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Yang Y, Hua C, Liu Y, Yang C, Mi Y, Qiu W. Droplet digital PCR aids in the diagnosis of children with fever of unknown origin --A typical case report. Heliyon 2024; 10:e30961. [PMID: 38778949 PMCID: PMC11109792 DOI: 10.1016/j.heliyon.2024.e30961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 05/08/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
Many clinical conditions can cause fever of unknown origin (FUO) in children, but the etiological diagnosis remains challenging despite the variety of inspection methods available at present. This study aims to investigate the effectiveness of droplet digital polymerase chain reaction (ddPCR) in identifying pathogens in children with FUO as a novel application. A 7-month-old boy failed to obtain etiology evidence for his disease through various tests. After collecting peripheral blood for ddPCR analysis, Staphylococcus aureus and Escherichia coli were detected, and Sanger sequencing confirmed the pathogens. During the disease, the child developed septic arthritis and osteomyelitis in the femur. Despite the patient's fever being removed, his limb activity improving, and inflammatory biomarkers decreasing, avascular necrosis of the femoral head remained after targeted antibiotic treatment and surgery. If the patient had undergone ddPCR analysis at an early stage, it may be possible to avoid sequelae. ddPCR helps identify pathogens in the diagnosis of children with FUO and could be a promising complementary tool.
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Affiliation(s)
- Ying Yang
- Department of Infectious Diseases, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 3333 Binsheng Road, Binjiang District, Hangzhou, Zhejiang, 310052, China
| | - Chunzhen Hua
- Department of Infectious Diseases, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 3333 Binsheng Road, Binjiang District, Hangzhou, Zhejiang, 310052, China
| | - Yan Liu
- Department of Expanded Program on Immunization, Hangzhou Center for Disease Control and Prevention, Hangzhou, Zhejiang, 310021, China
| | - Cheng Yang
- Clinical Laboratory Center, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, 310052, China
| | - Yumei Mi
- Department of Infectious Diseases, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, 3333 Binsheng Road, Binjiang District, Hangzhou, Zhejiang, 310052, China
| | - Wei Qiu
- Department of Radiology, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, 310052, China
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2
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Valenzise M, D’Amico F, La Barbera G, Cassone CM, Patafi S, Lombardo F, Aversa T, Wasniewska MG, Salzano G, Morace C. Retrospective Analysis of Fever in Pediatric Age: Our Experience over the Last 5 Years. CHILDREN (BASEL, SWITZERLAND) 2024; 11:539. [PMID: 38790534 PMCID: PMC11120056 DOI: 10.3390/children11050539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 04/18/2024] [Accepted: 04/19/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Fever is one of the most frequent symptoms highlighted during medical assistance. Due to this great impact, our study has the purpose of analyzing the demographic and laboratory characteristics of patients hospitalized in our center and identifying predictive markers to make the differential diagnosis between infectious and non-infectious fever. METHODS Our population included 220 children, collected from January 2017 to August 2022, hospitalized for continuous fever (4 days or more in duration with at least one temperature peak ≥37.5 °C) and excluded cases of discharge against medical advice and/or transfer to other operating units. Demographic (mean age at the time of admission, frequency of hospitalization, and mean days of hospitalization), laboratory, and instrumental variables were analyzed in order to find correlation with fever etiology. RESULTS Older age at the time of hospitalization, family history of periodic fever, fever lasting more than 8 days, and longer hospitalization are strongly associated with non-infectious fever, together with anemia, high platelet count, high CRP and ferritin, and hyponatremia at the time of admission. Paracetamol is the preferred antipyretic treatment. Echocardiogram has shown anomalies in patients with infectious fever, while ECG anomalies were detected in non-infectious fever. CONCLUSIONS Our data underline the importance of predictive markers, such as clinical and laboratory parameters, to differentiate infectious from non-infectious fevers, but further studies are necessary.
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Affiliation(s)
- Mariella Valenzise
- Department of Human Pathology of the Adulthood and Childhood, University of Messina, 98121 Messina, Italy; (F.D.); (G.L.B.); (C.M.C.); (S.P.); (F.L.); (T.A.); (M.G.W.); (G.S.)
| | - Federica D’Amico
- Department of Human Pathology of the Adulthood and Childhood, University of Messina, 98121 Messina, Italy; (F.D.); (G.L.B.); (C.M.C.); (S.P.); (F.L.); (T.A.); (M.G.W.); (G.S.)
| | - Giulia La Barbera
- Department of Human Pathology of the Adulthood and Childhood, University of Messina, 98121 Messina, Italy; (F.D.); (G.L.B.); (C.M.C.); (S.P.); (F.L.); (T.A.); (M.G.W.); (G.S.)
| | - Carlo Maria Cassone
- Department of Human Pathology of the Adulthood and Childhood, University of Messina, 98121 Messina, Italy; (F.D.); (G.L.B.); (C.M.C.); (S.P.); (F.L.); (T.A.); (M.G.W.); (G.S.)
| | - Silvia Patafi
- Department of Human Pathology of the Adulthood and Childhood, University of Messina, 98121 Messina, Italy; (F.D.); (G.L.B.); (C.M.C.); (S.P.); (F.L.); (T.A.); (M.G.W.); (G.S.)
| | - Fortunato Lombardo
- Department of Human Pathology of the Adulthood and Childhood, University of Messina, 98121 Messina, Italy; (F.D.); (G.L.B.); (C.M.C.); (S.P.); (F.L.); (T.A.); (M.G.W.); (G.S.)
