View clinical trials related to Fever of Unknown Origin.
Filter by:The investigators retrospectively evaluated the efficacy of granulocyte transfusions as adjunctive treatment for severe infections in neutropenic fever unresponsive to antimicrobial therapy in hematological patients.
Viral respiratory infections are common and often require use of health care resources. Patients receive inappropriate bacterial antibiotics, which has many problems including side-effects, development of resistance and costs. A small portion of the infections leads to severe clinical manifestations including hospitalisations and deaths. The significance of influenza virus is well known and it is actively detected in all age groups. However, the benefits of detecting other respiratory viruses have mainly been studied among children but not among adults. The development of multiplex PCR technique has provided a new and sensitive method for diagnosing a large panel of viruses. To convince the economical benefits of the rapid viral diagnostic in adult infectious patient, more evidence is needed. In our randomized study, nasal and pharyngeal samples from the patients evaluated at the emergency clinic of internal medicine in the University Hospital of Oulu because of any respiratory symptom, chest pain or fever, will be collected. The samples will be tested for 16 different respiratory viruses by using Anyplex TMII RV16 Detection. The adult participants will be randomized in two groups. In one group the results of the testing will be reported for the attending physician as soon as possible, and in the other group 7 days after sampling. The effect of this delay to patient care is monitored. Also the results of children and adults are compared as well as results of men and women. The hypothesis is that rapid viral diagnostics shortens the length of admission and diminishes the use of bacterial antibiotics. New information on the viral epidemiology among children and adults is provided and clinical manifestations of specific viral infections in adults are described. The estimated 1500 samples are also tested for 5 different respiratory bacteria by Anyplex TM II RB5 Detection. These results will be examined after completion of the study period. The benefits of rapid bacterial detection are evaluated in respect to the clinical course of the disease and considering the infection control aspects as well.
The aim of this single-center randomized controlled trial is to assess clinical usefulness of positron emission tomography combined with computed tomography (PET CT) in the diagnostic process of suspected cardiovascular implantable electronic device (CIED) infection (lead dependent infective endocarditis, generator pocket infection, fever of unknown origin).
This randomized pilot clinical trial studies how well positron emission tomography (PET)-magnetic resonance imaging (MRI) works compared to standard-of-care PET-computed tomography (CT) in diagnosing patients with cancer, cardiac diseases, or neurologic diseases. PET-MRI combines two imaging methods that can be used to evaluate disease. PET-MRI is similar to standard-of-care PET-CT, but exposes the patient to less radiation. It is not yet known whether PET-MRI produces better image quality than PET-CT in diagnosing patients with cancer, cardiac disease, or neurologic disease.
The purpose of this study is to determine whether two-step method of diagnostic strategy is effective in the diagnosis and treatment of fever of unknown origin (FUO). (TSMD research, a pilot study) Fever of unknown origin (FUO) is a fever in excess of 38.3◦C continued for more than 3 weeks, and its cause could not be identified by tests during hospitalization for more than 1 week [1]. As diagnostic techniques such as imaging technology and clinical tests have been developed and outpatient access to diagnostic tests have improved, the FUO is defined as a shortened period where the cause could not be revealed despite diagnostic tests during three visits to the outpatient department or during 3 days of hospitalization [2]. FUO can be caused by many diseases, and causes can vary depending on region and time period. FUO was first reported in the medical literature 80 years ago. Since then, the causative diseases have greatly changed with changes in the social environment and widespread use of diagnostic imaging. The causes of FUO, according to traditional diagnosis and treatment, could be divided into four principal groups: infections, non-infectious inflammatory diseases (NIID, including rheumatic diseases and vasculitic diseases), neoplasms, and other diseases. Despite the development of various diagnostic techniques, 34-51% of FUO patients remain undiagnosed [3,4]. In China, over-reliance on antibiotics for disease therapy and infection prevention are common phenomena in traditional treatment of FUO[5]. Two-step method of diagnostic strategy is a method to diagnose FUO disease. First step is to differentiate FUO according to the onset of disease and invasive pathogens. Second step is to further differentiate FUO according to trends of disease and inflammation scores. The diagnosis of FUO can be difficult for both patients and their physicians. Depending on the experience and qualifications of the treating physicians, time to reach a diagnosis can vary. Two-step method of diagnostic strategy would afford a standard method for physicians to diagnoses the FUO. So many reports of FUO have also been published in China, but have been limited to single-facility or limited-region studies; no nationwide studies have yet been conducted. Moreover, few assessments of tests used in the diagnostic evaluation of FUO have been reported. In particular, few studies have assessed the clinical usefulness of tests such as serum procalcitonin or positron emission tomography (PET) in China, although these tests are now frequently used. We therefore will conduct a multicenter collaborative retrospective and prospective （randomized and controlled ）study of patients with FUO at hospitals affiliated with China's Ministry of Health. This is the first nationwide study in China on diseases causing FUO and the diagnostic workup, and identified diseases that should be considered when evaluating FUO in China. In addition, we will investigate the rate of performing various tests in the current diagnostic workup of FUO. Classical FUO was diagnosed based on the definition by Durack et al[6] in patients meeting all of criteria 1-4 below. 1. Fever with axillary temperature ≥38°C at least twice over a ≥3-week period. 2. Unknown cause after three outpatient visits or during 3 days of hospitalization. 3. Not diagnosed with immunodeficiency before fever onset. 4. No confirmed HIV infection before fever onset. The data described below were collected. No additional testing was performed in this study due to insufficient data. 1. Patient characteristics: sex, age, concomitant disease, medical history and medication history. 2. Clinical findings: subjective symptoms and objective physical findings. 3. Blood tests: blood count, biochemical examination and inflammatory markers (C reactive protein (CRP), erythrocyte sedimentation rate (ESR), procalcitonin, etc.). 4. Results of blood cultures if performed. 5. Results of imaging studies and endoscopy if performed. 6. Results of cytology, histology, genetic testing or autopsy findings if performed. 7. Final diagnosis, day of diagnosis and outcome. This study is safety for no drug involved to determine the effectiveness of two-step method of diagnostic strategy in the diagnosis and treatment of fever of unknown origin.