1998년부터 2003년까지 일개 대학 병원에서 관찰된 성인 불명열 환자의 원인
Etiology of Adult Patients with Fever of Unknown Origin (FUO) Observed in A University Hospital in Korea from 1998-2003
1
조회
0
다운로드
4
인용
0
참고문헌
초록
목 적 : 진단기법의 발전으로 불명열의 원인질환의 범주가 시간이 경과하면서 그동안 알려졌던 원인들과 다른 경향을 보인다는 보고들이 국내외에서 제시되어 비교적 최근 불명열을 진단받은 환자들의 원인질환의 경향을 분석하고자 하였다. 재료 및 방법 : 1998년 1월부터 2003년 7월까지 6년 반 동안 고려대학교 의료원 구로병원에 내원한 성인 환자 중 고전적 불명열로 진단된 73명의 의무기록을 열람하여 후향적인 연구를 통해 불명열의 원인 질환 및 최종 진단 방법을 파악하였다. 결 과 : 대상 환자 69명 중 불명열의 원인 중 감염질환에 의한 경우는 모두 22명(31.9%)이었으며 비감염성 염증질환은 모두 8명(11.6%) 이었고 종양에 의한 불명열은 모두 3명(4.3%)였으며 그 외의 원인들에 의한 불명열은 모두 21명(30.4%), 진단을 내릴 수 없는 경우는 총 15명으로서 전체의 21.7%이었다. 감염 중에는 폐외결핵 5명(7.3 %), 속립결핵 2명(2.9%), 폐결핵 1명(1.5%)으로 결핵이 제일 많았으며, 비감염성 염증 질환은 성인형 스틸씨 병이 3명(4.4%)으로 가장 많았고, 기타 원인중에는 약물에 의한 발열이 모두 13명(18.8%)로 가장 많았다. 최종 진단을 가능하게 한 방법으로는 임상적 진단이 35명(64.8%)으로 가장 많았고 방사선학적 검사가 10명 (18.5%)으로 그 다음이었으며 혈청학적 검사 5명(9.3%), 조직검사 4명(7.4%) 순이었고, 배양검사로 진단한 경우는 한 명도 없었다. 결 론:감염질환이 불명열의 가장 흔한 원인이 되고 있으며 이 가운데 결핵의 빈도가 가장 높고 임상 경과의 관찰로 진단을 하는 경우가 가장 많으므로 이에 대한 지각을 가지고 불명열 환자에게 접근해야겠다.
Abstract
Background : Due to advances in various diagnostic methods, recent studies reported changes in the pattern of etiology of fever of unknown origin (FUO). To identify the current pattern of the causes of FUO, we analyzed the etiology of recently diagnosed FUO at a university hospital in Korea. Materials and Methods : We reviewed 69 cases that fulfilled the criteria of classic FUO and retrospectively analyzed the etiology and decisive methods of diagnosis. Results : The etioloies of FUO were infectious disease, non-infectious inflammatory disease, malignancy and miscellaneous cases in 22 (31.9%), 8 (11.6%), 4 (2.3%) and 21 (30.4%) patients, respectively. In 15 (21.7%) cases the cause could not be identified. Among infectious diseases, tuberculosis and suspected typhoid fever were the most common causes of infection (8 case, 11.7%) with tuberculosis being the most common confirmed infection. Adult onset Still‘s disease (13 cases, 4.4%) and drug-related fever (13 cases, 18.8%) were the most common cause of non-infectious inflammatory disease and miscellaneous causes, respectively. Decisive methods of final diagnosis were by observation of clinical course in 35 (64.8%), radiologic examination in 10 (18.5%), serologic or biochemical test in 5 (9.3%) and tissue biopsy in 4 (7.4%); none were diagnosed by culture. Conclusion : Infection remains the most common etiology of classic FUO in Korea and observing the clinical course is the most commonly used method for decisive diagnosis and its importance should be emphasized in approaching patients with FUO.
