| Objective The diagnosis of fever of unknown origin (FUO) with classic type is difficult due to its perplexing causes and multifarious clinical features. This study tries to investigate its cause characteristics and clinical features.Methods The clinical data of 497 cases with classic type of FUO admitted to the Chinese PLA general hospital from January 2000 to April 2005 were analyzed, and compared with general cases from the literature (4784 cases) about FUO and literature (1115 cases) about adult-onset Still's disease (AOSD).Results 1. The final diagnosis was made in the 92.2% (458/497) FUO cases. (1). The cause distribution of the FUO was the infective diseases (189/497,38.0%), connective tissue diseases (165/497, 33.2%), malignant tumor disease (58/497, 11.7%), the other diseases (46/497, 9.3%) and unknown diseases (39/497, 7.8%). The most frequent diseases in the infective, connective tissue, malignant tumor and the other diseases were tuberculosis (98/189, 51.8%), AOSD (51.5%,85/165) , lymphoma (56.9%,33/58) and Crohn disease ( 8/46,17.4%) separately. (2). The cause types in the final diagnosis were related with the age of patients. The infective diseases were the most frequent cause in FUO groups of younger than 20 years and older than 60 years. The malignant tumor was the second frequent causes in the patients with older than 60 years. The connective tissue diseases were the second frequent causes in the group of younger than 20 years, and the top frequent in the group of between 20 and 59 years. (3). There was the relation between the diseases and the sex of patients. The infective, connective tissue and malignant tumor diseases were in turn the causes of the male patients, and the connective tissue, infective, and other diseases were in turn the causes for the female.2. The percentage of infective diseases (189/497,38.0%) in 497 FUO caseswas obviously lower than the general cases from the literature( 2484/4784,51.9%), and their difference was significant ( x2=34.77,P<0.0001 ) . The percentage of connective tissue diseases (165/497, 33.2%) in 497 FUO cases was obviously higher than the general cases from the literature (802/4784,16.8%) , and the difference was also significant ( x2=81.30, P<0.0001 ) . The percentage of malignant tumor diseases ( 58/497,11.7%) in 497 FUO cases is a litter bit lower than the general cases from the literature ( 734/4784,15.3%) , but the difference was significant ( x 2=4.76,P=0.029) .3. Tuberculosis was the most part among the infective diseases, and it was difficult to diagnose. The most frequent misdiagnosis was tuberculosis suffer from the part out of the lungs.4. The AOSD was the highest disease (85/165,51.5%) in the connective tissue disease subgroup of the FUO. The percentage of sore throat and serum hepatic enzymes, CRP and LDH levels in FUO-AOSD were higher than the general cases from the literature. The difference was significant (All i>0.05). The treatment of FUO-AOSD, such as the use of steroids drugs and antirheumatic drugs or immunosuppressant, was more difficult than the general cases possibly.5. The lymphoma and lung cancer were also the causes of FUO. The measures, such as the marrow puncture and biopsy from different position, biopsy of lymph node, liver, spleen, skin and so on, were important for the early diagnosis of FUO.Conclusion 1. This study investigated the distributing character of FUO with classic type and was instructive for their clinical diagnosis. 2. The infective diseases were the most frequent cause in the FUO. Tuberculosis, suffer from the organs out of lungs was also frequently. 3. The percentage of the connective tissue and malignant tumor disease in FUO was also more frequently and AOSD and lymphoma were more difficultly to diagnose. 4. The most case with FUO could be diagnosed clearly though careful examination and analysis, but the prognosis ofthe FUO patients without clear causes was very poor. |
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