| | - Tommaso Aversa
- Department of Human Pathology of the Adulthood and Childhood, University of Messina, 98121 Messina, Italy; (F.D.); (G.L.B.); (C.M.C.); (S.P.); (F.L.); (T.A.); (M.G.W.); (G.S.)
| | - Malgorzata Gabriela Wasniewska
- Department of Human Pathology of the Adulthood and Childhood, University of Messina, 98121 Messina, Italy; (F.D.); (G.L.B.); (C.M.C.); (S.P.); (F.L.); (T.A.); (M.G.W.); (G.S.)
| | - Giuseppina Salzano
- Department of Human Pathology of the Adulthood and Childhood, University of Messina, 98121 Messina, Italy; (F.D.); (G.L.B.); (C.M.C.); (S.P.); (F.L.); (T.A.); (M.G.W.); (G.S.)
| | - Carmela Morace
- Department of Clinical and Sperimental Medicine, University of Messina, 98121 Messina, Italy;
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3
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Zhou Y, Shen N, Luo L, Liu Y, Cao Q. Clinical and metagenomic characteristics of lymphadenopathy related to fever of unknown origin in children. Pediatr Res 2024:10.1038/s41390-024-03187-3. [PMID: 38678116 DOI: 10.1038/s41390-024-03187-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 03/20/2024] [Accepted: 03/25/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Diagnosis of fever of unknown origin remains challenge for pediatricians. Lymphadenopathy is a separate entity that mainly originates from infection or malignancy. METHODS 168 patients with FUO accompanied by lymphadenectasis were reviewed. 33 lymph node tissue samples were examined by mNGS. Differences in clinical characteristics were compared among different disease groups. The value of mNGS in diagnosing and improving the clinical situation was assessed. RESULTS Multivariate analysis revealed that hepatosplenomegaly and LDH levels were associated with infectious diseases. Arthralgia was correlated with non-infectious inflammatory diseases. Weight loss and a node located in supraclavicular region may indicate neoplastic diseases. mNGS-positive rate was 60.60%, higher than that obtained with traditional methods. Treatment for 3/4 patients was adjusted according to the pathogen detected by mNGS, and antibiotics uses was discontinued or degraded in over 1/2 of the patients according to mNGS results. CONCLUSIONS Clinical characteristics of children with lymphadenopathy related to FUO have limited diagnostic value for distinguishing different kinds of diseases, while mNGS of lymph node tissue serves as a useful tool for identifying infectious diseases, especially those caused by rare pathogens. mNGS results can lead to not only adjustments in targeted treatment but also further confirmation of underlying diseases. IMPACT STATEMENT 1. The clinical features of children with FUO and lymphadenopathy differ according to disease group,although multivariate analysis indicated little diagnostic value for these features. 2. mNGS on lymph node tissue from children with FUO may serve as a efficient tool for distinguishing infectious diseases from other diseases. This is especially useful when a diagnosis cannot be determined with traditional methods. 3. mNGS targeted treatment can be administered in a timely manner and some underlying diseases can be indicated.
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Affiliation(s)
- Yajuan Zhou
- Department of Infectious Diseases, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Nan Shen
- Department of Infectious Diseases, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Lijuan Luo
- Department of Infectious Diseases, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yandi Liu
- Department of Infectious Diseases, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Qing Cao
- Department of Infectious Diseases, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
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4
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Ryan K. Fever of Unknown Origin. Med Clin North Am 2024; 108:79-92. [PMID: 37951657 DOI: 10.1016/j.mcna.2023.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Fever of unknown origin in adolescents is a challenging disease state for which potential underlying etiology can include infectious, non-infectious inflammatory, and malignancy processes. Careful and thorough history (including exposure history), serial examination, and targeted laboratory and imaging testing is critical for these patients. In adolescents in which an etiology is discovered, infectious etiology remains the most prevalent, followed by non-infectious inflammatory diseases. In patients with non-diagnostic overall reassuring work up, the prognosis is typically self-limiting and favorable.
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Affiliation(s)
- Kathleen Ryan
- Infectious Disease, Department of Pediatric, Medical College of Wisconsin & Children's Hospital of Wisconsin, Suite C450, 999 North 92 nd Street, Wauwatosa, WI 53226, USA.
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Trapani S, Fiordelisi A, Stinco M, Resti M. Update on Fever of Unknown Origin in Children: Focus on Etiologies and Clinical Approach. CHILDREN (BASEL, SWITZERLAND) 2023; 11:20. [PMID: 38255334 PMCID: PMC10814770 DOI: 10.3390/children11010020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 12/14/2023] [Accepted: 12/21/2023] [Indexed: 01/24/2024]
Abstract
Fever of unknown origin (FUO) can be caused by four etiological categories of diseases. The most common cause of FUO in children is represented by infections, followed by inflammatory conditions and neoplastic causes; a decreasing quote remains still without diagnosis. Despite the fact that several diagnostic and therapeutic approaches have been proposed since the first definition of FUO, none of them has been fully validated in pediatric populations. A focused review of the patient's history and a thorough physical examination may offer helpful hints in suggesting a likely diagnosis. The diagnostic algorithm should proceed sequentially, and invasive testing should be performed only in select cases, possibly targeted by a diagnostic suspect. Pioneering serum biomarkers have been developed and validated; however, they are still far from becoming part of routine clinical practice. Novel noninvasive imaging techniques have shown promising diagnostic accuracy; however, their positioning in the diagnostic algorithm of pediatric FUO is still not clear. This narrative review aims to provide a synopsis of the existent literature on FUO in children, with its major causes and possible diagnostic workup, to help the clinician tackle the complex spectrum of pediatric FUO in everyday clinical practice.
