Unexplained fever
Introduction
Introduction The concept of generalized unexplained fever refers to all fevers of unknown origin. However, in the clinic, the narrow concept of fever, fever of unknown origin (FUO) is also adopted. Due to advances in medical technology and diagnostic procedures, many patients can be treated and examined in outpatient clinics. In 1992, Petersdorf proposed that the diagnosis could not be confirmed 1 week after admission was revised to: The detailed examination for 1 week is still unclear. diagnosis". In 1999, Chinas National Symposium on Febrile Diseases defined fever of unknown origin as: fever lasted for more than 3 weeks, body temperature was above 38.5 °C, and the diagnosis was not confirmed by detailed medical history, physical examination and routine laboratory examination. .
Cause
Cause
The key to the diagnosis of unexplained fever is to find out the cause. Clinically, it should mainly identify four types of diseases, namely infectious diseases, malignant tumors, autoimmune diseases and other diseases that can cause fever. The method in the research literature for unexplained fever is not suitable for daily clinical work. The reasons are that the medical records are from different regions and the research institutions are different (such as community hospitals, teaching hospitals, mobile clinics), patients with unexplained fever. Subgroups are different and so on. Despite these influencing factors, infection is still the most common cause of unexplained fever research reports.
Examine
an examination
Related inspection
Body temperature measurement of total number of bone marrow nucleated cells
First, physical examination
Taking a medical history gives us a first impression and revelation, and also guides us to a concept of the nature of the disease.
Second, laboratory inspection
Laboratory examinations must be summarized and analyzed based on objective data learned from medical history and physical examination, from which several diagnostic possibilities may be proposed, and further consideration should be given to those examinations to confirm the diagnosis. Such as: blood routine, viral infection check, etc.
Diagnosis
Differential diagnosis
Infectious diseases and fever of unknown origin:
Among the related infectious diseases, tuberculosis (especially extrapulmonary tuberculosis), abdominal abscess and pelvic abscess are the most common. Abdominal abscesses are found in hollow organs (such as appendicitis), diverticulitis, malignant tumors, and trauma after perforation. They are also found in subacute bacterial endocarditis, sinusitis, osteomyelitis, and oral abscesses. The longer the course of fever, the less likely it is to have an infectious disease. Long-term unexplained fever often distinguishes between malignant tumors and human fever.
Malignant tumor:
Due to the growth of the elderly population and the improvement of the diagnosis and treatment of geriatric diseases, it is often found in clinical work that the elderly suffer from malignant tumors. Malignant tumors are sometimes difficult to diagnose, such as chronic leukemia, lymphoma, renal cell carcinoma, metastatic cancer, which can cause fever of unknown origin.
Autoimmune diseases and fever of unknown origin:
The associated common inflammations are rheumatoid arthritis and rheumatic fever, which can be quickly diagnosed using new serological techniques. At present, the proportion of this type of disease is gradually increasing. The main reason is the improvement of doctors' awareness level and laboratory diagnosis. Adult Still's disease and temporal arteritis, which are difficult to diagnose due to laboratory tests, have become the main cause of fever of unknown origin. Patients over 60 years of age with unexplained fever often develop multiple systemic inflammations, such as temporal arteritis or rheumatic, multiple myopathy. In elderly patients with temporal arteritis, if accompanied by an increase in erythrocyte sedimentation rate, a radial artery biopsy should be performed.
