Aetiology of pyrexia of unknown origin in north India. (January 2021)

• Record Type: Journal Article
• Authors: Pannu, Ashok Kumar; Golla, Rithvik; Kumari, Savita; Suri, Vikas; Gupta, Pankaj; Kumar, Rajender
• Is Part Of: Tropical doctor. Volume 51:Number 1(2021)
• Page Start: 34
• Page End: 40
• Publication Date: 2021-01
• Subjects: Pyrexia of unknown origin -- tuberculosis -- lymphoma -- adult-onset Still's disease -- enteric fever -- tuberculin skin testing; Tropical medicine -- Periodicals; Medical care -- Developing countries -- Periodicals; Developing Countries -- Periodicals; Tropical Medicine -- Periodicals; Tropische geneeskunde; 616.9883
• DOI: 10.1177/0049475520947907
• Languages: English
• ISSNs: 0049-4755

Abstract

The aetiology of pyrexia of unknown origin (PUO) varies dramatically according to epidemiology. We studied the cause and spectrum of PUO in Indian adults. A total of 152 patients (112 prospectively and 40 retrospectively) met Petersdorf and Beeson's criteria. The diagnostic evaluation was guided by potentially diagnostic clues, based on a 'step-wise' approach. The five main categories, i.e. infectious, neoplastic, non-infectious inflammatory, miscellaneous and undiagnosed comprised 43.4%, 21.5%, 19.7%, 2.0% and 12.5%, respectively. The top three causes were tuberculosis (n = 43, 28.3%), lymphoma (n = 19, 12.5%) and adult-onset Still's disease (n = 12, 7.9%). Tuberculosis predominated in all age groups, and about 70% of cases had the extrapulmonary form, the most common being gastrointestinal. Hodgkin and non-Hodgkin lymphomas were equally distributed, but solid malignancies were uncommon. Adult-onset Still's disease was the second commonest cause in adults aged ≤ 40 years. Fever resolved spontaneously in 12/19 cases of undiagnosed cause. Extrapulmonary tuberculosis remains the most prevalent PUO in India.