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Affiliation(s)
- Sandra Trapani
- Department of Health Sciences, University of Florence, 50139 Florence, Italy
- Pediatric Unit, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy; (A.F.); (M.R.)
| | - Adele Fiordelisi
- Pediatric Unit, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy; (A.F.); (M.R.)
| | | | - Massimo Resti
- Pediatric Unit, Meyer Children’s Hospital IRCCS, 50139 Florence, Italy; (A.F.); (M.R.)
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Watts S, Diaz M, Teller C, Hamby T, Guirola R, Perez M, Eames G, Howrey R, Rios A, Trinkman H, Ray A. Pediatric Hemophagocytic Lymphohistiocytosis: Formation of an Interdisciplinary HLH Working Group at a Single Institution. J Pediatr Hematol Oncol 2023; 45:e328-e333. [PMID: 36729645 DOI: 10.1097/mph.0000000000002602] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 10/28/2022] [Indexed: 02/03/2023]
Abstract
Fever of unknown origin is a common presentation in children with an extensive differential diagnosis that encompasses multiple specialties. From a hematologic standpoint, the differential includes hyperinflammatory syndrome, such as hemophagocytic lymphohistiocytosis (HLH), among others. Due to the rarity of HLH and nonspecific symptoms at initial presentation, specialists are often consulted later in the disease progression, which complicates disease evaluation further. Cook Children's Medical Center (CCMC) has recently developed a multidisciplinary histiocytic disorder group that is often consulted on cases presenting with fever of unknown origin to increase awareness and potentially not miss new HLH cases. In this study, we examine the clinical presentation and workup of 13 patients consulted by the HLH work group at a single institution and describe the clinical course of 2 patients diagnosed with HLH. The goal of this project was to describe the formation of a disease-specific team and the development of a stepwise diagnostic approach to HLH. A review of the current diagnostic criteria for HLH may be warranted given findings of markers such as soluble IL2 receptor and ferritin as nonspecific and spanning multiple disciplines including rheumatology, infectious disease, and hematology/oncology.
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Affiliation(s)
- Shelley Watts
- Texas College of Osteopathic Medicine, University of North Texas Health Science Center
| | | | | | - Tyler Hamby
- Texas College of Osteopathic Medicine, University of North Texas Health Science Center
- Research Operations
| | | | | | | | | | - Ana Rios
- Pediatric Infectious Disease, Cook Children's Health Care System, Fort Worth, TX
| | | | - Anish Ray
- Departments of Pediatric Hematology/Oncology
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7
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Zhang P, Zhang ZH, Liang J, Shen DY, Li J, Wang D, Jin FF, Song H, Zhang JY, Xu WQ, Tang YM, Xu XJ. Metagenomic next-generation sequencing for the diagnosis of fever of unknown origin in pediatric patients with hematological malignancy. Clin Chim Acta 2022; 537:133-139. [DOI: 10.1016/j.cca.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 10/03/2022] [Accepted: 10/10/2022] [Indexed: 11/03/2022]
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8
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Yachie A. Clinical perspectives and therapeutic strategies: pediatric autoinflammatory disease-a multi-faceted approach to fever of unknown origin of childhood. Inflamm Regen 2022; 42:21. [PMID: 35778759 PMCID: PMC9250222 DOI: 10.1186/s41232-022-00204-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 02/27/2022] [Indexed: 11/25/2022] Open
Abstract
Among the different etiologies for fever of unknown origin in children, infectious diseases are the most frequent final diagnosis, followed by autoimmune diseases and malignancies. Autoinflammatory diseases are relatively rare among children and are frequently overlooked as differential diagnoses for fever of unknown origin. Once the possibility of a particular autoimmune disease is considered by physicians, the diagnosis might be easily made by a genetic approach because many of autoinflammatory diseases are of monogenic origin. To reach the diagnosis, detailed history-taking, precise physical examinations, and cytokine profiling as well as extensive mutation analysis of candidate genes should be undertaken for febrile children. Such the approach will protect the patients, and their family to undergo “diagnostic odyssey” in which unnecessary and sometimes risky diagnostic and therapeutic interventions are taken. This short review discusses the clinical and laboratory features of familial Mediterranean fever and systemic juvenile idiopathic arthritis, as representative illnesses of monogenic and polygenic autoinflammatory diseases, respectively. Cytokine profiling and mutation analyses both help to understand and decipher the heterogeneous pathologies in both disease categories.
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Affiliation(s)
- Akihiro Yachie
- Division of Medical Safety, Kanazawa University Hospital, 13-1 Takaramachi, Kanazawa, 920-8641, Japan.
