Skip to main content

Advertisement

SpringerLink
Log in

Prospective evaluation of fever of unknown origin in patients infected with the human immunodeficiency virus

  • Article
  • Published:
European Journal of Clinical Microbiology and Infectious Diseases Aims and scope Submit manuscript

Abstract

The aim of this study was to determine the frequency and aetiology of fever of unknown origin (FUO) in patients infected with the human immunodeficiency virus (HIV), to assess the value of the tests used in its diagnosis, and to evaluate possible models of diagnosis for the causes found most frequently. One hundred twenty-eight (3.5%) of 3603 hospitalised HIV-positive patients evaluated from October 1992 to December 1993 had FUO, defined by established criteria. Eighty-six percent of patients with FUO had previously progressed to AIDS. The median CD4+ cell count was 46/mm3. A definite diagnosis was made in 96 (75%) of the 128 patients and a possible diagnosis in 24 (18.7%), whilst no diagnosis was made in eight cases (6.2%). Tuberculosis (48.3%), visceral leishmaniasis (16%), and infection byMycobacterium avium complex (6.9%) were the diseases found most frequently. The most useful diagnostic tests were liver biopsy (68.9%) and bone marrow aspirate/biopsy (39.7%). It is not possible to predict clinically the cases of FUO due to tuberculosis, whilst thrombocytopaenia < 100,000 cells/mm3 alone is useful for differentiating the cases of visceral leishmaniasis, with a negative predictive value of 95.2%.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Durack DT, Street AC: Fever of unknown origin: reexamined and redefined. In: Remington JS, Swartz MN (ed): Current topics in infectious diseases. Blackwell Scientific Publications, Boston, 1991, p. 35–51.

    Google Scholar 

  2. Sullivan M, Feinberg J, Bartlett JG: Fever in patients with HIV infection. Infectious Disease Clinics of North America 1996, 10: 149–165.

    PubMed  Google Scholar 

  3. Sepkowitz KA, Telzak EE, Carrow M, Armstrong D: Fever among outpatients with advanced human immunodeficiency virus infection. Archives of Internal Medicine 1993, 153: 1909–1912.

    PubMed  Google Scholar 

  4. Petersdorf RG, Beeson PB: Fever of unexplained origin: report on 100 cases. Medicine 1961, 40: 1–30.

    PubMed  Google Scholar 

  5. Genne D, Chave JP: Glauser MP: Fever of unknown origin in a cohort of HIV-positive patients. Schweizerische Medizinische Wochenschrift 1992, 122: 1797–1802.

    PubMed  Google Scholar 

  6. Bissuel F, Leport C, Peronne C, Longuet P, Vilde JL: Fever of unknown origin in HIV-infected patients: a critical analysis of a retrospective series of 57 cases. Journal of Internal Medicine 1994, 236: 529–535.

    PubMed  Google Scholar 

  7. Miralles P, Moreno S, Pérez-Tascón M, Cosín J, Díaz MD, Bouza E: Fever of uncertain origin in patients infected with the human immunodeficiency virus. Clinical Infectious Diseases 1995, 20: 872–875.

    PubMed  Google Scholar 

  8. Centers for Disease Control: 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. Morbidity and Mortality Weekly Report 1992, 41 (RR-17): 1–19.

    Google Scholar 

  9. Bouza E, Martín-Scapa C, Bernardo de Quirós JC, Martínez-Hernández D, Menárquez J. Gómez-Rodrigo J, Cosín J, Sagues-Cifuentes MJ: High prevalence of tuberculosis in AIDS patients in Spain. European Journal of Clinical Microbiology & Infectious Diseases 1988, 7: 785–788.

    Google Scholar 

  10. Laguna F, Adrados M, Díaz F, Martínez R, García-Aguado C, Puente S, González-Lahoz JM: AIDS and tuberculosis in Spain. A report of 140 cases. Journal of Infection 1991, 23: 139–144.

    PubMed  Google Scholar 

  11. Raviglione MC, Sudre P, Rieder HL, Spinaci S, Kochi A: Secular trends of tuberculosis in western Europe: epidemiological situation in 14 countries. Bulletin of the World Health Organization 1993, 71: 297–306.

