Nejasno febrilno stanje – dijagnostičke metode u evropskoj zemlji u razvoju
Sažetak
Uvod/Cilj. Nejasno febrilno stanje (fewer of unknown origin − FUO) ostaje među najvećim dilemama u dijagnostici savremene medicine. Cilj ovog rada bio je da se prikažu uzroci FUO i da se definišu metode kojima je postavljena dijagnoza kod ovih bolesnika u tercijernoj medicinskoj ustanovi u Republici Makedoniji. Metode. Retrospektivno su proučavane istorije bolesti 123 imunokompetentna bolesnika starija od 14 godina sa klasičnim FUO koji su bili ispitivani na Univerzitetskoj klinici za infektivne bolesti i febrilna stanja u Skoplju, u periodu 2006−2012. godine. FUO je bila definisana kao aksilarna temperatura ≥ 37,5°C u nekoliko navrata, trajanja dužeg od 21 dana i nepostavljanje dijagnoze posle inicijalnog dijagnostičkog pristupa sastavljenog od nekoliko definisanih ispitivanja. Rezultati. Infekcije su bile razlog za FUO kod 51 (41,5%) bolesnika, praćene neinfektivnim inflamatornim bolestima kod 28 (22,8%), raznim drugim stanjima kod 12 (9,7%) i neoplazmama kod 11 (8,9%). Kod 21 (17,1%) bolesnika razlog za FUO nije bio pronađen. Najćešći razlozi za FUO bili su visceralna lajšmanioza, apscesi, infekcije urinarnog sistema, subakutni endokarditis, reumatska polimijalgija kao i Stilova bolest. Krajnja dijagnoza bazirala se na histologiji kod 24 (23,5%), radiološkim i endoskopskim procedurama kod 21 (20,6%), kliničkom toku i odgovoru na empirijsku terapiju kod 20 (19,6%), serologiji kod 18 (17,6%) i kulturama kod 16 (15,7%) bolesnika. Zaključak. U Republici Makedoniji infekcije predstavljaju vodeći uzrok FUO, u prvom redu visceralna lajšmanioza. U budućnosti, kod bolesnika sa FUO lekari bi trebalo češće da misle na ovu bolest kao i na mogućnost za atipičnu prezentaciju uobičajenih klasičnih bolesti koje izazivaju FUO.
Reference
Vickery DM, Quinnell RK. Fever of unknown origin. An algo-rithmic approach. JAMA 1977; 238(20): 2183−8.
Mourad O, Palda V, Detsky AS. A comprehensive evidence-based approach to fever of unknown origin. Arch Intern Med 2003; 163(5): 545−51.
Vanderschueren S, Knockaert D, Adriaenssens T, Demey W, Durnez A, Blockmans D, et al. From prolonged febrile illness to fever of unknown origin: the challenge continues. Arch Intern Med 2003; 163(9): 1033−41.
Hirschmann JV. Fever of unknown origin in adults. Clin Infect Dis 1997; 24(3): 291−300.
Holder BM, Ledbetter C. Fever of unknown origin: an evidence-based approach. Nurse Pract 2011; 36(8): 46−52.
Varghese GM, Trowbridge P, Doherty T. Investigating and manag-ing pyrexia of unknown origin in adults. BMJ 2010; 341: C5470.
Handa R, Singh S, Singh N, Wali JP. Fever of unknown origin: a prospective study. Trop Doct 1996; 26(4): 169−70.
Roth AR, Basello GM. Approach to the adult patient with fever of unknown origin. Am Fam Physician 2003; 68(11): 2223−8.
Kejariwal D, Sarkar N, Chakraborti SK, Agarwal V, Roy S. Pyrex-ia of unknown origin: a prospective study of 100 cases. J Post-grad Med 2001; 47(2): 104−7.
de Kleijn EM, Vandenbroucke JP, van der Meer JW. Fever of un-known origin (FUO). I A. prospective multicenter study of 167 patients with FUO, using fixed epidemiologic entry crite-ria. The Netherlands FUO Study Group. Medicine (Baltimore) 1997; 76(6): 392−400.