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Hu B, Chen TM, Liu SP, Hu HL, Guo LY, Chen HY, Li SY, Liu G. Fever of unknown origin (FUO) in children: a single-centre experience from Beijing, China. BMJ Open 2022; 12:e049840. [PMID: 35296470 PMCID: PMC8928314 DOI: 10.1136/bmjopen-2021-049840] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To date, there is no standard diagnostic practice to identify the underlying disease-causing mechanism for paediatric patients suffering from chronic fever without any specific diagnosis, which is one of the leading causes of death in paediatric patients. Therefore, we aimed this retrospective study to analyse medical records of paediatric patients with fever of unknown origin (FUO) to provide a preliminary basis for improving the diagnostic categories and facilitate the treatment outcomes. DESIGN A retrospective study. SETTING Beijing Children's Hospital. PARTICIPANTS Clinical data were collected from 1288 children between 1 month and 18 years of age diagnosed with FUO at Beijing Children's Hospital between January 2010 and December 2017. INTERVENTIONS According to the aetiological composition, age, duration of fever and laboratory examination results, the diagnostic strategies were analysed and formulated. PRIMARY AND SECONDARY OUTCOME MEASURES The statistical analyses were carried out using SPSS V.24.0 platform along with the χ2 test and analysis of variance (p<0.05). RESULTS The duration of fever ranged from 2 weeks to 2 years, with an average of 6 weeks. There were 656 cases (50.9%) of infectious diseases, 63 cases (4.9%) of non-infectious inflammatory diseases (NIIDs), 86 cases (6.7%) of neoplastic diseases, 343 cases (26.6%) caused by miscellaneous diseases and 140 cases (10.9%) were undiagnosed. With increasing age, the proportion of FUO from infectious diseases gradually decreased from 73.53% to 44.21%. NIID was more common in children over 3 years old, and neoplastic diseases mainly occurred from 1 to 6 years of age. Among miscellaneous diseases, the age distribution was mainly in school-aged children over 6 years. Respiratory tract infection was the most common cause of FUO in children, followed by bloodstream infections. Bacterial infection was the most common cause in children with less than 1 year old, while the virus was the main pathogen in children over 1 year old. CONCLUSIONS The diagnosis of neoplastic diseases and miscellaneous diseases-related diseases still depends mainly on invasive examination. According to our clinical experience, the diagnostic process was formulated based on fever duration and the type of disease. This process can provide a guide for the diagnosis and treatment of paediatric FUO in the future.
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Affiliation(s)
- Bing Hu
- Department of Infectious Diseases, National Center for Children's Health, Beijing Children's Hospital Capital Medical University, Beijing, China
| | - Tian-Ming Chen
- Department of Infectious Diseases, National Center for Children's Health, Beijing Children's Hospital Capital Medical University, Beijing, China
| | - Shu-Ping Liu
- Department of Infectious Diseases, National Center for Children's Health, Beijing Children's Hospital Capital Medical University, Beijing, China
| | - Hui-Li Hu
- Department of Infectious Diseases, National Center for Children's Health, Beijing Children's Hospital Capital Medical University, Beijing, China
| | - Ling-Yun Guo
- Department of Infectious Diseases, National Center for Children's Health, Beijing Children's Hospital Capital Medical University, Beijing, China
| | - He-Ying Chen
- Department of Infectious Diseases, National Center for Children's Health, Beijing Children's Hospital Capital Medical University, Beijing, China
| | - Shao-Ying Li
- Department of Infectious Diseases, National Center for Children's Health, Beijing Children's Hospital Capital Medical University, Beijing, China
| | - Gang Liu
- Department of Infectious Diseases, National Center for Children's Health, Beijing Children's Hospital Capital Medical University, Beijing, China
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10
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Xu T, Wang L, Wu S, Zhou F, Huang H. Utility of a Simple Scoring System in Differentiating Bacterial Infections in Cases of Fever of Unknown Origin. Clin Infect Dis 2020; 71:S409-S415. [PMID: 33367576 DOI: 10.1093/cid/ciaa1520] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Infectious disease is the leading cause of fever of unknown origin (FUO). Serum inflammatory markers historically used to diagnose bacterial infection have sufficient diagnostic sensitivity but low specificity. This study aimed to develop a simple scoring system for differentiating bacterial infections from other causes of early-stage FUO. METHODS This study included a retrospective cohort of patients presenting with FUO at the Huashan Hospital (January 2014 to June 2017). The diagnostic utility of serum inflammatory markers for bacterial infection was evaluated using the receiver operating characteristic (ROC) curve analysis. Relevant markers were subsequently measured prospectively in a separate cohort of FUO patients (December 2017 to May 2019). A scoring system was based on inflammatory markers and other test results. RESULTS Bacterial infection was identified in 34% of patients in the retrospective cohort. The area under the ROC curve (AUC) was 0.644 (95% confidence interval [CI], .595-.693) for C-reactive protein, 0.624 (95% CI, .573-.675) for procalcitonin, and 0.646 (95% CI, .595-.697) for serum ferritin (SF) in diagnosing bacterial infection. Bacterial infection was found in 29% of cases in the prospective cohort. A model based on serum amyloid A (SAA) and SF levels and neutrophil percentage yielded an AUC of 0.775 (95% CI, .695-.854). Validation analysis indicated lower probability (<15%) of bacterial infection for patients with a score <16.5 points. CONCLUSIONS A scoring system based on SAA and SF levels and neutrophil percentage can help distinguish bacterial infection from other causes of FUO, potentially reducing antibiotic use.
