Fever of unknown origin in Turkey: evaluation of 87 cases during a nine-year-period of study

Saltoğlu, Neşe; Taşova, Yeşim; Midikli, Dürdane; Aksu, Hasan Salih Zeki; Sanli, Aslihan; Dundar, I.H.

doi:10.1016/j.jinf.2003.08.006

Cited by 73 publications

(62 citation statements)

References 13 publications

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“…In developing countries, infections are the major cause of FUO [7][8][9][10][11][12][13][14] , whereas in developed countries NIID account for most cases. [15][16][17][18] In several recent studies no cause could be found in a large proportion of patients (Table 1).…”

Section: Defi Nition and Causesmentioning

confidence: 99%

Fever of unknown origin

2015

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Fever of unknown originMore than 50 years after the fi rst defi nition of fever of unknown origin (FUO), it still remains a diagnostic challenge. Evaluation starts with the identifi cation of potential diagnostic clues (PDCs), which should guide further investigations. In the absence of PDCs a standardised diagnostic protocol should be followed with PET-CT as the imaging technique of fi rst choice. Even with a standardised protocol, in a large proportion of patients from western countries the cause for FUO cannot be identifi ed. The treatment of FUO is guided by the fi nal diagnosis, but when no cause is found, antipyretic drugs can be prescribed. Corticosteroids should be avoided in the absence of a diagnosis, especially at an early stage. The prognosis of FUO is determined by the underlying cause. The majority of patients with unexplained FUO will eventually show spontaneous remission of fever. We describe the defi nition, diagnostic workup, causes and treatment of FUO. Defi nition and causesFever of unknown origin (FUO) was fi rst defi ned by Petersdorf and Beeson in 1961, who defi ned FUO as body temperature above 38.3°C (101°F) on three or more occasions and a duration of illness of at least three weeks, in which no diagnosis was made after one week of hospital admission. 1 In the following years this defi nition was modifi ed. Immunocompromised patients are now excluded, 2 as these patients have other etiologies of FUO and need a different therapeutic approach. To refl ect the increasing outpatient-based healthcare it was suggested to shorten the duration of investigation to three inpatient days or three outpatient visits. 2 However, as investigations in three outpatient visits and three inpatient days cannot be compared, different causes of FUO will be found in admitted patients. Instead of using arbitrary quantitative time criteria, a quantitative criterion of obligatory investigations was implemented in the defi nition. [3][4][5] The current defi nition of FUO is: ABSTRACT > temperature ≥38.3°C (101°F) on at least two occasions > duration of illness ≥3 weeks or multiple febrile episodes in ≥3 weeks > not immunocompromised (neutropenia for ≥1 week in the 3 months prior to the start of the fever; known HIVinfection; known hypogammaglobulinemia or use of 10 mg prednisone or equivalent for ≥2 weeks in the 3 months prior to the start of the fever) > Diagnosis uncertain despite thorough history-taking, physical examination and the following investigations: erythrocyte sedimentation rate or C-reactive protein, haemoglobin, platelet count, leukocyte count and differentiation, electrolytes, creatinine, total protein, protein electrophoresis, alkaline phosphatase, aspartate aminotransferase, alanine aminotransferase, lactate dehydrogenase, creatine kinase, antinuclear antibodies, rheumatoid factor, microscopic urinalysis, ferritin, three blood cultures, urine culture, chest X-ray, abdominal ultrasonography and tuberculin skin test.

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Section: Defi Nition and Causesmentioning

confidence: 99%

Fever of unknown origin

2015

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“…The commonest syndrome presented is one of a flu-like illness, with fever that may be protracted (often presenting as fever of unknown origin [24]), arthralgia, myalgia, fatigue and malodorous perspiration. The propensity for reticuloendothelial system invasion leads often to hepatomegaly, splenomegaly and lymphadenopathy.…”

Section: Clinical Characteristicsmentioning

confidence: 99%

Biological weapons

Pappas¹,

Panagopoulou²,

Christou

et al. 2006

Cell. Mol. Life Sci.

218

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Brucella has traditionally been considered a biological weapon. It was the subject of extensive offensive research in the past, and still belongs to category B pathogens on most lists. Its propensity for airborne transmission and induction of chronic debilitating disease requiring combined antibiotic regimens for treatment, its abundance around the world and its vague clinical characteristics defying rapid clinical diagnosis are some of the characteristics that apply to the pathogen's weapons potential. Yet minimal mortality, availability of treatment options, protracted inoculation period and the emergence of new, more virulent potential weapons means that its inclusion among agents of bioterrorism is nowadays mainly of historical significance. Nevertheless, in the interest of literacy and of avoiding panic, physicians and the public both should be aware of the most common zoonosis worldwide.

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“…TB was found to be the most common infection causing FUO not only in India but also in studies done in Turkey and Taiwan. [4,[7][8][9][10][11][12][13] Brucellosis and enteric fever were found to be the commonest infections in a study from Kashmir while brucellosis and infective endocarditis were most frequent in Egypt. [3,14] In a study with critically ill patients Ventilator associated Pneumonia(VAP) was found to be the most common infection.…”

Section: Discussionmentioning

confidence: 99%

A Cross-sectional Study of Undiagnosed Fever in a Rural Population at a Tertiary Care Hospital of West Bengal

Chatterjee¹,

Chakraborty²,

Mukhopadhyay³

et al. 2018

AIMDR

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Background: Undiagnosed fever has been a predicament to physicians all over the world for decades. This study was undertaken to evaluate the demographic and etiological pattern of a rural population in Eastern India. Objectives. 1. To study the spectrum of etiology of prolonged fever. 2. To evaluate the demographic characteristics of the patients. Methods: All patients with undiagnosed fever for more than three weeks attending the Medicine outpatient Department were included in the study. History and clinical examination were recorded in a proforma. All patients under went routine as well as relevant special investigations including RDT for Malaria, IgM ELISA for Leptospira and Chikungunya and Brucella. Blood, urine and other body fluid culture including BACTEC and CB NAAT (as required) were also done. Endoscopies, imaging studies and guided biopsies were performed where needed. Results were recorded and analysed using appropriate descriptive statistical methods using SPSS Software (version 20). Results: A total number of 110 patients were included in the study. Of them 52(47.2%) were male and 58 (52.7%) were female. The age of the patients varied from 15 years to 78 years mean age being 33.68±18.77. Conclusion: The patients were mainly from rural background, most common districts being Murshidabad (40%) followed by24 Parganas S (20%), Midnapur (14.5%) and Nadia (10.9%). Socioeconomic status of the patients varied from lower (47.2%) lower middle class (39%) to middle class(13.8%). 65.3% of the patients were literate of whom 10.9 % of the people were matriculate while 1.8% were graduates. The commonest etiology of prolonged fever were infections 76(69%) out of which Tuberculosis 44(40%), took the lions' share. Tuberculosis was followed by chronic UTI (8.2%) enteric fever(5.5%) and malaria(4.5%). This was followed by various malignancies 14(12.7%) and inflammatory disorders 12(10.9%) It was notable that while prevalence of infections were comparable in males and females the prevalence of cancers (15.3%vs10.3%) and inflammatory disorders (7.6%vs 13.8%) varied. No diagnosis could be reached in 3.6% cases.

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Fever of unknown origin in Turkey: evaluation of 87 cases during a nine-year-period of study

Cited by 73 publications

References 13 publications

Fever of unknown origin

Fever of unknown origin

Biological weapons

A Cross-sectional Study of Undiagnosed Fever in a Rural Population at a Tertiary Care Hospital of West Bengal

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