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Rev Clin Esp. 1996 Jan;196(1):4-8.

[Fever of unknown origin in patients infected with the human immunodeficiency virus].

Revista clinica espanola

[Article in Spanish]
C Carbonell Biot, J Ena Muñoz, F Pasquau Liaño, P Badía Ferrando, A Ortiz de Salazar Martín, A Vilar Zanón

Affiliations

  1. Servicio de Medicina Interna, Hospital Marina Baixa, Villajoyosa, Alicante.

PMID: 8948835

Abstract

BACKGROUND: To describe the clinical features and the final diagnosis of patients infected with human immunodeficiency virus who presented fever of unknown origin.

METHODS: Retrospective study, from November 1989 to January 1994, of all patients infected with HIV who had fever of unknown origin and who were admitted to a community hospital in a Mediterranean area in Alicante (Spain). Fever of unknown origin was defined as fever exceeding 38.3 degrees C lasting for at least three weeks with no diagnosis in the first three days of hospitalization after fulfilling clinical exam, three blood cultures, acid-fast bacilli stain in sputum and chest-X-ray.

RESULTS: Of a cohort of 231 patients, 27 (12%) were evaluated because of fever of unknown origin during their follow-up. Patients' mean age was 31 years (interval, 22-75) and intravenous drug use (81%) was the most common risk factor for HIV infection. A total of 31 episodes of fever of unknown origin were reviewed. Twenty-three (74%) episodes occurred in patients with less than 200 CD4 lymphocytes/mm3. A final diagnosis of fever of unknown origin was achieved in 24 (77%) episodes: visceral leishmaniasis (n = 11), tuberculosis (n = 9), non-Hodgkin's lymphoma (n = 1), CNS toxoplasmosis (n = 1), cryptococcal meningitis (n = 1) and drug adverse reaction (n = 1).

CONCLUSIONS: HIV-infected patients with fever of unknown origin very often show severe immunodeficiency. Cryptococcal antigen testing should be carried out in the initial evaluation of fever of unknown origin in HIV-infected patients. In our area, 64% of episodes of fever of unknown origin were caused by visceral leishmaniasis or tuberculosis.

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