The medical records of patients with
AIDS admitted to a general hospital in Brazil from 1989 to 1997 were reviewed retrospectively with the aim at defining the frequency and etiology of
fever of undetermined origin (FUO) in HIV-infected patients of a tropical country and to evaluate the usefulness of the main diagnostic procedures. 188 (58.4%) out of 322 patients reported
fever at admission to hospital and 55 (17.1%) had FUO. Those with FUO had a mean CD4+ cell count of 98/ml. A cause of
fever was identified for 45 patients (81.8%).
Tuberculosis (32.7%),
Pneumocystis carinii pneumonia (10.9%), and Mycobacterium avium complex (9.1%) were the most frequent diagnoses. Other
infectious diseases are also of note, such as
cryptococcal meningitis (5.5%),
sinusitis (3.6%), Salmonella-S. mansoni association (3.6%),
disseminated histoplasmosis (3.6%),
neurosyphilis (1.8%), and
isosporiasis (1.8%). Four patients had
non-Hodgkin's lymphoma (7.3%). We conclude that an initial aggressive diagnostic approach should be always considered because biopsies (lymph node, liver and bone marrow) produced the highest yield in the diagnosis of FUO and the majority of the diagnosed diseases are treatable. The association of diseases is common and have contributed to delay the final diagnosis of FUO in most cases. In our study area the routine request of hemocultures for
Salmonella infection and the investigation of cryptococcal
antigen in the serum should be considered.