Evaluation of Diagnosis of Fever and Biologic Inflammatory Syndrome of Unknown Origin

Study Overview
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Brief Summary
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Fever of unknown origin (FUO) and biologic inflammatory syndrome of unknown origin (SII) are two frequent causes of hospitalization or consultation in infectious disease unit and internal medicine. There are many etiologies, in four categories: infections, auto-immune disease, cancer and miscellaneous causes. Currently there is no specifics recommendations to follow a diagnosis way of FUO and SII. Purpose: Evaluation of clinical practices in the diagnosis of fever and biologic inflammatory syndrome of unknown origin, in two units of the University Grenoble Hospital.

Detailed Description
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Fever of unknown origin (FUO) and biologic inflammatory syndrome of unknown origin (SII) are two frequent causes of hospitalization or consultation in infectious disease unit and internal medicine unit. The initial definition for FUO was proposed by Petersdorf and Beeson in 1961 : fever > 38,3°C, permanent or recurrent, for more than 3 weeks, without diagnosis after one week hospitalisation and explorations. This definition has been updated by Durack and Street in 1991 who distinguish classics FUO from 3 other categories : nosocomial, patient with HIV and neutropenia. They also choose an other way of diagnosis : 3 days of investigations in hospital OR in consultation. Finally, Knokaert and al. proposed a new definition, based on a qualitative criterion: No diagnosis after a first step and complete clinical and paraclinical check up. The evolution of FUO's prevalence is not describe so much. There are many etiologies, classified in four categories: infections, auto-immune disease, cancer and miscellaneous causes. The distribution of FUO's causes may change according to geographical localisation, and seems to evolve over time, with apparition of new infectious and inflammatory diseases, and the advent of new diagnosis tools. Currently there is no specifics recommendations to follow a diagnosis way of FUO and SII. It starts with a complete physical examination and some first lign further exams. Without diagnosis, paraclinical explorations are continued with more specific exams, according to the presence or the absence of diagnosis clues. The TEP scanner has shown a great value in the diagnosis of FUO, and trend to be more performed. Investigators propose to evaluate professional practices in the diagnosis of fever and biologic inflammatory syndrome of unknown origin, and especially the interest of TEP Scan, in two units of the University Grenoble Hospital. Investigators will study prevalence of FUO and SII, and of each causes of FUO and SII, and the prognosis of patients with FUO and SII, according to the presence or the absence of final diagnosis, as well as the economic impact of the different complementary exams.

Official Title
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Evaluation of Diagnosis of Fever and Biologic Inflammatory Syndrome of Unknown Origin

Conditions
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Fever of Unknown Origin

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: patients > 18 years old with fever> 38.5°C and/or CRP> 5mg/L for more than a week with standard check-up that did not allow a causal diagnosis Exclusion Criteria: immunosuppression : HIV, neutropenia, known cancer with chemotherapy, immunosuppressive treatment or corticotherapy (> 10mg/L for >3 weeks) nosocomial fever pregnant women patients who are not able to sign a consent

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| FUO and SII patients<br>Patients with fever > 38,3°C for more than a week, OR CRP> 5mg/L, without diagnosis after a first step clinical examination and paraclinical exams. | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Presence of a final diagnosis after paraclinical explorations | Final diagnosis according to the previous classification : infectious disease, inflammatory or auto-immune disease, cancer, or miscellaneous cause. | 1 year | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| prevalence of FUO/SII : | Number of patients with FUO and SII, assessed by inclusion in the present study . | 1 year | 
| causes of FUO/SII: Proportion of each causes of FUO/SII, according to the main outcome after final diagnosis | 5 possible causes : infectious diseases, auto-immune and inflammatory diseases, cancers, miscellaneous causes. Final diagnosis is determined according to the usual criteria, reviewed by two practitioners. | 1 year | 
| Mortality rate of patient with FUO and SII, according to the presence or absence of a final diagnosis | mortality rate | 1 year | 
| Medical economic evaluation of the utility of the TEP scan in the diagnostic approach | Benefit of TEP Scan in the diagnosis of FUO and SII : The utility is defined as an examination which allows : the direct diagnosis or direct the examination which will allow the diagnosis. The utility will be validated for every examination by 2 responsible doctors | 1 year | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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TEP-scan