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Affiliation(s)
- Teng Xu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.,Key Laboratory of Clinical Pharmacology of Antibiotics, National Health and Family Planning Commission, Shanghai, China
| | - Li Wang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.,Key Laboratory of Clinical Pharmacology of Antibiotics, National Health and Family Planning Commission, Shanghai, China
| | - Shi Wu
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.,Key Laboratory of Clinical Pharmacology of Antibiotics, National Health and Family Planning Commission, Shanghai, China
| | - Fenfen Zhou
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.,Key Laboratory of Clinical Pharmacology of Antibiotics, National Health and Family Planning Commission, Shanghai, China
| | - Haihui Huang
- Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China.,Key Laboratory of Clinical Pharmacology of Antibiotics, National Health and Family Planning Commission, Shanghai, China
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11
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Ko TM, Kiyotani K, Chang JS, Park JH, Yin Yew P, Chen YT, Wu JY, Nakamura Y. Immunoglobulin profiling identifies unique signatures in patients with Kawasaki disease during intravenous immunoglobulin treatment. Hum Mol Genet 2019; 27:2671-2677. [PMID: 29771320 PMCID: PMC6048982 DOI: 10.1093/hmg/ddy176] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 04/01/2018] [Accepted: 05/01/2018] [Indexed: 12/18/2022] Open
Abstract
Identifying the causes of high fever syndromes such as Kawasaki disease (KD) remains challenging. To investigate pathogen exposure signatures in suspected pathogen-mediated diseases such as KD, we performed immunoglobulin (Ig) profiling using a next-generation sequencing method. After intravenous Ig (IVIG) treatment, we observed disappearance of clonally expanded IgM clonotypes, which were dominantly observed in acute-phase patients. The complementary-determining region 3 (CDR3) sequences of dominant IgM clonotypes in acute-phase patients were commonly observed in other Ig isotypes. In acute-phase KD patients, we identified 32 unique IgM CDR3 clonotypes shared in three or more cases. Furthermore, before the IVIG treatment, the sums of dominant IgM clonotypes in IVIG-resistant KD patients were significantly higher than those of IVIG-sensitive KD patients. Collectively, we demonstrate a novel approach for identifying certain Ig clonotypes for potentially interacting with pathogens involved in KD; this approach could be applied for a wide variety of fever-causing diseases of unknown origin.
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Affiliation(s)
- Tai-Ming Ko
- Department of Medicine, University of Chicago, Chicago, Illinois, USA.,Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan.,Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Kazuma Kiyotani
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Jeng-Sheng Chang
- Department of Pediatrics, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Jae-Hyun Park
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Poh Yin Yew
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Yuan-Tsong Chen
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan.,Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
| | - Jer-Yuarn Wu
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan.,School of Chinese Medicine, China Medical University, Taichung, Taiwan
| | - Yusuke Nakamura
- Department of Medicine, University of Chicago, Chicago, Illinois, USA
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12
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Naito T, Tanei M, Ikeda N, Ishii T, Suzuki T, Morita H, Yamasaki S, Tamura J, Akazawa K, Yamamoto K, Otani H, Suzuki S, Kikuchi M, Ono S, Kobayashi H, Akita H, Tazuma S, Hayashi J. Key diagnostic characteristics of fever of unknown origin in Japanese patients: a prospective multicentre study. BMJ Open 2019; 9:e032059. [PMID: 31748308 PMCID: PMC6886908 DOI: 10.1136/bmjopen-2019-032059] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To identify the key diagnostic features and causes of fever of unknown origin (FUO) in Japanese patients. DESIGN Multicentre prospective study. SETTING Sixteen hospitals affiliated with the Japanese Society of Hospital General Medicine, covering the East and West regions of Japan. PARTICIPANTS Patient aged ≥20 years diagnosed with classic FUO (axillary temperature≥38.0°C at least twice within a 3-week period, cause unknown after three outpatient visits or 3 days of hospitalisation). A total of 141 cases met the criteria and were recruited from January 2016 to December 2017. INTERVENTION Japanese standard diagnostic examinations. OUTCOME MEASURES Data collected include usual biochemical blood tests, inflammatory markers (erythrocyte sedimentation rate (ESR), C reactive (CRP) protein level, procalcitonin level), imaging results, autopsy findings (if performed) and final diagnosis. RESULTS The most frequent age group was 65-79 years old (mean: 58.6±9.1 years). The most frequent cause of FUO was non-infectious inflammatory disease. After a 6-month follow-up period, 21.3% of cases remained undiagnosed. The types of diseases causing FUO were significantly correlated with age and prognosis. Between patients with and without a final diagnosis, there was no difference in CRP level between patients with and without a final diagnosis (p=0.121). A significant difference in diagnosis of a causative disease was found between patients who did or did not receive an ESR test (p=0.041). Of the 35 patients with an abnormal ESR value, 28 (80%) had causative disease identified. CONCLUSIONS Age may be a key factor in the differential diagnosis of FUO; the ESR test may be of value in the FUO evaluation process. These results may provide clinicians with insight into the management of FUO to allow adequate treatment according to the cause of the disease.