Larson EB, Featherstone HJ, Petersdorf RG. Fever of undeter-mined origin: diagnosis and follow-up of 105 cases, 1970-1980. Medicine (Baltimore) 1982; 61(5): 269−92.
Reid JV. Pyrexia of unknown origin; study of a series of cases. Br Med J 1956; 2(4983): 23−5.
Petersdorf RG, Beeson PB. Fever of unexplained origin: report on 100 cases. Medicine (Baltimore) 1961; 40: 1−30.
Durack DT, Street AC. Fever of unknown origin-reexamined and redefined. Curr Clin Top Infect Dis 1991; 11: 35−51.
de Kleijn EM, Knockaert DC, van der Meer JW. Fever of unknown origin: a new definition and proposal for diagnostic work-up. Europ J Int Med 2000; 11(1): 1−3.
Knockaert DC, Vanderschueren S, Blockmans D. Fever of unknown origin in adults: 40 years on. J Intern Med 2003; 253(3): 263−75.
Naito T, Mizooka M, Mitsumoto F, Kanazawa K, Torikai K, Ohno S, et al. Diagnostic workup for fever of unknown origin: a multicenter collaborative retrospective study. BMJ Open 2013;3(12) PubMed PMID: 24362014. doi: 10.1136/bmjopen-2013-003971
Goto M, Koyama H, Takahashi O, Fukui T. A retrospective re-view of 226 hospitalized patients with fever. Intern Med 2007; 46(1): 17−22.
Barbado FJ, Vazquez JJ, Peña JM, Seoane JG, Arnalich F, Gil A, et al. Fever of unknown origin: a survey on 133 patients. J Med 1984; 15(3): 185−92.
Saltoglu N, Tasova Y, Midikli D, Aksu HS, Sanli A, Dündar IH. Fever of unknown origin in Turkey: evaluation of 87 cases during a nine-year-period of study. J Infect 2004; 48(1): 81−5.
Küçükardaly Y, Koçak N. Fever of unknown origin in internal medicine. J Postgrad Med 2002; 48(2): 155−6.
Zamir D, Leibovitz I, Polychuck I, Reitblat T, Weiler Z, Zamir C. Fever of unknown origin in Israel. Acta Clin Belg 2003; 58(6): 356−9.
Mete B, Vanli E, Yemisen M, Balkan II, Dagtekin H, Ozaras R, et al. The role of invasive and non-invasive procedures in diag-nosing fever of unknown origin. Int J Med Sci 2012; 9(8): 682−9.
Campanella N, Pergolini M, Daher W, Moraca A, Borgognoni C, Mo-rosini P. Fever of unknown origin. Comparison of the diagnostic spectrum of 53 cases in a medical ward in an Italian hospital with those of other 9 countries. Pecenti Prog Med 1998; 89(9): 372−6.
Liu K, Sheng W, Chen Y, Chang S, Hsieh W. Fever of unknown origin: a retrospective study of 78 adult patients in Taiwan. J Microbiol Immunol Infect 2003; 36(4): 243−7.
Howard P, Hahn HH, Palmer PL, Hardin WJ. Fever of unknown origin: a prospective study of 100 patients. Tex Med 1977; 73(7): 56−9.
Knockaert DC, Vanneste LJ, Vanneste SB, Bobbaers HJ. Fever of unknown origin in the 1980s. An update of the diagnostic spectrum. Arch Intern Med 1992; 152(1): 51−5.
Sharma BK, Kumari S, Varma SC, Sagar S, Singh S. Prolonged undiagnosed fever in northern India. Trop Geogr Med 1992; 44(1−2): 32−6.
Bleeker-Rovers CP, Vos FJ, de Kleijn EM, Mudde AH, Dofferhoff TS, Richter C, et al. A prospective multicenter study on fever of unknown origin: the yield of a structured diagnostic protocol. Medicine (Baltimore) 2007; 86(1): 26−38.
