Clinical spectrum of fever of intermediate duration in the south of Spain

Abstract

Fever of intermediate duration (FID) is a new nosologic entity defined as fever higher than 38 degrees C that has a duration of between 1 and 4 weeks and that after an initial approach has not been diagnosed. It has clinical similarities with fever of unknown origin, but because of characteristic etiologies it requires the term FID. We describe the clinical characteristics and etiology of FID in the south of Spain and create a treatment algorithm. Retrospective study of the medical charts of patients attending at our Service during 2000 and 2005 who had an initial diagnosis of FID and who had a complete follow-up until the resolution of symptoms. Two hundred and thirty-three patients met the inclusion criteria, of whom 164 were men. Median number of days before being referred to our service was 9 (range 2-28). Half of the patients had elevation of transaminases, and CRP and ESR were slightly elevated, 2.8 mg/dl (range 0.1-50) and 16 mm/h (range 1-131) respectively. A final diagnosis was made in 80 patients, with infection with coxiella (32 patients), CMV (16 patients), rickettsial species (11 patients), VEB virus (6 patients), and brucella (5 patients) being the more frequent entities. Doxycycline was the antibiotic most frequently prescribed. Among patients with Q fever, CMV, and rickettsial infection, the majority had abnormal hepatic function, (87%, 93%, and 55% respectively). In FID, a diagnosis is reached in a minority of patients, although the prognosis is excellent in most of them. In our patients the clinical picture of Q fever, CMV, and rickettsial infections included abnormal hepatic function. In addition, these three infections are the most frequently diagnosed so when treating a patient with FID, if elevation of liver enzymes is present patients should start on doxycycline.

Strategies for Diagnosis and Treatment of Suspected Leptospirosis: A Cost-Benefit Analysis

“…In summary leptospirosis is a common cause of acute undifferentiated fever in rural areas where limited resources are available. Results of this study and other clinical studies [11] , [23] show that empirical treatment with doxycycline would be the most cost-effective option for these patients, as this strategy was also beneficial for patients with other diseases which clinically mimic leptospirosis such as scrub typhus. It should be noted that this strategy applies only to adult patients with acute fever suspected of mild leptospirosis.…”

“…Doxycycline was the most common empirical antimicrobial therapy for this syndrome and all episodes resolved without further complications. Shorter duration of fever among those patients who received treatment was also observed [23] .…”

“…Other epidemiological studies showed that “systemic infection” such as dengue infection, rickettsial infection, brucellosis, Q fever, CMV or EBV infection was common causes of acute fever syndrome, and in many cases fever disappeared without specific diagnosis being established [23] . Doxycycline was the most common empirical antimicrobial therapy for this syndrome and all episodes resolved without further complications.…”

Epidemiological Study of Rickettsial Infections in Patients with Hypertransaminemia in Madrid (Spain)

“…Further, the number of clinical SFG and TG infections has increased over the last few years in this country [22–24]. Studies in the general population, mainly for SFG, have tried to determine the circulating strains involved using molecular techniques, and to isolate them in animal reservoirs and vectors.…”

Is Brucella an enteric pathogen?

“…The brucellae belong to the Alphaproteobacteria 9 , together with Bartonella, Anaplasma, Ehrlichia and Rickettsia, all of which are intracellular pathogens and share common themes of pathobiology 10 . For example, fever is not manifested in concordance with proinflammatory acute responses triggered by PAMP-bearing molecules 2,6,11 , as occurs in typhoid fever, but rather as a consequence of adaptive immunity and, in some cases, hypersensitivity. In addition, Salmonella spp.…”