Fever of unknown origin: 98 cases from Saudi Arabia

Moawad, Mahmoud; Bassil, Habib; El-Sherif, Mona; Ibrahim, Abeer; El-Naggar, Moustafa H. M.; Edathodu, Jameela; Alharthi, Abdulaziz; Albugami, Muneerah; Sabry, Ahmed; Shoukri, Mohammed; Bakhsh, Ibtisam; Laudon, Ulrike

doi:10.4103/0256-4947.65259

Cited by 16 publications

(11 citation statements)

References 19 publications

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“…Among them, tuberculosis remains an important cause of FUO. In a study conducted in Pakistan, most of the infectious cases were pulmonary TB (22) but most researchers in our region found that extrapulmonary TB was more common than pulmonary TB (8,16,23,24). In our series, tuberculosis constituted 27.7% of the infectious cases.…”

Section: Discussionmentioning

confidence: 46%

“…This rheumatologic disease has also been reported as the most common noninfectious inflammatory cause of FUO in other studies in our region (28,30). On the other hand, some researchers have found systemic lupus erythematosus as the most common connective tissue disease among FUO cases (16,22,24,26). Other connective tissue diseases as the causes of fever in our FUO cases were undifferentiated polyarthritis, rheumatoid arthritis, systemic lupus erythematosus, giant cell arteritis, Wegener's granulomatosis, Behcet's diseases, and bullous pemphigoid, each of which was found in one patient.…”

Section: Discussionmentioning

confidence: 99%

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Etiology of Fever of Unknown Origin in Shiraz: A Southern Iranian Experience

et al. 2019

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Background: Although infectious diseases are the most common cause of fever of unknown origin (FUO) in many countries, the spectrum of its etiology is changing over time. Objectives: The purpose of this study was to determine the clinical spectrum and the pattern of FUO in Shiraz. Methods: This study was undertaken from 2011 to 2015 in the main hospitals of Shiraz, southern Iran. The data of 60 patients fulfilling the modified criteria for FUO referring to the main hospitals in Shiraz were used for analysis. The data were extracted from the patients' medical charts and probable etiologies responsible for FUO were assessed. The patients were followed up by further ambulatory and readmission assessment. Results: Of the identified etiologies, infections were the most common cause of FUO in 30% of the patients, followed by collagen vascular diseases with 15% and malignancies with 11.6%. However, 25 patients (41%) remained undiagnosed for their fever causes. Conclusions: The pattern of FUO in the region has changed in recent years and complicated cases are admitted to hospitals. With improving ambulatory tests and diagnostic modalities, most of the patients with FUO are being diagnosed in outpatient settings and it will cause some changes in the classic percentage of FUO etiologies among admitted patients in the future.

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Section: Discussionmentioning

confidence: 46%

Section: Discussionmentioning

confidence: 99%

Etiology of Fever of Unknown Origin in Shiraz: A Southern Iranian Experience

et al. 2019

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“…More than 200 causes of FUO have been reported [ 4 ] and inflammatory bowel disease is among them [ 3 , 9 , 10 ].…”

Section: Discussionmentioning

confidence: 99%

Ulcerative Colitis Activity Presenting as Fever of Unknown Origin, in a Patient with Longstanding Disease under Continuous Treatment with Mesalazine

Voukelatou

Sfendouraki

Karianos

et al. 2016

Case Reports in Medicine

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Background. The presence of ulcerative colitis (UC) with no bowel symptoms, as fever of unknown origin (FUO), is uncommon. Objective. To describe the case of an 80-year-old woman who presented with fever, with a history of UC under treatment with mesalazine. Case Presentation. She was admitted due to fever lasting for 12 days with no associated symptoms. Seven years earlier, she was diagnosed with UC. After an extended workup for FUO that failed to reach the diagnosis, she underwent a gallium-67 scintigraphy. This revealed a persistent diffuse concentration of gallium-67 in the ascending colon at 24-hour imaging that remained stable at 48- and 72-hour imaging without any topographic change after the use of laxatives. Considering the results and in the absence of another diagnosis, the patient was treated with 30 mg prednisone daily and mesalazine, as treatment of active UC. Subsequently, the patient's condition improved markedly and the fever retreated. One month later, she was reevaluated with a gallium-67 scintigraphy with total absence of gallium-67 concentration in the ascending colon. Conclusion. UC activity must be included in the differential diagnosis of FUO in patients with longstanding disease, since fever may present alone, with no other manifestations.

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“…Phase 1 diagnostic protocol is adopted in patients without potential diagnostic clues (PDCs) or with misleading clues, and a phase 2 diagnostic protocol for patients without PDCs is applied when phase 1 did not reveal any. In Saudi Arabia [22], a single diagnostic work-up is done for all cases of FUO that involve most of the abovementioned investigations. This variability in diagnostic work-up shows the lack of unified approach and guidelines to handle the cases of FUO.…”

Section: Discussionmentioning

confidence: 99%

Clinico-epidemiological profile of fever of unknown origin in an Egyptian setting: A hospital-based study (2009–2010)

Kabapy

Kotkat

Shatat

et al. 2016

J Infect Dev Ctries

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Introduction: Fever of unknown origin (FUO) is one of the most challenging diagnostic dilemmas in the field of infectious diseases and tropical medicine. Clinicians should use the frequency distribution of disorders causing FUO to guide their diagnostic approach in patients with prolonged, unexplained fevers meeting the definition of FUO. Methodology: The present study was undertaken to examine the etiologies, clinico-epidemiologic profile, and prognosis of classical FUO in patients reporting to the Alexandria Fever Hospital in Egypt. Records of 979 patients admitted to the fever hospital (from January 2009 to January 2010) and diagnosed as having FUO were examined carefully. FUO was defined as three outpatient visits or three days in the hospital without elucidation of cause of fever. Results: A total of 979 cases (57.0% males and 43.0% females), with ages ranging from 0.2 to 90 years, were investigated. The mean duration of fever before hospitalization was 31 ± 10 days. The etiology of FUO was delineated in 97% of cases, and only 3% remained undiagnosed. Diagnoses were grouped into five major categories. Infectious causes of FUO were strongly associated with better outcome (73.7% improved). Smoking, contact with animals or birds, drug addiction, and HIV seropositivity were important risk factors associated with infections. Conclusions: Infections are the most common cause of FUO, followed by collagen vascular diseases, in our region. A three-step diagnostic work-up approach is recommended to be applied in Egypt in order to improve the quality of medical service provided to FUO patients.

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Fever of unknown origin: 98 cases from Saudi Arabia

Cited by 16 publications

References 19 publications

Etiology of Fever of Unknown Origin in Shiraz: A Southern Iranian Experience

Etiology of Fever of Unknown Origin in Shiraz: A Southern Iranian Experience

Ulcerative Colitis Activity Presenting as Fever of Unknown Origin, in a Patient with Longstanding Disease under Continuous Treatment with Mesalazine

Clinico-epidemiological profile of fever of unknown origin in an Egyptian setting: A hospital-based study (2009–2010)

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