title: Incidence of fever of unknown origin and subsequent antitubercular medications in hemodialysis patients: a two-year prospective study.
abstract: BACKGROUND
  Hemodialysis (HD) patients are susceptible to atypical tuberculosis (TB), especially among patients presenting with fever of unknown origin (FUO), because of their impaired cellular immunity. Diagnostic trials of anti-TB drugs are therefore recommended in some TB endemic countries, including Japan, though clinical evidence for this therapy is scarce.
  
  
  METHODS
  We prospectively collected data for incident cases of clinical FUO for two years in 78 of 169 dialysis facilities in Aichi prefecture, located in central Japan. Clinical FUO was defined as sustained fever without any localizing signs and no infiltration on chest x-rays after a one-week antibiotic trial. The baseline characteristics, subsequent body temperatures on the days of HD therapy, and names of antibiotics including anti-TB drugs with the durations of medication were reported until fever alleviation or fever sustainment for over eight weeks.
  
  
  RESULTS
  We identified 15 newly developed clinical FUO patients among 8,125 HD patients. The incidence rate was estimated to be 92 (95% CI, 26-158) per 100,000 person-years. This corresponds to 244 cases per year among 264,473 HD patients in Japan. Anti-TB drugs were secondarily prescribed in 8 of 15 clinical FUO patients (53%). No improved fever alleviation was observed when anti-TB drugs were secondarily prescribed compared with cases in which other antibiotics were preferred.
  
  
  CONCLUSIONS
  We investigated the incidence of FUO in HD patients and found that the rate was not very high, whereas anti-TB drugs were frequently used for FUO cases. The efficacy of this diagnostic therapy should be elucidated in large-scale studies.
authors.affiliation: Department of Preventive Medicine/Biostatistics and Medical Decision Making, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Japan. rieokada@med.nagoya-u.ac.jp
authors.forename: Rieko
authors.initials: R
authors.lastname: Okada
authors.forename: Yukio
authors.initials: Y
authors.lastname: Yuzawa
authors.forename: Takashi
authors.initials: T
authors.lastname: Kawamura
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Hamajima
authors.forename: Yuzo
authors.initials: Y
authors.lastname: Watanabe
authors.forename: Seiichi
authors.initials: S
authors.lastname: Matsuo
mesh_terms: D000368:Aged; D000995:Antitubercular Agents / Q000627:therapeutic use*; D005260:Female; D005335:Fever of Unknown Origin / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
chemical_list: D000995:Antitubercular Agents