総合診療科における不明熱患者215症例の解析  [in Japanese] An analysis of the 215patients with fever of unknown origin  [in Japanese]

Author(s)

Abstract

目的:特定の診療科を決めかねる病態として不明熱がある.順天堂大学医学部附属順天堂医院総合診療科を初診し入院を要した不明熱患者215症例について,今後の診断の参考とするためその特徴を解析し検討した.対象および方法:1994年10月から2004年8月までに当科を初診し,入院治療が必要となった成人の原因不明の発熱患者215名について検討した.対象患者の発熱の原因を疾患別に分類し検討した.また,65歳以上の高齢者と65歳未満の非高齢者での原因疾患について比較を行った.結果:原因疾患として,感染症が102名(47.4%),非感染性炎症性疾患が40名(18.6%),悪性疾患が14名(6.5%),その他の疾患が21名(9.8%),原因不明が38名(17.7%)であった.頻度の高かった伝染性単核球症・髄膜炎・深部膿瘍・感染性心内膜炎の中で,初診時の平均年齢は深部膿瘍で有意に高く,平均体温は伝染性単核症で有意に低かった.65歳以上の高齢者では65歳未満の患者に比較し,感染症を原因とする不明熱の割合が低く,原因不明の症例が多かった.85歳以上の超高齢者も7名含まれた.考察:不明熱の原因の約半数は感染症であった.特に,伝染性単核球症・感染性心内膜炎・深部膿瘍・髄膜炎の頻度が高く注意が必要である.HIV関連不明熱・麻疹・風疹の患者も比較的多く認められた.悪性腫瘍は多岐に渡ったが,画像検査の普及や進歩のため不明熱の原因となることは少なくなっており,過去の報告に比べ割合が低下していた.7症例は診断確定までに60日以上を要しており,周期的な発熱のみを症状とし,診断の手掛かりが得られ難かった症例であった.この中で死亡後に病理解剖により原疾患が判明した患者が2名おり,共に悪性リンパ腫と診断された.不明熱患者の診断には,感染症を中心とした多疾患にわたる知識が必要であると考えられた.

Objective : Idiopathic fever is one of the symptoms for which it is difficult to determine which department should treat the patient. We analyzed and reviewed the characteristics of 215patients with idiopathic fever who required hospitalization after their first visits to the Department of General Medicine, Juntendo University School of Medicine in order to obtain useful information to facilitate diagnosis of future cases. Subjects and methodology : The subjects were 215 adult patients with idiopathic fever who required hospitalization for treatment after an initial visit to our department, between october 1994 and August 2004. We classified the causes of fever by disease that was eventually diagnosed. We also compared the elderly population aged 65 or older and the younger population under 65 years in terms of causal diseases. Results : The causal diseases were infections (102 patients, 47.4%), non-infectious inflammatory diseases (40, 18.6%), malignant diseases (14, 6.5%) .other diseases (21, 9.8%)and idiopathic diseases (38, 17.7%). Among the most frequent causal diseases, namely, infectious mononucleosis, meningitis, deep abscess, and infectious endocarditis, the mean patient age at initial consultation was significantly higher for deep abscess and the mean body temperature was significantly lower for infectious mononucleosis. In the population with idiopathic fever, the ratio of patients with infections was lower and that of patients with undetermined causes was higher in the group aged 65 or older in comparison with the group under 65 years. Seven patients were very old (85 or older). Discussion : Infections were diagnosed in about half of the cases of idiopathic fever. Infectious mononucleosis , infectious endocarditis, deep abscess, and meningitis were particularly frequent, requiring close attention. HIV-related fever of unknown origin, measles, and rubella were relatively frequent as causal diseases. Malignant tumors were wide-ranging, but these lesions now cause fewer cases of idiopathic fever because of the widespread use and advancement of diagnostic imaging systems. The ratio of malignant tumors has decreased from the levels in the past. In 7patients, 60 or more days were required before determination of diagnosis, because periodic fever was their only symptom and other clues for diagnosis were difficult to obtain. The underlying dis-ease in 2 of these oatients was not identified until pathologic autopsy , and both were found to have malignant lymphoma. Diagnosis of idiopathic fever requires knowledge centered on infections and covering a wide range of diseases.

Journal

  • Juntendo medical journal

    Juntendo medical journal 51(2), 167-173, 2005-06-30

    Juntendo University

References:  18

Cited by:  1

Codes

  • NII Article ID (NAID)
    110004616617
  • NII NACSIS-CAT ID (NCID)
    AN00113194
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • Journal Type
    大学紀要
  • ISSN
    00226769
  • NDL Article ID
    7416773
  • NDL Source Classification
    ZS7(科学技術--医学)
  • NDL Call No.
    Z19-432
  • Data Source
    CJP  CJPref  NDL  NII-ELS 
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