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Affiliation(s)
- Toshio Naito
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Mika Tanei
- Department of General Medicine, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Nobuhiro Ikeda
- Department of General Medicine, Eiju General Hospital, Tokyo, Japan
| | - Toshihiro Ishii
- Department of General Medicine, Oita University Faculty of Medicine, Oita, Japan
| | - Tomio Suzuki
- Department of General Medicine, Osaka Medical College Hospital, Osaka, Japan
| | - Hiroyuki Morita
- General Internal Medicine, Gifu University Graduate School of Medicine, Gifu, Japan
| | - Sho Yamasaki
- General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Jun'ichi Tamura
- General Medicine, Gunma University Graduate School of Medicine School of Medicine, Maebashi, Japan
| | - Kenichiro Akazawa
- Internal Medicine, Shonan Fujisawa Tokushukai Hospital, Fujisawa, Japan
| | | | - Hiroshi Otani
- General Medicine, Tachikawa Sogo Hospital, Tachikawa, Tokyo, Japan
| | - Satoshi Suzuki
- Division of General Medicine, Tone Chuo Hospital, Gunma, Japan
| | - Motoo Kikuchi
- Department of General Medicine, Nagoya City West Medical Center, Nagoya, Japan
| | - Shiro Ono
- General Medicine, Nara Medical University, Nara, Japan
| | | | - Hozuka Akita
- Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, Tamba, Japan
| | - Susumu Tazuma
- Department of General Internal Medicine, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan
| | - Jun Hayashi
- Kyushu General Internal Medicine Center, Haradoi Hospital, Fukuoka, Japan
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Yoshizato R, Koga H. Comparison of initial and final diagnoses in children with acute febrile illness: A retrospective, descriptive study: Initial and final diagnoses in children with acute fever. J Infect Chemother 2019; 26:251-256. [PMID: 31680036 DOI: 10.1016/j.jiac.2019.09.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/16/2019] [Accepted: 09/24/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND This study aimed to elucidate the etiologies and diagnostic errors of early-phase pediatric fever without an obvious cause. METHODS This single-center, retrospective, descriptive study included 1334 febrile children hospitalized at Beppu Medical Center in Japan between 2014 and 2018. Eligibility criteria were age ≤12 years, axillary temperature ≥38.0°C, and fever duration ≤7 days at admission. Initial diagnoses on the day of admission and final diagnoses at defervescence were divided into initial fever with identified source (FIS) and initial fever without source (FWS) and final FIS and final FWS, respectively. The etiology of initial FWS and diagnostic discordance between initial FIS and final FIS were investigated. RESULTS Of the 1334 participants, 94 (7.0%) were diagnosed with initial FWS. Among patients with initial FWS, final diagnoses were confirmed in 40 (43%), including Kawasaki disease in 17, urinary tract infection in 5, bacteremia in 4, exanthem subitum in 3, and the others in 11. Among the 1275 patients diagnosed with final FIS, diagnostic discordances between initial and final diagnoses were observed in 131 patients (10%). The multiple logistic regression analysis identified increased serum C-reactive protein value at admission (odds ratio [OR]: 1.09; 95% confidence interval [CI]: 1.06-1.13), exanthem subitum (OR: 409; 95% CI: 119-1399), and Kawasaki disease (OR: 14.3; 95% CI: 8.7-23.3) as independent risk factors for diagnostic discordance. CONCLUSION Exanthem subitum and Kawasaki disease may be undiagnosed or misdiagnosed in febrile children with fever duration ≤7 days.
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Affiliation(s)
- Rin Yoshizato
- Department of Pediatrics, National Hospital Organization Beppu Medical Center, 1473 Oaza-Uchikamado, Beppu, Oita, 874-0011, Japan.
| | - Hiroshi Koga
- Department of Pediatrics, National Hospital Organization Beppu Medical Center, 1473 Oaza-Uchikamado, Beppu, Oita, 874-0011, Japan.
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Jiang Y, Zhuo C, Huang J, Tan Y, Guan Y. Etiological distribution and clinical features of fever of unknown origin with pulmonary lesions in South China. CLINICAL RESPIRATORY JOURNAL 2019; 13:683-692. [PMID: 31364275 DOI: 10.1111/crj.13070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 04/19/2019] [Accepted: 07/01/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Fever of unknown origin (FUO) with pulmonary lesions is a common syndrome in respiratory diseases, which can be caused by infection, cancer, connective tissue disease and other rare diseases of South China. In patients with FUO associated with pulmonary lesions, pathogeny should be identified and followed by an appropriate treatment strategy. OBJECTIVE This study aimed to investigate the etiological distribution and clinical features of FUO with pulmonary lesions and to analyze the efficiency of different diagnostic methods for certain disease categories. METHODS Patients hospitalized at the Guangzhou Institute of Respiratory Health from July 2012 to December 2016 who had fever ≥38.3°C that lasted ≥21 days, in whom the chest X-ray or computed tomography (CT) revealed definite pulmonary infiltration, and for whom, despite being examined for a week, no definitive diagnosis could be made, were considered for this study. RESULTS A total of 104 patients were identified as having FUO with lung lesions, and 89.4% (93/104) patients were definitively diagnosed. Infectious disease was the most common cause (46.2%, 48/104). Histopathology was instrumental in the diagnosis of the causes of FUO with pulmonary manifestations, 47.3% (44/93) patients were diagnosed through histopathology, 35.4% (17/48) with infectious disease and 55.2% (16/29) with connective tissue diseases as the etiology were definitely diagnosed using histopathology. CONCLUSION Most FUO with pulmonary lesions are identified during infections and autoimmune diseases. The most important diagnostic measure for FUO with pulmonary lesions is histopathology. Additionally, lung biopsy must be encouraged in multi-level hospitals in the future.
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Affiliation(s)
- Ying Jiang
- The State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Chao Zhuo
- The State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Junting Huang
- The State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yunfang Tan
- The State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yubao Guan
- The State Key Laboratory of Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
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15
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Abstract
Unexplained fever is one of the most common and difficult diagnostic problems faced daily by clinicians. This study evaluated the differences in health service utilization, health care expenditures, and quality of care provided to patients with unexplained fever before and after global budget (GB) implementation in Taiwan.The National Health Insurance Research Database was used for analyzing the health care expenditures and quality of care before and after implementation of the GB system. Patients diagnosed as having unexplained fever during 2000-2001 were recruited; their 2000-2001 and 2004-2005 data were considered baseline and postintervention data, respectively.Data of 259 patients with unexplained fever were analyzed. The mean lengths of stay (LOSs) before and after GB system implementation were 4.22 ± 0.35 days and 5.29 ± 0.70 days, respectively. The mean costs of different health care expenditures before and after implementation of the GB system were as follows: the mean diagnostic, drug, therapy, and total costs increased respectively from New Taiwan Dollar (NT$) 1440.05 ± NT$97.43, NT$3249.90 ± NT$1108.27, NT$421.03 ± NT$100.03, and NT$13,866.77 ± NT$2,114.95 before GB system implementation to NT$2224.34 ± NT$238.36, NT$4272.31 ± NT$1466.90, NT$2217.03 ± NT$672.20, and NT$22,856.41 ± NT$4,196.28 after implementation. The mean rates of revisiting the emergency department within 3 days and readmission within 14 days increased respectively from 10.5% ± 2.7% and 8.3% ± 2.4% before implementation to 6.3% ± 2.2% and 4.0% ± 1.7% after implementation.GB significantly increased LOS and incremental total costs for patients with unexplained fever; but improved the quality of care.
