Fever of unknown origin: An evidence-based review

American Journal of the Medical Sciences

Volumn 344, Issue 4, 2012, Pages 307-316

  Hayakawa, Kayoko ^a   Ramasamy, Balaji ^a   Chandrasekar, Pranatharthi H ^a  

^a WAYNE STATE UNIVERSITY SCHOOL OF MEDICINE   (United States)

Author keywords

Classic FUO; Fever; Fever of unknown origin; FUO; Tuberculosis

Indexed keywords

ANTIBIOTIC AGENT; CORTICOSTEROID; FLUORODEOXYGLUCOSE; GALLIUM 67; INDIUM 111; TECHNETIUM 99M; TUBERCULOSTATIC AGENT;

BLOOD CULTURE; BONE MARROW BIOPSY; BONE MARROW CULTURE; BRADYCARDIA; CLOSTRIDIUM DIFFICILE INFECTION; COMPUTER ASSISTED TOMOGRAPHY; DEVICE INFECTION; DRUG FEVER; EVIDENCE BASED PRACTICE; FAMILY HISTORY; HOSPITAL INFECTION; HUMAN; INFLAMMATORY DISEASE; LIVER BIOPSY; LYMPH NODE BIOPSY; MEDICAL HISTORY; NONHUMAN; PHYSICAL EXAMINATION; POSITRON EMISSION TOMOGRAPHY; PROSTHESIS INFECTION; PYREXIA IDIOPATHICA; REVIEW; SCINTIGRAPHY; SOCIAL BACKGROUND; THORAX RADIOGRAPHY; TUBERCULOSIS;

EID: 84866922751     PISSN: 00029629     EISSN: 15382990     Source Type: Journal    
DOI: 10.1097/MAJ.0b013e31824ae504     Document Type: Review

References (107)

