Retrospective analysis of Pyrexia of Unknown Origin (PUO) among adult patients in a Tertiary Care Hospital in Sri Lanka

Abstract

Introduction and Objectives Pyrexia of “unknown origin” remains a clinical entity universally despite advances in diagnostic technologies. There are few if any systematic studies on PUO conducted in Sri Lanka. We retrospectively analysed data of patients with PUO from a tertiary care hospital. Methods Records of PUO patients admitted to Colombo North (Teaching) Hospital during the period of January 2015 – January 2020 were extracted from the archives. Details of etiology, diagnosis and usage of medication of each patient was recorded. Results A total of 100 PUO patients were recruited. Majority were males (n=55;54.5%). Median ages of male and female patients were 53.0 and 50.0 years respectively. A final diagnosis had been reached in the majority (n=65;65%). Mean number of days of hospital stay was 15.16 (SD; 7.81). Median of the total number of fever days among PUO patients was 30.5. Out of 65 patients whose etiology were identified, the majority were diagnosed with an infection (n = 47; 72.31%) followed by noninfectious inflammatory conditions (n=13; 20.0%) and malignancies (n=5; 7.7%). Tuberculosis was the commonest infection detected (n=15; 31.9%). Mean number of days taken to reach the final diagnosis was 11.57 (SD: 11.42). Contrast enhanced CT scan (CECT) pelvis/abdomen (n = 15; 23.1%) was the commonest investigation leading to the final diagnosis. Antibiotics had been prescribed for the majority of the PUO patients (n=90; 90%). Conclusion Infections, mainly tuberculous, was the commonest cause for PUO while a third of patients remained undiagnosed despite a prolonged hospital stay.