problem frequently faced by clinicians all over the world. One hundred and twenty-one cases of FUO presenting to a large teaching hospital in northern India were prospectively studied over a period of 2 years. Infections were the commonest cause accounting for 43.8% cases of FUO, with tuberculosis (TB) being the commonest infection encountered. Collagen vascular diseases and tumours accounted for 15.7 and 8.3% cases, respectively. No cause could be found out in a substantial number of cases (19%) even after invasive investigations. Knowledge of the current patterns of FUO is important since many patients present with potentially treatable diseases.

Prospective evaluation of fever of unknown origin in patients infected with the human immunodeficiency virus. Grupo Andaluz para el Estudio de las Enfermedades Infecciosas.

The aim of this study was to determine the frequency and aetiology of fever of unknown origin (FUO) in patients infected with the human immunodeficiency virus (HIV), to assess the value of the tests used in its diagnosis, and to evaluate possible models of diagnosis for the causes found most frequently. One hundred twenty-eight (3.5%) of 3603 hospitalised HIV-positive patients evaluated from October 1992 to December 1993 had FUO, defined by established criteria. Eighty-six percent of patients with FUO had previously progressed to AIDS. The median CD4+ cell count was 46/mm3. A definite diagnosis was made in 96 (75%) of the 128 patients and a possible diagnosis in 24 (18.7%). whilst no diagnosis was made in eight cases (6.2%). Tuberculosis (48.3%), visceral leishmaniasis (16%), and infection by Mycobacterium avium complex (6.9%) were the diseases found most frequently. The most useful diagnostic tests were liver biopsy (68.9%) and bone marrow aspirate/biopsy (39.7%). It is not possible to predict clinically the cases of FUO due to tuberculosis, whilst thrombocytopaenia < 100,000 cells/mm3 alone is useful for differentiating the cases of visceral leishmaniasis, with a negative predictive value of 95.2%.

Fever of Unknown Origin

This study was done to assess the value of percutaneous liver biopsy in the diagnosis of fever of unknown origin (FUO). We performed a retrospective analysis of all cases (43) seen at Vanderbilt University Hospital in the last 12 years in which a percutaneous liver biopsy was performed in the course of the evaluation or presence of FUO. The 43 patients who underwent biopsy were assigned to three arbitrary groups: group 1, liver biopsy abnormal and helpful in diagnosis and often in therapy; group 2, liver biopsy abnormal but of no definite diagnostic and therapeutic value; group 3, liver biopsy normal or essentially normal. Distribution of the 43 patients in these categories was as follows: group 1, six individuals (13.9%); group 2,11 patients (25.6%), and group 3, 26 patients (60.5%). Group 1 patients had hepatomegaly three times as often ( P P >.05) than the other two combined groups, but the overlap was substantial in both parameters. We conclude that percutaneous liver biopsy may be helpful in a positive manner in the diagnosis of FUO but only in a very small number of cases; that a surprisingly large number of patients with FUO are undiagnosed, but the overall prognosis is relatively good; and that in view of newly available diagnostic techniques and the small fraction of all cases of FUO that undergo biopsy, a prospective evaluation of the role of percutaneous liver biopsy in the diagnosis of FUO using a larger number of cases is warranted. ( Arch Intern Med 137:1001-1004, 1977)

VIROLOGICAL FINDINGS IN THE 1960 HEMORRHAGIC FEVER EPIDEMIC (DENGUE) IN THAILAND.

Summary Acute- and convalescent-phase sera from a series of Bangkok Hospital patients of 1960 with clinical diagnoses of hemorrhagic fever, dengue, fever of unknown origin (FUO) and other diseases were tested rather extensively for arbovirus isolations and serological responses. Five dengue virus isolations were made from acute-phase sera, one of which was typed in the type 1–6 complex, another in the 2–5 complex, two as type 4, and one as yet untypable. Several probable latent mouse viruses were also encountered. A number of cases of hemorrhagic fever, dengue or FUO was serologically confirmed with demonstrated antibody rises by complement fixation, neutralization, or hemagglutination inhibition as group-B arbovirus infections, probably due to dengue viruses. None was confirmed as a chikungunya virus infection, although several gave indication of recent infection. Antibody rises to group B fell in most cases into either of two patterns, group-B primary infections or those with previous group-B experience. These two types of responses were quite different. Further evidence was found to support calling TH-36 and TH-Sman, dengue prototypes previously isolated in Bangkok, dengue types 5 and 6 respectively, although they are closely related to types 2 and 1. Human primary group-B convalescent-phase sera, but not animal sera, usually permitted clear differentiation. Difficulties of dengue virus isolation, adaptation and typing, and limitations of serological studies are described. No evidence was found for the activity of viruses in the Bunyamwera group, California group, or Sindbis and Eastern equine viruses in group A. Japanese B, Murray Valley and Langat viruses in group B frequently gave positive reactions with sera from the dengue virus infected patients.