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2022.06.04湖北
图1.建议对不明原因发热采取的诊断和治疗步骤（FUO）
该方法应根据具体的临床状况做到个体化。ANA表示抗核抗体，CBC表示全血细胞计数，CRP表示C反应蛋白，CT表示计算机断层扫描，ESR表示红细胞沉降率，FDGPET-CT表示18F-氟脱氧葡萄糖正电子发射断层扫描-CT，HIV表示人类免疫缺陷病毒，PCR表示聚合酶链反应，RF表示类风湿因子，TSH表示促甲状腺素。
发热反应
发热的后遗症
FUO分类
表1.不明原因发热（FUO）的大类*
经典型FUO
细菌感染
图2.感染引起的FUO病例举例
病毒感染
表2.有可能导致FUO的部分人畜共患感染和媒介传播感染*
*其中许多疾病的诊断可能有难度，诊断检查（包括血清学检查、聚合酶链反应检测和培养）可能不敏感或不易获得（可能导致FUO的其他疾病参见补充附录表S1，补充附录与本文全文可在NEJM.org获取）。ARDS表示急性呼吸窘迫综合征，DIC表示弥散性血管内凝血，TMP-SMX表示甲氧苄啶-磺胺甲噁唑。
真菌感染
其他感染
癌症
表3.FUO的部分恶性肿瘤、自身炎症和自身免疫及其他原因*
这些疾病可能同时具有自身炎症和自身免疫特征。
自身炎症疾病和自体免疫疾病
其他原因和药物热
半衰期较长的药物（例如氟西汀）即使提前5周停药，也可能诱发该综合征。
如果在选择性5-羟色胺再摄取抑制剂的基础上加用对细胞色素P-450具有抑制作用的同工酶（CYP2D6和CYP3A4），后者可能引发5-羟色胺综合征。
院内FUO
免疫缺陷和FUO
HIV感染者
器官移植受者
血液系统癌症患者
造血细胞移植受者可在植入后的早期出现发热，原因包括细胞植入、感染性或非感染性肺综合征（例如特发性肺炎综合征）、真菌感染、CMV、EBV和HHV-6等疱疹病毒复活（尤其是脑膜脑炎）、腺病毒感染、超急性GVHD或其他因素。在植入后的后期，造血细胞移植后不明原因发热的原因广泛，包括GVHD、机会性霉菌感染、移植后淋巴组织增生性疾病和癌症复发（表1）。
接受其他免疫抑制治疗的患者
返乡旅行者
诊断
治疗
未来方向
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