1. Petersdorf RG, Beeson PB. Fever of unexplained origin: Report on 100 cases. Medicine (Baltimore) 1961;40:1-"30.
2. Durack DT, Street AC. Fever of unknown origin-reexamined and redefined. Curr Clin Top Infect Dis 1991;11:35-"51.
3. Freifeld AG, Bow EJ, Sepkowitz KA, et al. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the infectious diseases society of America. Clin Infect Dis 2011;52:e56-"93.
4. Mourad O, Palda V, Detsky AS. A comprehensive evidence-based approach to fever of unknown origin. Arch Intern Med 2003;163:545-"51.
5. Sharma BK, Kumari S, Varma SC, et al. Prolonged undiagnosed fever in northern India. Trop Geogr Med 1992;44:32-"6.
6. Tolia J, Smith LG. Fever of unknown origin: Historical and physical clues to making the diagnosis. Infect Dis Clin North Am 2007;21:917-" 36, viii.
7. Amin K, Kauffman CA. Fever of unknown origin. A strategic approach to this diagnostic dilemma. Postgrad Med 2003;114:69-"75.
8. Brusch JL, Weinstein L. Fever of unknown origin. Med Clin North Am 1988;72:1247-"61.
9. Musher DM, Fainstein V, Young EJ, et al. Fever patterns. Their lack of clinical significance. Arch Intern Med 1979;139:1225-"8.
10. Mackowiak PA, Durack DT. Fever of unknown origin. In: Mandell GL, Bennett JE, Dolin R, editors. Mandell, Douglas, and Bennett's principles and practice of infectious diseases. London: Churchill Livingstone; 2009. p. 779-"89.
11. Ostergaard L, Huniche B, Andersen PL. Relative bradycardia in infectious diseases. J Infect 1996;33:185-"91.
12. Cunha BA. Fever of unknown origin: Focused diagnostic approach based on clinical clues from the history, physical examination, and laboratory tests. Infect Dis Clin North Am 2007;21:1137-"87, xi.
13. Zeaiter Z, Fournier PE, Greub G, et al. Diagnosis of Bartonella endocarditis by a real-time nested PCR assay using serum. J Clin Microbiol 2003;41:919-"25.
14. Horsburgh CR Jr, Mason UG III, Farhi DC, et al. Disseminated infection with Mycobacterium avium-intracellulare. A report of 13 cases and a review of the literature. Medicine (Baltimore) 1985;64: 36-"48.
15. Assi MA, Sandid MS, Baddour LM, et al. Systemic histoplasmosis: A 15-year retrospective institutional review of 111 patients. Medicine (Baltimore) 2007;86:162-"9.
16. Wheat LJ, Slama TG, Norton JA, et al. Risk factors for disseminated or fatal histoplasmosis. Analysis of a large urban outbreak. Ann Intern Med 1982;96:159-"63.
17. Raoult D, Fournier PE, Drancourt M, et al. Diagnosis of 22 new cases of Bartonella endocarditis. Ann Intern Med 1996;125:646-"52.
18. Bleeker-Rovers CP, Vos FJ, de Kleijn EM, et al. A prospective multicenter study on fever of unknown origin: The yield of a structured diagnostic protocol. Medicine (Baltimore) 2007;86:26-"38.
19. de Kleijn EM, van Lier HJ, van der Meer JW. Fever of unknown origin (FUO). II. Diagnostic procedures in a prospective multicenter study of 167 patients. The Netherlands FUO Study Group. Medicine (Baltimore) 1997;76:401-"14.
20. Meller J, Ivancevic V, Conrad M, et al. Clinical value of immunoscintigraphy in patients with fever of unknown origin. J Nucl Med 1998;39:1248-"53.
21. Becker W, Meller J. The role of nuclear medicine in infection and inflammation. Lancet Infect Dis 2001;1:326-"33.
22. Bleeker-Rovers CP, Vos FJ, Mudde AH, et al. A prospective multicentre study of the value of FDG-PET as part of a structured diagnostic protocol in patients with fever of unknown origin. Eur J Nucl Med Mol Imaging 2007;34:694-"703.
23. Dorfman RF, Remington JS. Value of lymph-node biopsy in the diagnosis of acute acquired toxoplasmosis. N Engl J Med 1973;289: 878-"81.
24. Sinclair S, Beckman E, Ellman L. Biopsy of enlarged, superficial lymph nodes. JAMA 1974;228:602-"3.
25. Tsang WY, Chan JK, Ng CS. Kikuchi's lymphadenitis. A morphologic analysis of 75 cases with special reference to unusual features. Am J Surg Pathol 1994;18:219-"31.
26. de Kleijn EM, Vandenbroucke JP, van der Meer JW. Fever of unknown origin (FUO). I. A prospective multicenter study of 167 patients with FUO, using fixed epidemiologic entry criteria. The Netherlands FUO Study Group. Medicine (Baltimore) 1997;76:392-"400.
