Zusammenfassung
Infektionen sind mit einem Anteil von etwa 30% eine der häufigsten Ursachen eines ungeklärten Fiebers. Das Spektrum der Infektionen hängt von der klinischen Situation bzw. vom Risikoprofil des Patienten ab und variiert hinsichtlich der Kategorien des „klassischen“ Fiebers ungeklärter Genese und des ungeklärten Fiebers bei HIV-Infektion, bei immunsupprimierten Patienten und bei nosokomialem Fieber. Die wichtigste Frage ist, welche Eigenschaften von Erreger und Wirt eine spezifische Infektion zur Ursache eines ungeklärten Fiebers machen können.
Abstract
Infectious diseases remain one of the most important causes of fever of unexplained origin (FUO). We review the spectrum of infectious diseases in the different clinical situations of patients with FUO, namely in classical FUO, in patients with HIV infection, in health care-associated or nosocomial FUO, and in immunocompromised patients with FUO. The most important question is which clinical features make a specific disease a candidate to cause FUO.
This is a preview of subscription content, log in via an institution to check access.
Literatur
Petersdorf RG, Beeson PB (1961) Fever of unexplained origin: report on 100 cases. Medicine 40:1–30
Knockaert DC, Vanderschueren S, Blockmans D (2003) An evidence-based approach to fever of unknown origin. Arch Intern Med 163:1976–1977 (Autorenantwort: 1977–1978)
Mourad O, Palda V, Detsky AS (2003) A comprehensive evidence-based approach to fever of unknown origin. Arch Intern Med 163:545–551
Mackowiak PA, Durack DT (2010) Fever of unknown origin. In: Mandell GL, Bennett JE, Dolin R (Hrsg) (2010) Mandell, Douglas and Bennett’s principles and practices of infectious diseases. Elsevier, Philadelphia, S 779–790
Al-Tonbary YA, Soliman OE, Sarhan MM et al (2011) Nosocomial infections and fever of unknown origin in pediatric hematology/oncology unit: a retrospective annual study. World J Pediatr 7:60–64
George DL, Falk PS, Umberto Meduri G et al (1998) Nosocomial sinusitis in patients in the medical intensive care unit: a prospective epidemiological study. Clin Infect Dis 27:463–470
Hayakawa K, Ramasamy B, Chandrasekar PH (2012) Fever of unknown origin: an evidence-based review. Am J Med Sci 344:301–316
Link H, Bohme A, Cornely OA et al (2003) Antimicrobial therapy of unexplained fever in neutropenic patients—guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO), Study Group Interventional Therapy of Unexplained Fever, Arbeitsgemeinschaft Supportivmassnahmen in der Onkologie (ASO) of the Deutsche Krebsgesellschaft (DKG-German Cancer Society). Ann Hematol 82(Suppl 2):S105–117
Bouza E, Loeches B, Munoz P (2007) Fever of unknown origin in solid organ transplant recipients. Infect Dis Clin North Am 21:1033–1054
Auner HW, Sill H, Mulabecirovic A et al (2002) Infectious complications after autologous hematopoietic stem cell transplantation: comparison of patients with acute myeloid leukemia, malignant lymphoma, and multiple myeloma. Ann Hematol 81:374–377
Heussel CP, Kauczor HU, Heussel GE et al (1999) Pneumonia in febrile neutropenic patients and in bone marrow and blood stem-cell transplant recipients: use of high-resolution computed tomography. J Clin Oncol 17:796–805
Bongartz T, Sutton AJ, Sweeting MJ et al (2006) Anti-TNF antibody therapy in rheumatoid arthritis and the risk of serious infections and malignancies: systematic review and meta-analysis of rare harmful effects in randomized controlled trials. JAMA 295:2275–2285
Gluck T, Kiefmann B, Grohmann M et al (2005) Immune status and risk for infection in patients receiving chronic immunosuppressive therapy. J Rheumatol 32:1473–1480
Armstrong WS, Katz JT, and Kazanjian PH (1999) Human immunodeficiency virus-associated fever of unknown origin: a study of 70 patients in the United States and review. Clin Infect Dis 28:341–345
Kitkungvan D, Apisarnthanarak A, Plengpart P et al (2008) Fever of unknown origin in patients with HIV infection in Thailand: an observational study and review of the literature. Int J STD AIDS 19:232–235
Abellan-Martinez J, Guerra-Vales JM, Fernandez-Cotarelo MJ et al (2009) Evolution of the incidence and aetiology of fever of unknown origin (FUO), and survival in HIV-infected patients after HAART (highly active antiretroviral therapy). Eur J Intern Med 20:474–477
Letang E, Miro JM, Nhampossa T et al (2011) Incidence and predictors of immune reconstitution inflammatory syndrome in a rural area of Mozambique. PLoS One 6:e16946
Muller M, Wandel S, Colebunders R et al (2010) Immune reconstitution inflammatory syndrome in patients starting antiretroviral therapy for HIV infection: a systematic review and meta-analysis. Lancet Infect Dis 10:251–261
Novak RM, Richardson JT, Buchacz K et al (2012) Immune reconstitution inflammatory syndrome: incidence and implications for mortality. AIDS 26:721–730
Dong MJ, Zhao K, Liu ZF et al (2011) A meta-analysis of the value of fluorodeoxyglucose-PET/PET-CT in the evaluation of fever of unknown origin. Eur J Radiol 80:834–844
Interessenkonflikt
Der korrespondierende Autor gibt für sich und seine Koautoren an, dass kein Interessenkonflikt besteht. Für keinen der beteiligten Autoren besteht ein Interessenkonflikt durch in diesem Artikel beschriebene Produkte.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Salzberger, B., Schneidewind, A., Hanses, F. et al. Fieber ungeklärter Genese. Internist 53, 1445–1455 (2012). https://doi.org/10.1007/s00108-012-3173-8
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00108-012-3173-8
Schlüsselwörter
- Fieber ungeklärter Genese
- Fieber unbekannter Genese
- HIV-Infektionen
- Immunsuppression
- Immunrekonstitutionssyndrom