成人不明原因发热的评估

不明原因发热（fever of unknown origin, FUO）定义为持续 3 周以上体温＞38.3°C（＞100.9°F）数次，尽管在医院评估了至少 1 周也没有发现明确来源。[1]Petersdorf RG, Beeson PB. Fever of unexplained origin: report on 100 cases. Medicine (Baltimore). 1961 Feb;40:1-30. http://www.ncbi.nlm.nih.gov/pubmed/13734791?tool=bestpractice.com 现已提出修订后的评估频率/持续时间，为“至少在门诊就诊 3 次或住院 3 日。”[2]Durack DT, Street AC. Fever of unknown origin - reexamined and redefined. Curr Clin Top Infect Dis. 1991;11:35-51. http://www.ncbi.nlm.nih.gov/pubmed/1651090?tool=bestpractice.com 后续作者提出了定量标准（即 1 周后或检查 3 日后未确诊）并提出了定性要求，即在进行最低限度的诊断性检查后，发热仍未得到诊断。​[3]Fusco FM, Pisapia R, Nardiello S, et al. Fever of unknown origin (FUO): which are the factors influencing the final diagnosis? A 2005-2015 systematic review. BMC Infect Dis. 2019 Jul 22;19(1):653. https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-019-4285-8 http://www.ncbi.nlm.nih.gov/pubmed/31331269?tool=bestpractice.com [4]Bleeker-Rovers CP, Vos FJ, de Kleijn EMHA, et al. A prospective multicenter study on fever of unknown origin: the yield of a structured diagnostic protocol. Medicine (Baltimore). 2007 Jan;86(1):26-38. https://journals.lww.com/md-journal/Fulltext/2007/01000/A_Prospective_Multicenter_Study_on_Fever_of.3.aspx http://www.ncbi.nlm.nih.gov/pubmed/17220753?tool=bestpractice.com [5]De Kleijn EM, Vandenbroucke JP, van der Meer JW. Fever of unknown origin (FUO). I A. prospective multicenter study of 167 patients with FUO, using fixed epidemiologic entry criteria. Medicine (Baltimore). 1997 Nov;76(6):392-400. http://www.ncbi.nlm.nih.gov/pubmed/9413425?tool=bestpractice.com [6]Knockaert DC, Vanderschueren S, Blockmans D. Fever of unknown origin in adults: 40 years on. J Intern Med. 2003 Mar;253(3):263-75. https://onlinelibrary.wiley.com/doi/full/10.1046/j.1365-2796.2003.01120.x?sid=nlm%3Apubmed http://www.ncbi.nlm.nih.gov/pubmed/12603493?tool=bestpractice.com [7]Petersdorf RG. Fever of unknown origin. An old friend revisited. Arch Intern Med. 1992 Jan;152(1):21-2. http://www.ncbi.nlm.nih.gov/pubmed/1728921?tool=bestpractice.com ​​​​​​​

​人体体温在 1.1℃（2℉）以内的波动属于正常。体温升高可以是生理性，或者由感染、炎症或恶性肿瘤等病理过程引起。该诊断见于所有年龄段，男女发病率相近。然而年龄也是鉴别诊断的重要因素。全球范围内，在 FUO 病因学方面的流行病学趋势存在差异。详细的个人史包括近期旅行。感染仍然是 FUO 的一个主要原因，结核病和腹内脓肿及盆腔脓肿与之的相关性现在比感染性心内膜炎更高。[8]Varghese GM, Trowbridge P, Doherty T. Investigating and managing pyrexia of unknown origin in adults. BMJ. 2010;341:C5470. http://www.ncbi.nlm.nih.gov/pubmed/22312655?tool=bestpractice.com ​ 本地的流行病学数据必须考虑在内。

FUO 的鉴别诊断可被分为感染、恶性肿瘤、自身免疫性疾病和其他。