27. Holtz T, Moseley RH, Scheiman JM. Liver biopsy in fever of unknown origin. A reappraisal. J Clin Gastroenterol 1993;17:29-"32.
28. Tobkes AI, Nord HJ. Liver biopsy: Review of methodology and complications. Dig Dis 1995;13:267-"74.
29. Hot A, Jaisson I, Girard C, et al. Yield of bone marrow examination in diagnosing the source of fever of unknown origin. Arch Intern Med 2009;169:2018-"23.
30. Volk EE, Miller ML, Kirkley BA, et al. The diagnostic usefulness of bone marrow cultures in patients with fever of unknown origin. Am J Clin Pathol 1998;110:150-"3.
31. Bryan CS, Ahuja D. Fever of unknown origin: Is there a role for empiric therapy? Infect Dis Clin North Am 2007;21:1213-"20, xi.
32. Tarkkanen A. Giant cell arteritis and the ophthalmologist. Acta Ophthalmol Scand 2002;80:353-"4.
33. Mayordomo L, Marenco JL, Gomez-Mateos J, et al. Pulmonary miliary tuberculosis in a patient with anti-TNF-Alpha treatment. Scand J Rheumatol 2002;31:44-"5.
34. Garcia-Goez JF, Linares L, Benito N, et al. Tuberculosis in solid organ transplant recipients at a tertiary hospital in the last 20 years in Barcelona, Spain. Transplant Proc 2009;41:2268-"70.
35. Korner MM, Hirata N, Tenderich G, et al. Tuberculosis in heart transplant recipients. Chest 1997;111:365-"9.
36. Kazanjian PH. Fever of unknown origin: Review of 86 patients treated in community hospitals. Clin Infect Dis 1992;15:968-"73.
37. Larson EB, Featherstone HJ, Petersdorf RG. Fever of undetermined origin: Diagnosis and follow-up of 105 cases, 1970-1980. Medicine (Baltimore) 1982;61:269-"92.
38. Iikuni Y, Okada J, Kondo H, et al. Current fever of unknown origin 1982-1992. Intern Med 1994;33:67-"73.
39. Knockaert DC, Dujardin KS, Bobbaers HJ. Long-term follow-up of patients with undiagnosed fever of unknown origin. Arch Intern Med 1996;156:618-"20.
40. Norman DC, Wong MB, Yoshikawa TT. Fever of unknown origin in older persons. Infect Dis Clin North Am 2007;21:937-"45, viii.
41. Keating HJ III, Klimek JJ, Levine DS, et al. Effect of aging on the clinical significance of fever in ambulatory adult patients. J Am Geriatr Soc 1984;32:282-"7.
42. Gur H, Aviram R, Or J, et al. Unexplained fever in the ED: Analysis of 139 patients. Am J Emerg Med 2003;21:230-"5.
43. Berland B, Gleckman RA. Fever of unknown origin in the elderly. A sequential approach to diagnosis. Postgrad Med 1992;92:197-"200, 3-5, 9-10.
44. Knockaert DC, Vanneste LJ, Bobbaers HJ. Fever of unknown origin in elderly patients. J Am Geriatr Soc 1993;41:1187-"92.
45. de Kleijn EM, van der Meer JW. Fever of unknown origin (FUO): Report on 53 patients in a Dutch university hospital. Neth J Med 1995; 47:54-"60.
46. Erkoc R, Dogan E, Sayarlioglu H, et al. Tuberculosis in dialysis patients, single centre experience from an endemic area. Int J Clin Pract 2004;58:1115-"7.
47. Konecny P, Davidson RN. Pyrexia of unknown origin in the 1990s: Time to redefine. Br J Hosp Med 1996;56:21-"4.
48. Lopez de Castilla D, Schluger NW. Tuberculosis following solid organ transplantation. Transpl Infect Dis 2010;12:106-"12.
49. Agmon-Levin N, Ziv-Sokolovsky N, Shull P, et al. Carcinoma of colon presenting as fever of unknown origin. Am J Med Sci 2005;329:322-"6.
50. Berger L, Sinkoff MW. Systemic manifestations of hypernephroma; a review of 273 cases. Am J Med 1957;22:791-"6.
51. Zenone T. Fever of unknown origin in rheumatic diseases. Infect Dis Clin North Am 2007;21:1115-"35, x-xi.
52. Johnson DH, Cunha BA. Drug fever. Infect Dis Clin North Am 1996; 10:85-"91.
53. Singh N, Yu VL, Wagener MM, et al. Cirrhotic fever in the 1990s: A prospective study with clinical implications. Clin Infect Dis 1997;24: 1135-"8.
54. Weiss BM, Hepburn MJ, Mong DP. Subacute thyroiditis manifesting as fever of unknown origin. South Med J 2000;93:926-"9.
55. Kejariwal D, Sarkar N, Chakraborti SK, et al. Pyrexia of unknown origin: A prospective study of 100 cases. J Postgrad Med 2001;47: 104-"7.
