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

Abstract

Introduction. The study aimed to compare the etiologic spectrum of diseases causing fever of unknown origin (FUO) and methods for definitive diagnosis in a tertiary care hospital in the Republic of North Macedonia during two different time periods. Patients and methods. There were analysed retrospectively the causes for FUO and final diagnostic approaches in 185 patients with classic FUO that were treated at the University Hospital for Infectious Diseases in Skopje during two time periods. Seventy nine patients were treated during 1991 to 1995 and 106 patients during 2011 to 2015. Results. When comparing these two periods, infections were present in 46.8% and 29.2% (p = 0.014), non-infective inflammatory disorders in 22.8% and 25.5% (p = 0.674), neoplasms in 10.1% and 13.2% (p = 0.522), miscellaneous in 8.9% and 12.3% (p = 0.461) and undiagnosed cases in 11.4% and 19.8% (p = 0.124), respectively. The most common causes for FUO during the first period were abscesses (8.9%), tuberculosis and systemic lupus erythematosus (7.6% each), whereas in the second period the commonest causes were adult onset Still disease and solid organ neoplasm (7.6% each), polymyalgia rheumatica, abscesses and visceral leishmaniasis (5.7% each). The newer imaging techniques and clinical course evaluation had superior diagnostic significance during the second period. Conclusion. A changing pattern of diseases causing FUO during the examined periods was evident. Infections continue to be the most common cause but with decreasing incidence when compared to 20 years ago. Even nowadays clinical evaluation and follow-up still remain the vital diagnostic tools in determining the etiology of FUO.

Human brucellosis in pregnancy – an overview

“…Human brucellosis is one of the most common zoonoses in the world and important public health problem in many parts of Africa, South and Central America, Asia, and the Mediterranean region [1,2]. Clinically, it is presented as febrile disease with affection of various body systems [3] or as a fever of unknown origin [4]. The disease is contracted through direct contact with infected animals, ingestion of unpasteurized dairy products, or by aerosol inhalation [3,5,6].…”

Utility of positron emission tomography–computed tomography in the evaluation of fever of unknown origin in a resource-limited tropical nation

“…There has been a shift in the predominant etiology of FUO in certain regions, with increase in NIIDs and reduction in infections. [ 21 22 23 ] The number of undiagnosed FUO patients have increased with time. [ 23 ] Robine et al .…”

“…There has been a shift in the predominant etiology of FUO in certain regions, with increase in NIIDs and reduction in infections. [21][22][23] The number of undiagnosed FUO patients have increased with time. [23] Robine et al found NIIDs in 61% of FUO patients with an established diagnosis, with PET-CT scan being contributory in merely 20.8% (10/48).…”

Fever of Unknown Origin (FUO): towards uniform definitions and classification system

“…One of the most challenging clinical syndromes related to elevated body temperature is fever of unknown origin (FUO). Despite the immense expansion of medical sciences, FUO currently remains a complex clinical entity and serious diagnostic challenge (4). The true incidence and prevalence of FUO are unknown.…”