Fever of Unknown Origin in AIDS Pts
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Fever of Unknown Origin in HIV/AIDS Patients Arnaud Hot, MD a , Laura Schmulewitz, BSc, MB, ChB a , Jean-Paul Viard, MD a , Olivier Lortholary, MD, PhD a,b, * a Universite ´ Paris V, Service des Maladies Infectieuses et Tropicales, Centre d’Infectiologie Necker-Pasteur, Ho ˆ pital Necker-Enfants Malades, 149 rue de Se `vres, 75743 Paris Cedex 15, France b Centre National de Re´ fe ´ rence Mycologie et Antifongiques, CNRS URA3012, Institut Pasteur, 25 rue du Dr Roux, 75724 Paris Cedex 15, France Fever of unknown origin (FUO) in adults is defined as a temperature greater than 38.3 C (100.9 F) lasting for more than 3 weeks with no obvious source, despite appropriate investigation. The four categories of FUO are (1) cla ssi cal, (2) nosoco mi al, (3) immune deficienc y–a ssociated, and (4) HIV-related [1], and the differential diagnoses can be subcategorized into in- fections, mal ignancies, aut oimmune conditi ons, and misc ella neous causes [2,3]. A thorough history, physical examination, and standard laboratory testing form the basis of the initial evaluation of the patient with FUO, although newer diagnostic modalities play an important role in assessment. Fever, either continuous or recurrent, is a common finding in patients infected with HIV and is often accompanied by significant morbidity, pro- long ed hosp italization, and ext ensi ve eval uation [4]. Before hig hl y active antiretroviral therapy (HAART) was introduced, patients with HIV experi- enced FUO with relative frequency, in most cases caused by opportunistic infections, such as tuberculosis, infection with Mycobacterium avium com- plex (MAC), and in the Middle East and Mediterranean regions of Europe visceral leishmaniasis. The use of HAART has reduced the frequency of HIV- ass oci at ed FUO, al thoug h the et iol ogic spectrum remains largely * Corr esp ond ing aut hor . Uni ver sit e ´ Pa ri s V, Se rvic e de s Ma la di es Infe ct ie us es et Tropicales, Centre d’Infectiologie Necker-Pasteur, Ho ˆ pital Necker-Enfants Malades, 149 rue de Se ` vres, 75743 Paris Cedex 15, France. E-mail address: [email protected] (O. Lortholary). 0891-5520/07/$ - see front matter Ó 2007 Elsevier Inc. All rights reserved. Infect Dis Clin N Am 21 (2007) 1013–1032
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Transcript of Fever of Unknown Origin in AIDS Pts
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