    PubMed  Google Scholar 

  12. Vigilancia epidemiológica del SIDA en España: Informe trimestral 4/94. Registro Nacional de Casos de SIDA. Centra Nacional de Epidemiología. Instituto de Salud Carlos III, Madrid. Publicación Oficial de la Sociedad Espanola Interdisciplinaria del SIDA 1995, 6: 412–423.

    Google Scholar 

  13. Reichman LB, Felton CP, Edsall JR: Drug dependence, a possible new risk factor for tuberculosis disease. Archives of Internal Medicine 1979, 139: 337–339.

    PubMed  Google Scholar 

  14. Selwyn PA: Tuberculosis in the AIDS era: a new threat from an old disease. New York State Journal of Medicine 1991, 91: 233–235.

    PubMed  Google Scholar 

  15. Soriano E, Mallolas J, Gatell JM, Latorre X, Miró JM, Pecchiar M, Mensa J, Trilla A, Moreno A: Characteristics of tuberculosis in HIV-infected patients: a case-control study. AIDS 1988, 2: 429–432.

    PubMed  Google Scholar 

  16. Shafer RW, Kim DS, Weiss JP, Quale JM: Extrapulmonary tuberculosis in patients with human immunodeficiency virus infection. Medicine 1991, 70: 384–397.

    PubMed  Google Scholar 

  17. Hopewell PD: Impact of human immunodeficiency virus infection on the epidemiology, clinical features, management, and the control of tuberculosis. Clinical Infectious Diseases 1992, 15: 540–547.

    PubMed  Google Scholar 

  18. Llibre JM, Tor J, Manterola JM, Carbonell C, Roset J: Risk stratification for dissemination of tuberculosis in HIV-infected patients. Quarterly Journal of Medicine 1992, 82: 149–157.

    PubMed  Google Scholar 

  19. Kramer F, Modilevsky T, Waliany AR, Leedom JM, Barnes PF: Delayed diagnosis of tuberculosis in patients with human immunodeficiency virus infection. American Journal of Medicine 1990, 89: 451–456.

    PubMed  Google Scholar 

  20. Long R, Maycher B, Scalcini M, Manfreda J: The chest roentgenogram in pulmonary tuberculosis patients seropositive for human immunodeficiency virus type 1. Chest 1991, 99: 123–127.

    PubMed  Google Scholar 

  21. Pedro-Botet J, Gutiérrez J, Miralles R, Coll J, Rubiés-Prat J: Pulmonary tuberculosis in HIV-infected patients with normal chest radiographs. AIDS 1992, 6: 91–93.

    PubMed  Google Scholar 

  22. Barnes PT, Bloch AB, Davidson PT, Snider DE Jr: Tuberculosis in patients with human immunodeficiency virus infection. New England Journal of Medicine 1991, 324: 1645–1650.

    Google Scholar 

  23. Medrano FJ, Hernández-Quero J, Jiménez-Mejías ME, Pineda JA, Rivero A, Sánchez-Quijano A, Vélez ID, Viciana P, Castillo R, Reyes MJ, Carvajal F, Leal M, Lissen E: Visceral leishmaniasis in HIV-1 infected people: a common opportunistic infection in Spain? AIDS 1992, 6: 1499–1503.

    PubMed  Google Scholar 

  24. Berenguer J, Moreno S, Cercenado E, Bernardo de Quiros JCL, García de la Fuente A, Bouza E: Visceral leishmaniasis in patients infected with the human immunodeficiency virus (HIV). Annals of Internal Medicine 1989, 111: 129–132.

    PubMed  Google Scholar 

  25. Montalban C, Martínez-Fernández R, Calleja JL, García-Díaz JD, Rubio R, Dronda F, Moreno S, Yebra M, Barros C, Cobo J: Visceral leishmaniasis (Kala-Azar) as an opportunistic infection in patients infected with the human immunodeficiency virus in Spain. Reviews of Infectious Diseases 1989, 11: 655–660.

    PubMed  Google Scholar 

  26. Bollinger RC, Quinn TC: Tropical diseases in the HIV-infected traveler. In: Broder S, Merigan TC Jr, Bolognesi D (ed): Textbook of AIDS medicine. Williams & Wilkins, Baltimore, 1994, p. 311–322.

