Prevalence of Connective Tissue Diseases in Egyptian Patients Presenting with Fever of Unknown Origin

Abstract

Objective:To estimate the prevalence of connective tissue diseases in patients presenting with fever of unknown origin (FUO).Patients and methods:In this study thirty patients diagnosed as FUO (Group 1), in 2008, were included in an observational study and diagnostic workup. Additionally, retrospective analysis of seventy patients’ files (Group 2), for patients who presented with prolonged unexplained pyrexia to the same hospital in the previous two years, was performed. Patients were subjected to: full clinical assessment including full history taking, thorough clinical examination, laboratory investigations including the basic investigations for patients with prolonged fever, complete blood count, erythrocytes sedimentation rate, urine analysis and culture, blood culture, sputum culture and plain chest X ray. Further diagnostic work up and/or procedures were requested according to the potential diagnostic clues (PDC) present in every patient.Results:Out of 100 FUO patients, 50% were found to have infectious diseases, 24% were found to have connective tissue diseases, 8% miscellaneous causes and 7% neoplastic diseases (P < 0.05). In 11 patients no definite cause for FUO could be identified. Connective tissue patients were: eight systemic lupus patients (33.3%), five patients with familial mediterranean fever (20.8%), four patients with rheumatoid arthritis (16.6%), three patients (12.5%) with Still’s disease and Rheumatic fever and one patient with Behçet syndrome/Crohn’s disease (4.3%), (P < 0.05).Conclusions:Despite the advanced technology, FUO remains a challenging medical problem. Infections were the most common cause of FUO in Egypt, confirming the trends found in other parts of the world. There was an increased prevalence of connective tissue patients presented with prolonged unexplained fever. A keen clinical eye, meticulous history taking and repeated physical examination remained the most important diagnostic tools in FUO patients.

The changing pattern of fever of unknown origin in the Republic of North Macedonia

“…In our study, the patients from the second time period were significantly older which can partially explain the changed etiological spectrum of FUO causes with increased frequency of solid organ neoplasms, polymyalgia rheumatica and deep vein thrombosis. Similar age distribution to the one found in our study was described by Barbado et al [23], while in other studies no age differences between the studied periods were noted [22,24].…”

“…In addition, in some studies the characteristics of FUO were investigated in periods where there was no substantial time difference, i.e. with the completion of one period, a new period of study was started [21][22][23][24]. Also, there are studies where one's own clinical material was compared with previously published data from the same or different regions [4,5,24,25].…”

Fever of unknown origin − diagnostic methods in a European developing country

“…A rather high frequency of bacterial infections such as abscesses, UTI and endocarditis can be ascribed to the all too common practice of repeatedly prescribing antibiotics to patients with prolonged fever. Interestingly, in our study there were no cases with human brucellosis as a cause of FUO, something that has been mentioned by other authors 7,35,36 . Possibly this is due to the fact that brucellosis, predominantly an endemic disease in this region 37 , is often thought of by doctors and patients, as well.…”

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

“…There is an increased prevalence of connective tissue diseases presented with prolonged unexplained fever [24]. The percentage of cases that remained undiagnosed was much lower than the global rates, even those reported in other studies in developed countries (3% versus 50% [19], 27% [15], 25.7% [16], 16.7% [18], and 13% [23]).…”