Diagnostic workup for fever of unknown origin: a multicenter collaborative retrospective study

• Project/Area Number: 25670359
• Research Category: Grant-in-Aid for Challenging Exploratory Research
• Allocation Type: Multi-year Fund
• Research Field: General internal medicine(including psychosomatic medicine)
• Research Institution: Juntendo University
• Principal Investigator: NAITO Toshio 順天堂大学, 医学部, 准教授 (10365570)
• Co-Investigator(Kenkyū-buntansha): SENDA Shoichi 香川大学, 医学部附属病院, 名誉教授 (30145049) ; OTSUKA Fumio 岡山大学, 医歯学総合研究科, 教授 (40362967) ; UKIMURA Akira 大阪医科大学, 医学部, 教授 (50257862) ; MORITA Hiroyuki 岐阜大学, 医学研究科, 教授 (90252147)
• Project Period (FY): 2013-04-01 – 2015-03-31
• Project Status: Completed (Fiscal Year 2014)
• Budget Amount: ¥1,560,000 (Direct Cost: ¥1,200,000、Indirect Cost: ¥360,000); Fiscal Year 2014: ¥910,000 (Direct Cost: ¥700,000、Indirect Cost: ¥210,000); Fiscal Year 2013: ¥650,000 (Direct Cost: ¥500,000、Indirect Cost: ¥150,000)
• Keywords: 不明熱 / 総合診療 / 炎症マーカー / CRP / 赤沈 / プロカルシトニン / 多施設共同研究 / PET

Outline of Final Research Achievements

A nationwide retrospective study including 17 hospitals affiliated with the Japanese Society of Hospital General Medicine was conducted.This study included 121 patients diagnosed with "classical FUO".
The causative disease was infectious diseases in 28 patients (23.1%), non-infectious inflammatory disease (NIID) in 37 patients (30.6%), malignancy in 13 patients (10.7%), other in 15 patients (12.4%) and unknown in 28 patients (23.1%). The rate of malignancy was significantly higher for lower WBC count (p=0.015). Among the patients with a higher WBC count, the rate of FUO due to NIID tended to be higher and the number of unknown cases tended to be lower. All FUO patients with malignancy showed an ESR of >40 mm/h. A normal ESR appeared to constitute powerful evidence for excluding a diagnosis of malignancy. The present study identified inflammatory markers that should be considered in the differential diagnosis of classical FUO, providing useful information for future diagnosis.

Research Products

• [Journal Article] Relationships between Causes of Fever of Unknown Origin and Inflammatory Markers: A Multicenter Collaborative Retrospective Study. (2015)
  • Author(s): Naito T, Torikai K, Mizooka M, Mitsumoto F, Kanazawa K, Ohno S, Morita H, Ukimura A, Mishima N, Otsuka F, Ohyama Y, Nara N, Murakami K, Mashiba K, Akazawa K, Yamamoto K, Senda S, Yamanouchi M, Tazuma S, Hayashi J
  • Journal Title: Internal Medicine Volume: 印刷中
  • NAID: 130005092893
  • Peer Reviewed / Open Access
• [Journal Article] Analysis of 256 cases of classic fever of unknown origin. (2014)
  • Author(s): Yamanouchi M, Uehara Y, Yokokawa H, Hosoda T, Watanabe Y, Shiga T, Inui A, Otsuki Y, Fujibayashi K, Isonuma H, Naito T.
  • Journal Title: Internal Medicine Volume: 53 Pages: 2471-2475
  • NAID: 130004704942
  • Peer Reviewed / Open Access
• [Journal Article] Diagnostic workup for fever of unknown origin: a multicenter collaborative retrospective study (2013)
  • Author(s): Naito T, Mizooka M, Mitsumoto F, Kanazawa K, Torikai K, Ohno S, Morita H, Ukimura A, Mishima N, Otsuka F, Ohyama Y, Nara N, Murakami K, Mashiba K, Akazawa K, Yamamoto K, Senda S, Yamanouchi M, Tazuma S, Hayashi J
  • Journal Title: BMJ Open Volume: 20 Issue: 12 Pages: e003971-e003971
  • DOI: 10.1136/bmjopen-2013-003971
  • Peer Reviewed
• [Presentation] 日本病院総合診療医学会による不明熱の原因疾患・診断方法に関する多施設共同レトロスペクティブ研究 (2014)
  • Author(s): 内藤俊夫
  • Organizer: 第9回 日本病院総合診療医学会学術集会
  • Place of Presentation: 群馬
  • Year and Date: 2014-09-19 – 2014-09-20
  • Invited
• [Presentation] A joint, multi-institution retrospective study, conducted via the Japanese Society of Hospital General Medicine, on causative diseases and diagnostic methods for Fevers of Unknown Origin (FUO) (2013)
  • Author(s): Naito T, Mitsumoto F, Morita H, Mizooka M, Oono S, Ukimura A, Torikai K,Kanazawa K, Yamanouchi M, Tazuma S, Hayashi J
  • Organizer: Annual Meeting of Society of General Internal Medicine
  • Place of Presentation: Denver, USA