    Google Scholar 

  27. Zurlo JJ, Feverstein IM, Lebovics R, Lane HC: Sinusitis in HIV infection. American Journal of Medicine 1992, 93: 157–170.

    PubMed  Google Scholar 

  28. Godofsky EW, Zinreich J, Armstrong M, Leslie JM, Weikel CS: Sinusitis in HIV infected patients: a clinical and radiographic review. American Journal of Medicine 1992, 93: 163–170.

    PubMed  Google Scholar 

  29. Holtz H, Lavery D, Kapila R: Actinomycetales infection in the acquired immunodeficiency syndrome. Annals of Internal Medicine 1985, 102: 203–205.

    PubMed  Google Scholar 

  30. Ungar BLP:Cryptosporidium and cryptosporidiosis. In: Broder S, Merigan TC Jr, Bolognesi D (ed): Textbook of AIDS medicine. Williams & Wilkins, Baltimore, 1994, p. 323–343.

    Google Scholar 

  31. Prego V, Glatt AE, Roy V, Thelmo W, Dincsoy H, Raufman JP: Comparative yield of blood culture for fungi and mycobacteria, liver biopsy and bone marrow biopsy in the diagnosis of fever of undetermined origin in human immunodeficiency virus infected patients. Archives of Internal Medicine 1990, 150: 333–336.

    PubMed  Google Scholar 

  32. Cappell MS, Schwartz MS, Biempica L: Clinical utility of liver biopsy in patients with serum antibodies to the human immunodeficiency virus. American Journal of Medicine 1990, 88: 123–130.

    PubMed  Google Scholar 

  33. Cavicchi M, Pialoux G, Carnot F, Offredo C, Romana D, Deslandes P, Dupont B, Berthelot P, Pol S: Value of liver biopsy for the rapid diagnosis of infection in human immunodeficiency virus infected patients who have unexplained fever and elevated serum levels of alkaline phosphatase or gammaglutamyl transferase. Clinical Infectious Diseases 1995, 20: 606–610.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Infectious Diseases Section, Hospital Universitario de Valme, Autovía de Cádiz s/n, 41014, Seville, Spain

    F. Lozano & J. Polo

  2. Hospital Universitario Reina Sofía, Cordoba, Spain

    J. Torre-Cisneros

  3. Hospital Universitario Puerta del Mar, Cádiz, Spain

    A. Bascuñana

  4. Hospital Universitario Virgen del Rocío, Seville, Spain

    P. Viciana

  5. Hospital Regional Carlos Haya, Málaga, Spain

    M. A. García-Ordóñez

  6. Hospital Clinico Universitario, Granada, Spain

    J. Hernández-Quero

  7. Hospital Universitario Virgen de la Victoria, Málaga, Spain

    M. Márquez

  8. Hospital Universitario de Puerto Real, Spain

    A. Vergara

  9. Hospital Torrecárdenas, Almería, Spain

    F. Díez

  10. Hospital Juan Ramón Jiménez, Huelva, Spain

    E. Pujo

  11. Hospital Punta de Europa, Algeciras, Spain

    M. Torres-Tortosa

  12. Hospital Virgen de las Nieves, Granada, Spain

    J. Pasquau

  13. Hospital General, Jaén, Spain

    J. J. Hernández-Burruezo

  14. Hospital Infanta Elena, Huelva, Spain

    I. Suárez

Authors
  1. F. Lozano
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Torre-Cisneros
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Bascuñana
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. J. Polo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. P. Viciana
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. A. García-Ordóñez
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J. Hernández-Quero
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. M. Márquez
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. A. Vergara
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. F. Díez
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. E. Pujo
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. M. Torres-Tortosa
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. J. Pasquau
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. J. J. Hernández-Burruezo
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. I. Suárez
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

Grupo Andaluz para el Estudio de las Enfermedades Infecciosas

Rights and permissions

Reprints and permissions

About this article

Cite this article

Lozano, F., Torre-Cisneros, J., Bascuñana, A. et al. Prospective evaluation of fever of unknown origin in patients infected with the human immunodeficiency virus. Eur. J. Clin. Microbiol. Infect. Dis. 15, 705–711 (1996). https://doi.org/10.1007/BF01691956

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01691956

Keywords

Search

Navigation