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Key diagnostic characteristics of fever of unknown origin in Japanese patients: a prospective multicentre study
OBJECTIVE: To identify the key diagnostic features and causes of fever of unknown origin (FUO) in Japanese patients. DESIGN: Multicentre prospective study. SETTING: Sixteen hospitals affiliated with the Japanese Society of Hospital General Medicine, covering the East and West regions of Japan. PARTI...
Autores principales: | , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6886908/ https://www.ncbi.nlm.nih.gov/pubmed/31748308 http://dx.doi.org/10.1136/bmjopen-2019-032059 |
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author | Naito, Toshio Tanei, Mika Ikeda, Nobuhiro Ishii, Toshihiro Suzuki, Tomio Morita, Hiroyuki Yamasaki, Sho Tamura, Jun'ichi Akazawa, Kenichiro Yamamoto, Koji Otani, Hiroshi Suzuki, Satoshi Kikuchi, Motoo Ono, Shiro Kobayashi, Hiroyuki Akita, Hozuka Tazuma, Susumu Hayashi, Jun |
author_facet | Naito, Toshio Tanei, Mika Ikeda, Nobuhiro Ishii, Toshihiro Suzuki, Tomio Morita, Hiroyuki Yamasaki, Sho Tamura, Jun'ichi Akazawa, Kenichiro Yamamoto, Koji Otani, Hiroshi Suzuki, Satoshi Kikuchi, Motoo Ono, Shiro Kobayashi, Hiroyuki Akita, Hozuka Tazuma, Susumu Hayashi, Jun |
author_sort | Naito, Toshio |
collection | PubMed |
description | OBJECTIVE: To identify the key diagnostic features and causes of fever of unknown origin (FUO) in Japanese patients. DESIGN: Multicentre prospective study. SETTING: Sixteen hospitals affiliated with the Japanese Society of Hospital General Medicine, covering the East and West regions of Japan. PARTICIPANTS: Patient aged ≥20 years diagnosed with classic FUO (axillary temperature≥38.0°C at least twice within a 3-week period, cause unknown after three outpatient visits or 3 days of hospitalisation). A total of 141 cases met the criteria and were recruited from January 2016 to December 2017. INTERVENTION: Japanese standard diagnostic examinations. OUTCOME MEASURES: Data collected include usual biochemical blood tests, inflammatory markers (erythrocyte sedimentation rate (ESR), C reactive (CRP) protein level, procalcitonin level), imaging results, autopsy findings (if performed) and final diagnosis. RESULTS: The most frequent age group was 65–79 years old (mean: 58.6±9.1 years). The most frequent cause of FUO was non-infectious inflammatory disease. After a 6-month follow-up period, 21.3% of cases remained undiagnosed. The types of diseases causing FUO were significantly correlated with age and prognosis. Between patients with and without a final diagnosis, there was no difference in CRP level between patients with and without a final diagnosis (p=0.121). A significant difference in diagnosis of a causative disease was found between patients who did or did not receive an ESR test (p=0.041). Of the 35 patients with an abnormal ESR value, 28 (80%) had causative disease identified. CONCLUSIONS: Age may be a key factor in the differential diagnosis of FUO; the ESR test may be of value in the FUO evaluation process. These results may provide clinicians with insight into the management of FUO to allow adequate treatment according to the cause of the disease. |
format | Online Article Text |
id | pubmed-6886908 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-68869082019-12-04 Key diagnostic characteristics of fever of unknown origin in Japanese patients: a prospective multicentre study Naito, Toshio Tanei, Mika Ikeda, Nobuhiro Ishii, Toshihiro Suzuki, Tomio Morita, Hiroyuki Yamasaki, Sho Tamura, Jun'ichi Akazawa, Kenichiro Yamamoto, Koji Otani, Hiroshi Suzuki, Satoshi Kikuchi, Motoo Ono, Shiro Kobayashi, Hiroyuki Akita, Hozuka Tazuma, Susumu Hayashi, Jun BMJ Open Geriatric Medicine OBJECTIVE: To identify the key diagnostic features and causes of fever of unknown origin (FUO) in Japanese patients. DESIGN: Multicentre prospective study. SETTING: Sixteen hospitals affiliated with the Japanese Society of Hospital General Medicine, covering the East and West regions of Japan. PARTICIPANTS: Patient aged ≥20 years diagnosed with classic FUO (axillary temperature≥38.0°C at least twice within a 3-week period, cause unknown after three outpatient visits or 3 days of hospitalisation). A total of 141 cases met the criteria and were recruited from January 2016 to December 2017. INTERVENTION: Japanese standard diagnostic examinations. OUTCOME MEASURES: Data collected include usual biochemical blood tests, inflammatory markers (erythrocyte sedimentation rate (ESR), C reactive (CRP) protein level, procalcitonin level), imaging results, autopsy findings (if performed) and final diagnosis. RESULTS: The most frequent age group was 65–79 years old (mean: 58.6±9.1 years). The most frequent cause of FUO was non-infectious inflammatory disease. After a 6-month follow-up period, 21.3% of cases remained undiagnosed. The types of diseases causing FUO were significantly correlated with age and prognosis. Between patients with and without a final diagnosis, there was no difference in CRP level between patients with and without a final diagnosis (p=0.121). A significant difference in diagnosis of a causative disease was found between patients who did or did not receive an ESR test (p=0.041). Of the 35 patients with an abnormal ESR value, 28 (80%) had causative disease identified. CONCLUSIONS: Age may be a key factor in the differential diagnosis of FUO; the ESR test may be of value in the FUO evaluation process. These results may provide clinicians with insight into the management of FUO to allow adequate treatment according to the cause of the disease. BMJ Publishing Group 2019-11-19 /pmc/articles/PMC6886908/ /pubmed/31748308 http://dx.doi.org/10.1136/bmjopen-2019-032059 Text en © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. |
spellingShingle | Geriatric Medicine Naito, Toshio Tanei, Mika Ikeda, Nobuhiro Ishii, Toshihiro Suzuki, Tomio Morita, Hiroyuki Yamasaki, Sho Tamura, Jun'ichi Akazawa, Kenichiro Yamamoto, Koji Otani, Hiroshi Suzuki, Satoshi Kikuchi, Motoo Ono, Shiro Kobayashi, Hiroyuki Akita, Hozuka Tazuma, Susumu Hayashi, Jun Key diagnostic characteristics of fever of unknown origin in Japanese patients: a prospective multicentre study |
title | Key diagnostic characteristics of fever of unknown origin in Japanese patients: a prospective multicentre study |
title_full | Key diagnostic characteristics of fever of unknown origin in Japanese patients: a prospective multicentre study |
title_fullStr | Key diagnostic characteristics of fever of unknown origin in Japanese patients: a prospective multicentre study |
title_full_unstemmed | Key diagnostic characteristics of fever of unknown origin in Japanese patients: a prospective multicentre study |
title_short | Key diagnostic characteristics of fever of unknown origin in Japanese patients: a prospective multicentre study |
title_sort | key diagnostic characteristics of fever of unknown origin in japanese patients: a prospective multicentre study |
topic | Geriatric Medicine |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6886908/ https://www.ncbi.nlm.nih.gov/pubmed/31748308 http://dx.doi.org/10.1136/bmjopen-2019-032059 |
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