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Fever of unknown origin (FUO): which are the factors influencing the final diagnosis? A 2005–2015 systematic review
BACKGROUND: The differential diagnosis of Fever of Unknown Origin (FUO) is very extensive, and includes infectious diseases (ID), neoplasms and noninfectious inflammatory diseases (NIID). Many FUO remain undiagnosed. Factors influencing the final diagnosis of FUO are unclear. METHODS: To identify fa...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6647059/ https://www.ncbi.nlm.nih.gov/pubmed/31331269 http://dx.doi.org/10.1186/s12879-019-4285-8 |
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author | Fusco, Francesco Maria Pisapia, Raffaella Nardiello, Salvatore Cicala, Stefano Domenico Gaeta, Giovanni Battista Brancaccio, Giuseppina |
author_facet | Fusco, Francesco Maria Pisapia, Raffaella Nardiello, Salvatore Cicala, Stefano Domenico Gaeta, Giovanni Battista Brancaccio, Giuseppina |
author_sort | Fusco, Francesco Maria |
collection | PubMed |
description | BACKGROUND: The differential diagnosis of Fever of Unknown Origin (FUO) is very extensive, and includes infectious diseases (ID), neoplasms and noninfectious inflammatory diseases (NIID). Many FUO remain undiagnosed. Factors influencing the final diagnosis of FUO are unclear. METHODS: To identify factors associated with FUO diagnostic categories, we performed a systematic review of classical FUO case-series published in 2005–2015 and including patients from 2000. Moreover, to explore changing over time, we compared these case-series with those published in 1995–2004. RESULTS: Eighteen case-series, including 3164 patients, were included. ID were diagnosed in 37.8% of patients, NIID in 20.9%, and neoplasm in 11.6%, FUO were undiagnosed in 23.2%. NIIDs significantly increased over time. An association exists between study country income level and ID (increasing when the income decreases) and undiagnosed FUO (increasing when the income increases); even if not significant, the use of a pre-defined Minimal Diagnostic Work-up to qualify a fever as FUO seems to correlate with a lower prevalence of infections and a higher prevalence of undiagnosed FUO. The multivariate regression analysis shows significant association between geographic area, with ID being more frequent in Asia and Europe having the higher prevalence of undiagnosed FUO. Significant associations were found with model of study and FUO defining criteria, also. CONCLUSIONS: Despite advances in diagnostics, FUO still remains a challenge, with ID still representing the first cause. The main factors influencing the diagnostic categories are the income and the geographic position of the study country. |
format | Online Article Text |
id | pubmed-6647059 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-66470592019-07-31 Fever of unknown origin (FUO): which are the factors influencing the final diagnosis? A 2005–2015 systematic review Fusco, Francesco Maria Pisapia, Raffaella Nardiello, Salvatore Cicala, Stefano Domenico Gaeta, Giovanni Battista Brancaccio, Giuseppina BMC Infect Dis Research Article BACKGROUND: The differential diagnosis of Fever of Unknown Origin (FUO) is very extensive, and includes infectious diseases (ID), neoplasms and noninfectious inflammatory diseases (NIID). Many FUO remain undiagnosed. Factors influencing the final diagnosis of FUO are unclear. METHODS: To identify factors associated with FUO diagnostic categories, we performed a systematic review of classical FUO case-series published in 2005–2015 and including patients from 2000. Moreover, to explore changing over time, we compared these case-series with those published in 1995–2004. RESULTS: Eighteen case-series, including 3164 patients, were included. ID were diagnosed in 37.8% of patients, NIID in 20.9%, and neoplasm in 11.6%, FUO were undiagnosed in 23.2%. NIIDs significantly increased over time. An association exists between study country income level and ID (increasing when the income decreases) and undiagnosed FUO (increasing when the income increases); even if not significant, the use of a pre-defined Minimal Diagnostic Work-up to qualify a fever as FUO seems to correlate with a lower prevalence of infections and a higher prevalence of undiagnosed FUO. The multivariate regression analysis shows significant association between geographic area, with ID being more frequent in Asia and Europe having the higher prevalence of undiagnosed FUO. Significant associations were found with model of study and FUO defining criteria, also. CONCLUSIONS: Despite advances in diagnostics, FUO still remains a challenge, with ID still representing the first cause. The main factors influencing the diagnostic categories are the income and the geographic position of the study country. BioMed Central 2019-07-22 /pmc/articles/PMC6647059/ /pubmed/31331269 http://dx.doi.org/10.1186/s12879-019-4285-8 Text en © The Author(s). 2019 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Fusco, Francesco Maria Pisapia, Raffaella Nardiello, Salvatore Cicala, Stefano Domenico Gaeta, Giovanni Battista Brancaccio, Giuseppina Fever of unknown origin (FUO): which are the factors influencing the final diagnosis? A 2005–2015 systematic review |
title | Fever of unknown origin (FUO): which are the factors influencing the final diagnosis? A 2005–2015 systematic review |
title_full | Fever of unknown origin (FUO): which are the factors influencing the final diagnosis? A 2005–2015 systematic review |
title_fullStr | Fever of unknown origin (FUO): which are the factors influencing the final diagnosis? A 2005–2015 systematic review |
title_full_unstemmed | Fever of unknown origin (FUO): which are the factors influencing the final diagnosis? A 2005–2015 systematic review |
title_short | Fever of unknown origin (FUO): which are the factors influencing the final diagnosis? A 2005–2015 systematic review |
title_sort | fever of unknown origin (fuo): which are the factors influencing the final diagnosis? a 2005–2015 systematic review |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6647059/ https://www.ncbi.nlm.nih.gov/pubmed/31331269 http://dx.doi.org/10.1186/s12879-019-4285-8 |
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