Clinical and etiological spectrum of prolonged fever and special reference to HIV patients at a tertiary care centre

Authors

  • Suresh Behera Department of Cardiology, IMS And SUM Hospital, Bhubaneshwar, Odisha, India
  • D. K. S. Subrahmanyam Department of Medicine, JIPMER, Pondicherry, India
  • Jyoti Bajpai Department of Respiratory Medicine, King George Medical University, Lucknow, Uttar Pradesh, India
  • Akshyaya Pradhan Department of Cardiology, King George’s Medical University, Lucknow, Uttar Pradesh, India
  • Abhishek Singh Department of Medicine, King George’s Medical University, Lucknow, Uttar Pradesh, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20182454

Keywords:

Fever, Human Immunodeficiency Virus (HIV), Neoplasm, Tuberculosis

Abstract

Background: Prolonged fever is a diagnostic challenge and will tend to remain so in times to come because of the changing spectrum of etiologies and influence of technology, environmental changes, and many other ill-understood factors which influence the etiological spectrum. Prolonged fever is also undergoing change in its duration. The aim of the present was study to determine the etiologies of prolonged fever in patients in India and to evaluate the clinical and etiological relationship between the diagnosis and patient’s laboratory data.

Methods: Patients aged more 13 years with fever >38.3ºC for more than three weeks without apparent source after preliminary investigations were included prospectively over a period of twenty two months. Fever duration, symptom, signs, laboratory investigations and final diagnosis were recorded. The distribution of etiologies and age, fever duration, laboratory examinations, and associated symptoms and signs were analyzed.

Results: Out of total of 86 patients were enrolled, fifty one (59.3%) were men. The median age was 28 years (range, 13-65 yr). Among 86 patients, diagnosis could be made in only 69 (80.2%) patients. Infections, neoplasms, NIIDs, miscellaneous causes were responsible for prolonged fever in 42 (48.8%), 18 (20.9%), 6 (7%), and 3 (3.5%) patients respectively. Seveteen (19.8%) cases remained undiagnosed, even after relevant investigations, six of them recovered spontaneously. Tuberculosis (TB) was the cause of prolonged fever in 21 (24.4%) patients.

Conclusions: Infections, amongst which tuberculosis, remain the major cause of prolonged fever and its subset: fever of unknown origin (FUO), in this country. The percent of undiagnosed cases appears to be identical worldwide.

References

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. Archives of internal medicine. 2003 May 12;163(9):1033-41.

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.

Danarello CA, Gelfand JA. Fever and hyperthermia. Harrison’s Principles of Internal Medicine. 16th edition. Kasper DL, Braunwald E, Fauci AS, Hauser SL, Longo DL. McGraw-Hill; 2005:104.

Mourad O, Palda V, Detsky AS. A comprehensive evidence-based approach to fever of unknown origin. Arch Intern Med. 2003;163(5):545-51.

Bryan CS. Fever of unknown origin- The evolving definition. Arch Intern Med. 2003;163:1003-4.

Chang JC. Why Do We Still Use the Term FUO? Arch Intern Med. 2003;163:2102.

Durack DT, Street AT. Fever of unknown origin reexamined and redefined. Current Clin Tropical Infec Dis. 1991;11:35-51.

Lozano F, Torre-Cisneros J, Santos J, León E, Domínguez A, Montesdeoca M, et al. Impact of highly active antiretroviral therapy on fever of unknown origin in HIV-infected patients. European Journal of Clinical Microbiology and Infectious Diseases. 2002 Feb 1;21(2):137-9.

Knockaert DC, Vanderschueren S, Blockmans D. Fever of unknown origin in adults: 40 years on (Review). J Intern Med 2003;253:263-75.

De Kleijn EMH, Knockaert DC, van der Meer JWM. Fever of unknown origin: a new definition and proposal for diagnostic work-up. Eur J Intern Med. 2000;11:1-3.

Mourad O, Palda V, Detsky A. A comprehensive evidence-based approach to fever of unknown origin. Arch Intern Med. 2003;163:545-51.

Mackowiak P, Durack D. Fever of unknown origin. In: Mandell GL, Douglas RG, Bennett JE, Dolin R, eds. Mandell, Douglas, and Bennett’s Principles and practice of infectious diseases. 5th Ed. Philadelphia: Churchill Livingstone; 2000:623-631.

Rupali P, Abraham OC, Zachariah A, Subramanian S, Mathai D. Aetiology of prolonged fever in antiretroviral-naive human immunodeficiency virus-infected adults. Natl Med J India. 2003;16(4):193-9.

Kupferwasser LI, Darius H, Muller AM, Martin C, Mohr-Kahaly S, Erbel R, et al. Diagnosis of culture-negative endocarditis: the role of the Duke criteria and the impact of transesophageal echocardiography. Am Heart J. 2001;142:146-52.

Lorenzen J, Buchert R, Bohuslavizki KH. Value of FDG PET in patients with fever of unknown origin. Nucl Med Commun. 2001;22:779-83.

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.

Downloads

Published

2018-06-25

How to Cite

Behera, S., Subrahmanyam, D. K. S., Bajpai, J., Pradhan, A., & Singh, A. (2018). Clinical and etiological spectrum of prolonged fever and special reference to HIV patients at a tertiary care centre. International Journal of Research in Medical Sciences, 6(7), 2243–2250. https://doi.org/10.18203/2320-6012.ijrms20182454

Issue

Section

Original Research Articles