Pyrexia of unknown origin
Pyrexia of unknown origin
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DOI：
10.7861/clinmedicine.18-2-170
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发表时间：
2018-04-01
影响因子：
4.4
通讯作者：
Beeching, Nick J.
中科院分区：
文献类型：
--
作者：
Fernandez, Cristina;Beeching, Nick J.
不明原因发热综合征（PUO）于1961年首次定义，但对许多医生来说仍然是一个临床挑战。已提出不同的PUO亚组，每个亚组需要不同的研究策略：经典，医院，贫血和HIV相关。这可以扩大到包括老年人作为第五个群体。病因大致分为四类：感染性、炎症性、肿瘤性和其他。正电子发射断层扫描-计算机断层扫描（PET-CT）的早期使用增加以及新的感染分子和血清学检测的发展提高了诊断能力，但尽管进行了充分的调查，仍有高达50%的患者没有找到病因。令人欣慰的是，未确诊患者的队列预后良好。在这篇文章中，我们回顾了PUO的可能病因，并提出了一个系统的临床方法来调查和管理患者，建议潜在的二线调查时，病因不清楚。
The syndrome of pyrexia of unknown origin (PUO) was first defined in 1961 but remains a clinical challenge for many physicians. Different subgroups with PUO have been suggested, each requiring different investigative strategies: classical, nosocomial, neutropenic and HIV-related. This could be expanded to include the elderly as a fifth group. The causes are broadly divided into four groups: infective, inflammatory, neoplastic and miscellaneous. Increasing early use of positron emission tomography-computed tomography (PET-CT) and the development of new molecular and serological tests for infection have improved diagnostic capability, but up to 50% of patients still have no cause found despite adequate investigations. Reassuringly, the cohort of undiagnosed patients has a good prognosis. In this article we review the possible aetiologies of PUO and present a systematic clinical approach to investigation and management of patients, recommending potential second-line investigations when the aetiology is unclear.