UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate®

成人不明原因发热的病因

Author
David H Bor, MD
Section Editor
Peter F Weller, MD, MACP
Deputy Editor
Anna R Thorner, MD
Translators
马小军, 主任医师

引言

临床医生通常将初步评估无法确定病因或没有局灶体征的发热性疾病称为不明原因发热(fever of unknown origin, FUO)。但这种说法并不准确。大多数发热性疾病在做出诊断前已缓解或出现可据其做出诊断的显著特征。FUO是指虽经详细评估和诊断性试验，依然无法明确病因的持续时间较长的发热性疾病。

在过去几十年里，已搜集了大量采用上述FUO定义的病例系列研究；这些研究有助于识别FUO患者，有助于理解FUO随时间的变化的模式，还有助于更新的诊断技术的发展。

导致成人FUO的常见和不常见的疾病将总结在此。FUO的定义、成人FUO的诊断以及儿童FUO的病因将单独讨论。 (参见“认识成人不明原因发热”和“儿童不明原因发热的病因”)

引起大部分“经典”FUO病例的疾病大体分为三类，且历经数十年仍无改变。

  • 感染性疾病
  • 结缔组织病(如脉管炎、系统性红斑狼疮、风湿性多肌痛)
  • 恶性肿瘤

                    

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: 2017-06 . | This topic last updated: 2016-04-25.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
References
Top
  1. Alt HL, Barker MH. Fever of unknown origin. JAMA 1930; 94:1457.
  2. PETERSDORF RG, BEESON PB. Fever of unexplained origin: report on 100 cases. Medicine (Baltimore) 1961; 40:1.
  3. 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.
  4. 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.
  5. Miller RF, Hingorami AD, Foley NM. Pyrexia of undetermined origin in patients with human immunodeficiency virus infection and AIDS. Int J STD AIDS 1996; 7:170.
  6. Knockaert DC, Vanneste LJ, Bobbaers HJ. Fever of unknown origin in elderly patients. J Am Geriatr Soc 1993; 41:1187.
  7. 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. 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.
  9. Horowitz HW. Fever of unknown origin or fever of too many origins? N Engl J Med 2013; 368:197.
  10. Knockaert DC, Dujardin KS, Bobbaers HJ. Long-term follow-up of patients with undiagnosed fever of unknown origin. Arch Intern Med 1996; 156:618.
  11. Foley NM, Miller RF. Tuberculosis and AIDS: is the white plague up and coming? J Infect 1993; 26:39.
  12. 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.
  13. Arnow PM, Flaherty JP. Fever of unknown origin. Lancet 1997; 350:575.
  14. Metcalfe JZ, Everett CK, Steingart KR, et al. Interferon-γ release assays for active pulmonary tuberculosis diagnosis in adults in low- and middle-income countries: systematic review and meta-analysis. J Infect Dis 2011; 204 Suppl 4:S1120.
  15. Tholcken CA, Huang S, Woods GL. Evaluation of the ESP Culture System II for recovery of mycobacteria from blood specimens collected in isolator tubes. J Clin Microbiol 1997; 35:2681.
  16. Smith MB, Bergmann JS, Woods GL. Detection of Mycobacterium tuberculosis in BACTEC 12B broth cultures by the Roche Amplicor PCR assay. J Clin Microbiol 1997; 35:900.
  17. Molavi A. Endocarditis: recognition, management, and prophylaxis. Cardiovasc Clin 1993; 23:139.
  18. Kamimura T, Hatakeyama M, Torigoe K, et al. Muscular polyarteritis nodosa as a cause of fever of undetermined origin: a case report and review of the literature. Rheumatol Int 2005; 25:394.
  19. Mueller PS, Terrell CL, Gertz MA. Fever of unknown origin caused by multiple myeloma: a report of 9 cases. Arch Intern Med 2002; 162:1305.
  20. Mackowiak PA, LeMaistre CF. Drug fever: a critical appraisal of conventional concepts. An analysis of 51 episodes in two Dallas hospitals and 97 episodes reported in the English literature. Ann Intern Med 1987; 106:728.
  21. Harb GE, Alldredge BK, Coleman R, Jacobson MA. Pharmacoepidemiology of adverse drug reactions in hospitalized patients with human immunodeficiency virus disease. J Acquir Immune Defic Syndr 1993; 6:919.
  22. Siminoski K. Persistent fever due to occult dental infection: case report and review. Clin Infect Dis 1993; 16:550.
  23. Cohen JA, Kaplan MM. The SGOT/SGPT ratio--an indicator of alcoholic liver disease. Dig Dis Sci 1979; 24:835.
  24. Simon HB, Daniels GH. Hormonal hyperthermia: endocrinologic causes of fever. Am J Med 1979; 66:257.
  25. Drenth JP, van der Meer JW. Hereditary periodic fever. N Engl J Med 2001; 345:1748.