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Affiliation(s)
- Keh-Sen Liu
- Department of Infectious Diseases, Show Chwan Memorial Hospital, Changhua
| | - Tsung-Fu Yu
- Institute of Biomedical Sciences, Academia Sinica, Nankang District, Taipei
| | - Hsing-Ju Wu
- Research Assistant Center, Show Chwan Memorial Hospital, Changhua
- Department of Medical Research, Chang Bing Show Chwan Memorial Hospital, Lukang Town, Changhua County
| | - Chun-Yi Lin
- Department of Nursing, DaYeh University, Dacun, Changhua
- Department of Nuclear Medicine, Show Chwan Memorial Hospital, Changhua
- Department of Nuclear Medicine, Chang Bing Show Chwan Memorial Hospital, Lukang Town, Changhua County, Taiwan
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Yang TI, Chang TH, Lu CY, Chen JM, Lee PI, Huang LM, Chang LY. Mycoplasma pneumoniae in pediatric patients: Do macrolide-resistance and/or delayed treatment matter? JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2018; 52:329-335. [PMID: 30341022 DOI: 10.1016/j.jmii.2018.09.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 09/03/2018] [Accepted: 09/18/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mycoplasma pneumoniae is a common pathogen for pneumonia in children, especially in the post-pneumococcal conjugate vaccination era. Though self-limited disease was found in the majority of the patients, severe diseases occurred occasionally. The emergence of macrolide resistance was reported worldwide. It is important to delineate whether macrolide resistance or delayed treatment affects outcome. METHODS We retrospectively collected pediatric patients with M. pneumoniae infection confirmed by positive PCR in a tertiary medical center in Taiwan from 2010 to 2017. Patients' clinical characteristics, bacterial load, macrolide resistance and treatment outcome were analyzed. RESULTS Among 471 children with positive M. pneumoniae PCR, 95% were diagnosed with pneumonia. Seventeen percent of patients had extrapulmonary complications, and 1.5% had respiratory failure. Delayed treatment was associated with prolonged fever after appropriate treatment, fulminant disease, and extrapulmonary manifestations (p < 0.05). The mean rate of macrolide resistance was 24% and macrolide resistance was related to longer febrile duration, longer hospital stay, lung consolidation and impaired liver function tests (P < 0.05). CONCLUSIONS Macrolide resistance was fairly common and might lead to delayed appropriate antibiotic treatment. Delayed appropriate antimicrobial treatment, no matter macrolide resistance or not, was associated with more severe and/or prolonged diseases. Early diagnosis of M. pneumoniae as well as the awareness of macrolide resistance make early effective antibiotic treatment possible and may improve clinical outcomes.
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Affiliation(s)
- Tzu-I Yang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Tu-Hsuan Chang
- Department of Pediatrics, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chun-Yi Lu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Jong-Min Chen
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Ping-Ing Lee
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Li-Min Huang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan
| | - Luan-Yin Chang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, Taipei, Taiwan.
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Anti-Epstein-Barr virus antibodies in Beijing during 2013-2017: What we have found in the different patients. PLoS One 2018; 13:e0193171. [PMID: 29494658 PMCID: PMC5832223 DOI: 10.1371/journal.pone.0193171] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 02/06/2018] [Indexed: 12/11/2022] Open
Abstract
Background Epstein–Barr virus (EBV) is associated with nasopharyngeal carcinoma (NPC) which is prevalent in South China, and its association with systemic lupus erythematosus (SLE) or other autoimmune diseases has not been studied in the mainland of China. The EBV serological tests have been performed on patients with various diseases or manifestations for years at our institution and their values need to be evaluated. Methods For routine medical purposes, anti-EB viral capsid antigen (VCA) IgG, IgA and IgM antibodies, anti-EBV diffuse early antigen (EA-D) IgA antibodies, and anti-EBV nuclear antigen-1(EBNA-1) IgG antibodies were tested with commercial enzyme-linked immunosorbent assay (ELISA) in patients visiting Peking Union Medical College Hospital between 2013 and 2017. The test results were analyzed in this retrospective study. Results There were a total of 11122 serum samples available to be tested in the study. As indicators of past EBV infection, the prevalence of VCA-IgG/EBNA1-IgG were 66.6%/58.5%, 84.3%/78.8%, 92.9%/87.0% and 98.5%/95.4% in patients aged under 5 years, 6–10 years, 11–20 years and 21–30 years old, respectively, and these values maintained at this highest rate as age increased further. The prevalence of VCA-IgM, as a parameter of acute EBV infection, was 14.6%, 10.2%, 10.4%, 6.3% and 3.1% in patients aged under 5 years, 6–10 years,11–20 years, 21–30 years, 31–40 years old, respectively, and decreased to 2%~3% in older patients. Patients with elevated serum liver enzymes were more likely to have a higher prevalence of EA/D IgA antibody (P < 0.01) and young patients (≤30 years) with lymphadenopathy were more likely to have higher prevalence of VCA-IgM antibody (P < 0.01). The prevalence of VCA-IgA and EAD-IgA were 87.0% and 59.2% in NPC patients, respectively, and both were significantly higher (P < 0.001) than that in non-NPC patients. The prevalence of VCA-IgA was 45.4% and 25.6% in SLE patients and patients with other autoimmune diseases, respectively, which were significantly (P < 0.001) and mildly (P = 0.039) higher than their controls. In pediatric SLE patients between 6 and10 years old, the prevalence of VCA-IgG, VCA-IgA and EBNA1-IgG was 100%, 59.5% and 100%, respectively, all being significantly higher than the age (6-10y) related controls (P< 0.01). In the 705 cerebral spinal fluid (CSF) specimens, VCA-IgG, VCA-IgM, VCA-IgA and EAD-IgA were found to be positive in 12.1%, 0.15%, 0.25% and 0.25%, respectively. There were 157 paired specimens (CSF and serum were collected simultaneously) and VCA-IgG was identified as positive in 12.7% of the CSF and 100% of the serum specimens. Conclusions Around 98% of Chinese patients were infected with EBV before 30 years of age and the highest rate of acute EBV infection were observed in patients under 5 years old. EBV infection was found to be associated with elevated serum liver enzymes, NPC and SLE. Acute anti-EBV antibody was valued for young patients with lymphadenopathy but limited value for CNS neuropathy.