56. Vanderschueren S, Knockaert D, Adriaenssens T, et al. From prolonged febrile illness to fever of unknown origin: The challenge continues. Arch Intern Med 2003;163:1033-"41.
57. Tabak F, Mert A, Celik AD, et al. Fever of unknown origin in Turkey. Infection 2003;31:417-"20.
58. Zamir D, Leibovitz I, Polychuck I, et al. Fever of unknown origin in Israel. Acta Clin Belg 2003;58:356-"9.
59. Liu KS, Sheng WH, Chen YC, et al. Fever of unknown origin: A retrospective study of 78 adult patients in Taiwan. J Microbiol Immunol Infect 2003;36:243-"7.
60. Zhiyong Z, Bingjun L, Xiaoju L, et al. Fever of unknown origin: A report from China of 208 cases. Int J Clin Pract 2003;57:592-"6.
61. Saltoglu N, Tasova Y, Midikli D, et al. Fever of unknown origin in Turkey: Evaluation of 87 cases during a nine-year-period of study. J Infect 2004;48:81-"5.
62. Habib GS, Masri R, Ben-Haim S. The utility of gallium scintigraphy in the evaluation of fever of unknown origin. Isr Med Assoc J 2004;6: 463-"6.
63. Ergonul O, Willke A, Azap A, et al. Revised definition of 'fever of unknown origin': Limitations and opportunities. J Infect 2005;50:1-"5.
64. Erten N, Saka B, Ozturk G, et al. Fever of unknown origin: A report of 57 cases. Int J Clin Pract 2005;59:958-"60.
65. Zenone T. Fever of unknown origin in adults: Evaluation of 144 cases in a non-university hospital. Scand J Infect Dis 2006;38:632-"8.
66. Ammari F. Fever of unknown origin in North Jordan. Trop Doct 2006;36:251-"3.
67. Chin C, Chen YS, Lee SS, et al. Fever of unknown origin in Taiwan. Infection 2006;34:75-"80.
68. Colpan A, Onguru P, Erbay A, et al. Fever of unknown origin: Analysis of 71 consecutive cases. Am J Med Sci 2007;334:92-"6.
69. Seshadri N, Solanki CK, Balan K. Utility of 111In-labelled leucocyte scintigraphy in patients with fever of unknown origin in an era of changing disease spectrum and investigational techniques. Nucl Med Commun 2008;29:277-"82.
70. Mansueto P, Di Lorenzo G, Rizzo M, 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;3:219-"25.
71. Kucukardali Y, Oncul O, Cavuslu S, et al. The spectrum of diseases causing fever of unknown origin in Turkey: A multicenter study. Int J Infect Dis 2008;12:71-"9.
72. Hu Y, Lu H, Zhang Y, et al. Fever of unknown origin: Revisit of 142 cases in a tertiary Chinese hospital. Biosci Trends 2008;2:44-"6.
73. Balink H, Collins J, Bruyn GA, et al. F-18 FDG PET/CT in the diagnosis of fever of unknown origin. Clin Nucl Med 2009;34:862-"8.
74. Efstathiou SP, Pefanis AV, Tsiakou AG, et al. Fever of unknown origin: Discrimination between infectious and non-infectious causes. Eur J Intern Med 2010;21:137-"43.
75. Moawad MA, Bassil H, Elsherif M, et al. Fever of unknown origin: 98 cases from Saudi Arabia. Ann Saudi Med 2010;30:289-"94.
76. Pedersen TI, Roed C, Knudsen LS, et al. Fever of unknown origin: A retrospective study of 52 cases with evaluation of the diagnostic utility of FDG-PET/CT. Scand J Infect Dis 2012;44: 18-"23.
77. Kubota K, Nakamoto Y, Tamaki N, et al. FDG-PET for the diagnosis of fever of unknown origin: A Japanese multi-center study. Ann Nucl Med 2011;25:355-"64.
78. Keidar Z, Gurman-Balbir A, Gaitini D, et al. Fever of unknown origin: The role of 18F-FDG PET/CT. J Nucl Med 2008;49:1980-"5.
79. Kei PL, Kok TY, Padhy AK, et al. 18F FDG PET/CT in patients with fever of unknown origin: A local experience. Nucl Med Commun 2010;31:788-"92.
80. Ferda J, Ferdova E, Zahlava J, et al. Fever of unknown origin: A value of (18)F-FDG-PET/CT with integrated full diagnostic isotropic CT imaging. Eur J Radiol 2010;73:518-"25.
81. Sheng JF, Sheng ZK, Shen XM, et al. Diagnostic value of fluorine- 18 fluorodeoxyglucose positron emission tomography/computed tomography in patients with fever of unknown origin. Eur J Intern Med 2011;22:112-"6.
82. Meller J, Altenvoerde G, Munzel U, et al. Fever of unknown origin: Prospective comparison of [18F]FDG imaging with a double-head coincidence camera and gallium-67 citrate SPET. Eur J Nucl Med 2000;27:1617-"25.
