Set Up The Estimating Questionnaire Of Clues To Pathogens Invasion And Investigate The Diagnostic Value Of The Estimating Questionnaire In Aetiology Of Fever Of Unknown Origin

Objective To set up the estimating questionnaire of clues to pathogens invasion and to investigate the diagnostic value of the estimating questionnaire in etiologies of Fever of Unknown Origin diseases.Methods(1)Clarify the most probable time point of pathogens invading the body.(2)Search for clues to pathogens invasion from the five aspects of the host factors, epidemiological factors, behavioral factors, iatrogenic factors and drug factors, then set up the estimating questionnaire of clues to pathogens invasion.(3)Analyze the possibility of pathogens invading the human body.(4)Distinguish the etiologies of FUO from infectious and non-infectious diseases according to the above results and other relevant bases.(5)According to the results of the estimating questionnaire, we can select corresponding appropriate antibiotics for etiological treatment.(6) 293 patients with fever of unknown origin were enrolled prospectively and were carried out the above 5 steps. On the first day of admission, every patient was inquired comprehensively and systematically in accordance with the estimating questionnaire. The clues to pathogens invasion between infectious and non-infectious diseases were compared by univariate and multivariate analysis. At the same time, the receiver operating characteristic curve was drawn and a risk prediction model for infectious diseases in FUO was created to assess the early diagnostic value of the estimating questionnaire in etiologies of fever of unknown origin diseases.Results(1)Combined with traditional diagnostic methods and the results of this study, pathogen invasion occurred at the onset of stage most obviously.(2)There were 26 clues in the estimating questionnaire, which mucosal barrier injury, chronic disease, place of residence or work environment pollution, feeding and close contact with animals' history, cold history, recent mutations on life and work rhythm and iatrogenic factors in infectious diseases group positive rate was significantly higher than that of non-infectious diseases group(p<0.05). History of spleen and tonsil resection, long-term lack of sleep, bad habits of smoking and drinking, drug factors in infectious diseases group positive rate was higher than that of non-infection diseases group(p>0.05). Positive cases were found only in the infectious disease group including Long term overload work, the recent epidemic areas of living, the surrounding population epidemic area living history, poor eating habits, recent intake of unclean diet, unclean personal hygiene habits, malnutrition. Clues containing mucosal barrier injury, chronic disease, place of residence or work environment pollution, feeding and close contact with the history of animal, cold history, the recent pace of life and work mutation, long-term lack of sleep and iatrogenic factors, were brought into a risk score model of infectious diseases. The area under curve was 0.89( 95%CI 0.85-0.93) and the sensitivity and specificity were 0.83 and 0.80 respectively.Conclusions According to the estimating questionnaire of clues to pathogens invasion at the onset stage, a risk score model of infectious diseases was created, which can rapidly and systematically screen for associated invasive clues and pathways for infectious diseases in FUO. Therefore, the etiology of FUO is divided into infectious diseases and non-infectious diseases, which provides a strong basis for the final diagnosis of FUO. It also provides a sufficient basis for the selection of antibiotics in the treatment of pathogens.