| [Objective]To investigate the etiological distribution and change of fever of unknown origin (FUO). So as to improve clinicians awareness of FUO and raise the rate of accurate diagnosis.[Mthods]The clinical data were retrospectively analyzed from 500 patients with FUO who hospitalized in our hospital between December 2003 to June 2014, To investigate diagnostic methods, etiological distribution, the relationship between etiological distribution and sex, age, fever process. All the patients were divided into December 2003-December 2008 and January 2009-June 2014, etiological distribution of fever of unknown origin between the two periods were artificially compared. Through analysing the reported results of domestic literatures about FUO after 2000 years, To investigate the clinical characteristic of the patients with FUO.[Result]1. Of these 500 FUO cases,452 (90.4%) cases were confirmed to be with infectious diseases (46.2%, n=231),76 cases of tuberculosis (32.9%,76/231), connective tissue diseases(CTD)(19.8%, n=99), neoplasms (11.6%, n=58). other diseases (12.8%, n= 64) and 48 cases (9.6%) could not be confirmed until they were discharged from hospital; there were 83 kinds of diseases, The common diseases were tuberculosis (TB), Adult-onset still disease(AOSD), pulmonary infection, lymphoma, bloodstream infection etc.2. In infectious diseases, bacterial infections (176 cases) accounted for 35.2% of all cases(176/500) and 76.2% of infectious diseases (176/231), TB (76 cases) accounted for 15.2% of all cases (76/500) and 32.9% of infectious diseases (76/231), viral infections (35 cases) accounted for 7.0% of all cases (35/500) and 15.2% of infectious diseases (35/231), other infections (20 cases) accounted for 4.0% of all cases (20/500) and 8.7% of infectious diseases. In 30 kinds of infectious diseases, the common diseases were respectively TB, pulmonary infection and bloodstream infection, urinary tract infection, abscess and brucellosis etc, in 18 kinds of CTD, the common disease respectively were AOSD, vasculitis and systemic lupus erythematosus (SLE) etc; There were 17 kind of diseases in 58 malignant tumor cases, including 43 hematonosis cases(74.1%,43/58) and 15 solid tumors cases (25.9%,15/58), the common diseases were respectively lymphoma, hemophagocytic syndrome(HPS), leukemia etc,18 kinds of other diseases, the common diseases were necrotizing lymphadenitis, subacute thyroiditis and drug fever etc.3. The proportion of CTD in female patients was significantly higher than that in male patients [26.3%(59/224) vs 14.5%(40/276), X2=5.027, P=0.025], whereas the proportion of neoplasms in male patients was significantly higher than that in female patients [14.5%(40/276) vs 8.0%(18/224), X2=10.928,P=0.001]. Infectious diseases was the most common cause in all groups, CTD came second common cause in 21-39 years and 40-59 years groups, neoplasms also came second in the group including older than 60 years, The etiological distribution of patients with FUO in different age groups was significantly different (X2=43.10, P=0.000). Fever process in patients with neoplasms was longer than that with infectious diseases [60 (28,90) d vs 28 (21,42) d, Z=-4.168,P=0.000] and CTD [60 (28,90) d vs (30 (21,60) d, Z=-2.406, P=0.0016)]. During 2009-2014, compared to 2003-2008, connective tissue disease was increased (13.7% vs 23.8%, X2=8.598, P=0.003), infectious diseases, neoplasms and other diseases were decreased, but there were no statistics significant (P>0.05)[Conclusions]1. There were more than 80 kinds of diseases that could lead to fever of unknown,9.6% of all cases could not be confirmed, making a confirmed clinical diagnosis is still difficult in a small part of patients with FUO.2. Infectious diseases was the major causes of FUO, TB was the most common disease of infectious diseases, also the most common cause of FUO. CTD and neoplasms played an important role of FUO.3. The etiological distribution and proportion of FUU were significantly different in the different groups of the ages, sex, fever process and different years, the distribution and proportion of CTD in female patients was higher than in male patients; The distribution and proportion of neoplasms in male patients was higher than in female patients, With the growth of the age and the extension of fever process, infectious diseases gradually declined, non-infectious diseases gradually increased.4.Clinicians should pay attention to that the etiological distribution and proportion of FUO appeared to be changing along with years variance, the proportion of CTD was significantly increased, the proportion of infectious diseases and neoplasms were declined. |
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