참고문헌 (34)
- "Fever of unexplained origin report on 100 cases", pp.1~30 (1961)
- "Fever of unknown origin", diag(sis and treatment 8), pp.1302~6 (1988)
- "Fever of unknown origin", 350, pp.575~80 (1997)
- "Fever of unknown origin in adults: 40 years on.", 253, pp.263~75 (2003)
- "A Clinical study on 55 patients with fever of undetermined origin", pp.1~8 (1993)
- "A comparison of causes of fever of unknow origin between the 1998s and the 1990s", 614, pp.546~52 (2001)
- "Fever of undetermined origin diagnosis and follow-up of 105 cases", pp.269~92 (1970)
- "Miliary tuberculosis and pancytopenia in an eldery man Journal of the Hong Kong Geriatric Society 5", pp.22~36 (1994)
- "Fever of unknown origin in the 1980s An update of the diagnostic spectrum", pp.51~5 (1992)
- "Current fever of unknown origin 1982-1992", pp.67~73 (1994)
- "Fever of unknown origin in Turkey", 31, pp.417~20 (2003)
- "Fever of unknown origin a retrospective study of 78 adult patients in Taiwan", 36, pp.243~47 (2003)
- "I A. prospective multicenter study of 167 patients with FUO, using fixed epidemiologic entry criteria. The Netherlands FUO Study Group", 76, pp.392~400 (1997)
- "Wenya W:Fever of unknown origin: a report from China of 208 cases.", 57, pp.592~6 (2003)
- "Fever of unknown origin A prospective multicenter study of 164 patients", 107, pp.545~50 (2003)
- "From prolonged febrile illness to fever of unknown origin: the challenge continues.", 163, pp.1033~41 (2003)
- "Fever of unknown origin- reexamined and redefined", pp.35~51 (1991)
- "Fever of unknown origin A Clinical study on 55 patients with fever of undetermined origin", diag(sis and treatment 8), pp.1302 1~6 8
- "Fever of unknown origin In: Harrison’s principle of internal medicine 16th ed", pp.116~121 (2005), McGraw-Hill
- "Fever of unknown origin in the elderly", 252, pp.295~304 (2002)
- "A comparison of causes of fever of unknow origin between the 1998s and the 1990s", 614, pp.546~52 (2001)
- "Miliary tuberculosis and pancytopenia in an eldery man Journal of the Hong Kong Geriatric Society 5", pp.22~36 (1994)
- "Fever of unknown origin a review of 80 patients from the Shin'etsu area of Japan from 1986-1992", pp.74~76 (1994)
- "Fever of unknown origin in Turkey.", 31, pp.417~20 (2003)
- "The changing spectrum of fever of unknown origin trends and comparison with previous series at the Salvador Zubiran National Institute of Nutrition", pp.177~185 (1994)
- "Fever of unknown origin in Romania. II.Prospective multicenter study of 164 patients.", 107, pp.772~80 (2003)
- "Fever of unknown origin a retrospective study of 78 adult patients in Taiwan", 36, pp.243~47 (2003)
- "Fever of unknown origin A prospective multicenter study of 164 patients", 107, pp.545~50 (2003)
- "From prolonged febrile illness to fever of unknown origin: the challenge continues.", 163, pp.1033~41 (2003)
- "Fever of unknown origin Harrison’s principle of internal medicine 16th ed", pp.116~121 (2005), McGraw-Hill
- "Fever of unknown origin in the elderly", 252, pp.295~304 (2002)
- "Fever of unknown origin a review of 80 patients from the Shin'etsu area of Japan from 1986-1992", pp.74~76 (1994)
- "The changing spectrum of fever of unknown origin trends and comparison with previous series at the Salvador Zubiran National Institute of Nutrition", pp.177~185 (1994)
- "Fever of unknown origin in Romania. II. Prospective multicenter study of 164 patients.", 107, pp.772~80 (2003)