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Kim YS, Kim KR, Kang JM, Kim JM, Kim YJ. Etiology and clinical characteristics of fever of unknown origin in children: a 15-year experience in a single center. KOREAN JOURNAL OF PEDIATRICS 2017; 60:77-85. [PMID: 28392823 PMCID: PMC5383636 DOI: 10.3345/kjp.2017.60.3.77] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 10/23/2016] [Accepted: 10/25/2016] [Indexed: 11/27/2022]
Abstract
Purpose Fever is one of the most common symptoms in children. In previous studies, infectious disease was the most common cause of pediatric fever of unknown origin (FUO). The aim of this study is to investigate the etiology, clinical characteristics and prognosis of pediatric FUO in 21 century with more diagnostics available and to analyze the factors for certain disease categories. Methods Among the children under 18 years old who were hospitalized at Samsung Medical Center from January 2000 to December 2014, the patients who met the criteria including fever of ≥38.0℃ for longer than ≥14 days and failure to reach a diagnosis after one week of investigations were included. Results Total 100 patients were identified. Confirmed diagnosis was achieved in 57 patients (57%). Among them, infectious diseases (n=19, 19%) were most common, followed by connective tissue diseases (n=15, 15%), necrotizing lymphadenitis (n=8, 8%), and malignancies (n=7, 7%). Children with fever duration over 28 days had a trend for higher frequency of connective tissue diseases (28.3%) except undiagnosed etiology. The symptoms such as arthritis, lymph node enlargement and only fever without other symptoms were significantly related with connective tissue diseases, necrotizing lymphadenitis and undiagnosed respectively (P<0.001). Ninety-two patients have become afebrile at discharge and 1 patient died (1%). Conclusion Almost half of our patients were left without diagnosis. Although it has been known that infectious disease was most common cause of pediatric FUO in the past, undiagnosed portion of FUO have now increased due to development of diagnostic techniques for infectious diseases.
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Affiliation(s)
- Yi-Seul Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyung-Ran Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji-Man Kang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong-Min Kim
- Department of Pediatrics, Myoungji Hospital, Seonam University College of Medicine, Goyang, Korea
| | - Yae-Jean Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Chien YL, Huang FL, Huang CM, Chen PY. Clinical approach to fever of unknown origin in children. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2015; 50:893-898. [PMID: 27143687 DOI: 10.1016/j.jmii.2015.08.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 08/07/2015] [Accepted: 08/20/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND/PURPOSE Fever of unknown origin (FUO) can be caused by many clinical conditions and remains a diagnostic challenge in clinical practice. The etiology of FUO varies markedly among different age groups, geographic areas, and seasons. A four-stage investigative protocol for FUO is widely applied in clinical practice. The aim of this study was to evaluate the usefulness of this four-stage protocol for identifying the etiology of FUO in children. METHODS We enrolled children younger than 18 years of age who were admitted to the Taichung Veterans General Hospital during the period from January 2006 to December 2014 with FUO persisting for more than 3 weeks. The four-stage FUO investigative guideline was used to evaluate the etiology of fever in all patients enrolled in the study. RESULTS The etiology of FUO was identified in 79 (84.9%) of the 93 patients enrolled in the study. The most common cause of FUO was infectious disease (37.6%), followed by malignancy (17.2%), miscellaneous disease (16.1%), and collagen vascular disease (14.0%). With respect to the four-stage survey of FUO, 36 of the 79 patients (45.6%) were identified in Stage 3, 28 patients (35.4%) in Stage 2, 13 patients (16.5%) in Stage 4, and only two patients (2.5%) in Stage 1. CONCLUSION A well-designed systemic review of the epidemiological information, medical history, physical examination, laboratory analysis, and adequate invasive procedures provide adequate data to identify the most common causes of FUO in children.
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Affiliation(s)
- Ya-Li Chien
- Section of Pediatric Infectious Disease, Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Pediatrics, Lin Shin Medical Corporation Lin Shin Hospital, Taichung, Taiwan
| | - Fang-Liang Huang
- Section of Pediatric Infectious Disease, Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chung-Ming Huang
- Section of Pediatric Infectious Disease, Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Po-Yen Chen
- Section of Pediatric Infectious Disease, Department of Pediatrics, Taichung Veterans General Hospital, Taichung, Taiwan.
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