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.
Ključne reči
Array
Array
Array
Array
Array
Array
Array
Array
Array
Array
Array
Array
Array
Array
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.