83. Lorenzen J, Buchert R, Bohuslavizki KH. Value of FDG PET in patients with fever of unknown origin. Nucl Med Commun 2001;22: 779-"83.
84. Kjaer A, Lebech AM, Eigtved A, et al. Fever of unknown origin: Prospective comparison of diagnostic value of 18F-FDG PET and 111In-granulocyte scintigraphy. Eur J Nucl Med Mol Imaging 2004; 31:622-"6.
85. Bleeker-Rovers CP, de Kleijn EM, Corstens FH, et al. Clinical value of FDG PET in patients with fever of unknown origin and patients suspected of focal infection or inflammation. Eur J Nucl Med Mol Imaging 2004;31:29-"37.
86. Kjaer A, Lebech AM. Diagnostic value of (111)In-granulocyte scintigraphy in patients with fever of unknown origin. J Nucl Med 2002; 43:140-"4.
87. Esposito AL, Gleckman RA. Fever of unknown origin in the elderly. J Am Geriatr Soc 1978;26:498-"505.
88. Onal IK, Cankurtaran M, Cakar M, et al. Fever of unknown origin: What is remarkable in the elderly in a developing country? J Infect 2006;52:399- "404.
89. Chen Y, Zheng M, Hu X, et al. Fever of unknown origin in elderly people: A retrospective study of 87 patients in China. J Am Geriatr Soc 2008;56:182-"4.
90. Zheng M, Lin H, Luo S, et al. Fever of unknown origin in the elderly: Nine years experience in China. Trop Doct 2008;38:221-"2.
91. Turkulov V, Brkic S, Sevic S, et al. Fever of unknown origin in elderly patients. Srp Arh Celok Lek 2011;139:64-"8.
92. Tal S, Guller V, Gurevich A, et al. Fever of unknown origin in the elderly. J Intern Med 2002;252:295-"304.
93. Sharma SK, Mohan A, Sharma A, et al. Miliary tuberculosis: New insights into an old disease. Lancet Infect Dis 2005;5:415-"30.
94. Bofinger JJ, Schlossberg D. Fever of unknown origin caused by tuberculosis. Infect Dis Clin North Am 2007;21:947-"62, viii.
95. Collazos J, Guerra E, Mayo J, et al. Tuberculosis as a cause of recurrent fever of unknown origin. J Infect 2000;41:269-"72.
96. Angell SY, Behrens RH. Risk assessment and disease prevention in travelers visiting friends and relatives. Infect Dis Clin North Am 2005; 19:49-"65.
97. Jensen PA, Lambert LA, Iademarco MF, et al. Guidelines for preventing the transmission of Mycobacterium tuberculosis in health-care settings, . MMWR Recomm Rep2005 2005;54:1-"141.
98. Greenberg SD, Frager D, Suster B, et al. Active pulmonary tuberculosis in patients with AIDS: Spectrum of radiographic findings (including a normal appearance). Radiology 1994;193:115-"9.
99. Yang Z, Kong Y, Wilson F, et al. Identification of risk factors for extrapulmonary tuberculosis. Clin Infect Dis 2004;38:199-"205.
100. Jones BE, Young SM, Antoniskis D, et al. Relationship of the manifestations of tuberculosis to CD4 cell counts in patients with human immunodeficiency virus infection. Am Rev Respir Dis 1993;148: 1292-"7.
101. Kaplan JE, Benson C, Holmes KH, et al. Guidelines for prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: Recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America.MMWR Recomm Rep 2009;58:1-"207; quiz CE1-4.
102. Targeted tuberculin testing and treatment of latent tuberculosis infection. American Thoracic Society. MMWR Recomm Rep 2000;49:1-"51.
103. Saliu OY, Sofer C, Stein DS, et al. Tumor-necrosis-factor blockers: Differential effects on mycobacterial immunity. J Infect Dis 2006;194: 486-"92.
104. Torre-Cisneros J, Doblas A, Aguado JM, et al. Tuberculosis after solid-organ transplant: Incidence, risk factors, and clinical characteristics in the RESITRA (Spanish Network of Infection in Transplantation) cohort. Clin Infect Dis 2009;48:1657-"65.
105. Manfredi R, Calza L, Chiodo F. Primary cytomegalovirus infection in otherwise healthy adults with fever of unknown origin: A 3-year prospective survey. Infection 2006;34:87-"90.
106. Akan H, Arslan O, Akan OA. Tuberculosis in stem cell transplant patients. J Hosp Infect 2006;62:421-"6.
107. Horsburgh CR Jr. Priorities for the treatment of latent tuberculosis infection in the United States. N Engl J Med 2004;350:2060-"7.