Hayakawa K, Ramasamy B, Chandrasekar PH. Fever of unknown origin: an evidence-based review. Am J Med Sci 2012; 344(4): 307−16.
Mansueto P, di Lorenzo G, Rizzo M, di Rosa S, Vitale G, Rini G, et al. Fever of unknown origin in a Mediterranean survey from a division of internal medicine: report of 91 cases during a 12-year-period (1991–2002). Intern Emerg Med 2008; 3(3): 219−25.
Efstathiou SP, Pefanis AV, Tsiakou AG, Skeva II, Tsioulos DI, Achimastos AD, et al. Fever of unknown origin: discrimination between infectious and non-infectious causes. Eur J Intern Med 2010; 21(2): 137−43.
Colpan A, Onguru P, Erbay A, Akinci E, Cevik MA, Eren SS, et al. Fever of unknown origin: analysis of 71 consecutive cases. Am J Med Sci 2007; 334(2): 92−6.
Kazanjian PH. Fever of unknown origin: review of 86 patients treated in community hospitals. Clin Infect Dis 1992; 15(6): 968−73.
Abdelbaky MS, Mansour HE, Ibrahim SI, Hassan IA. Prevalence of connective tissue diseases in egyptian patients presenting with Fever of unknown origin. Clin Med Insights Arthritis Musculoskelet Disord 2011; 4: 33−41.
Onal IK, Cankurtaran M, Cakar M, Halil M, Ulger Z, Doğu BB, et al. Fever of unknown origin: what is remarkable in the elderly in a developing country. J Infect 2006; 52(6): 399−404.
Bosilkovski M, Dimzova M, Grozdanovski K. Natural history of brucellosis in an endemic region in different time periods. Acta Clin Croat 2009; 48(1): 41−6.
Zenone T. Fever of unknown origin in adults: evaluation of 144 cases in a non-university hospital. Scand J Infect Dis 2006; 38(8): 632−8.
Hu Y, Lu H, Zhang Y, Jiang W, Yin Y, Pan X, et al. Fever of unknown origin: revisit of 142 cases in a tertiary Chinese hos-pital. Biosci Trends 2008; 2(1): 44−6.
Alavi S, Nadimi M, Zamani GA. Changing pattern of infectious etiology of fever of unknown origin (FUO) in adult patients in Ahvaz, Iran. Caspian J Intern Med 2013; 4(3): 722−6.
Kucukardali Y, Oncul O, Cavuslu S, Danaci M, Calangu S, Erdem H, et al. The spectrum of diseases causing fever of unknown origin in Turkey: a multicenter study. Int J Infect Dis 2008; 12(1): 71−9.
Shoji S, Imamura A, Imai Y, Igarashi A, Yazawa M, Hirahara K, et al. Fever of unknown origin: a review of 80 patients from the Shin'etsu area of Japan from 1986-1992. Intern Med 1994; 33(2): 74−6.
Gaeta GB, Fusco FM, Nardiello S. Fever of unknown origin: a systematic review of the literature for 1995-2004. Nucl Med Commun 2006; 27(3): 205−11.
Bleeker-Rovers CP, van der Meer JW, Beeching NJ. Fever. Medicine 2009;3 7(1): 28−34.
Antoon JW, Knudson-Johnson M, Lister WM. Diagnostic approach to fever of unknown origin. Clin Pediatr (Phila) 2012; 51(11): 1091−4.
Sipahi OR, Senol S, Arsu G, Pullukcu H, Tasbakan M, Yamazhan T, et al. Pooled analysis of 857 published adult fever of un-known origin cases in Turkey between 1990-2006. Med Sci Monit 2007; 13(7): CR318−22.
Iikuni Y, Okada J, Kondo H, Kashiwazaki S. Current fever of un-known origin 1982-1992. Intern Med 1994; 33(2): 67−73.
de Kleijn EM, van Lier HJ, van der Meer JW. Fever of unknown origin (FUO). II. Diagnostic procedures in a prospective mul-ticenter study of 167 patients. The Netherlands FUO Study Group. Medicine (Baltimore) 1997; 76(6): 401−14.