Fever of unknown origin (FUO) on a land on cross‐roads between Asia and Europa; a multicentre study from Turkey

Abstract

Aims The differential diagnosis of Fever of Unknown Origin (FUO) is still a major clinical challenge despite the advances in diagnostic procedures. In this multicentre study, we aimed to reveal FUO aetiology and factors influencing the final diagnosis of FUO in Turkey. Methods A total of 214 patients with FUO between the years 2015 and 2019 from 13 tertiary training and research hospitals were retrospectively evaluated. Results The etiologic distribution of FUO was infections (44.9%), malignancies (15.42%), autoimmune/inflammatory (11.68%) diseases, miscellaneous diseases (8.41%) and undiagnosed cases (19.62%). Brucellosis (10.25%), extrapulmonary tuberculosis (6.54%) and infective endocarditis (6.54%) were the most frequent three infective causes. Solid malignancies (7.1%) and lymphoma (5.6%), adult‐onset still's disease (6.07%) and thyroiditis (5.14%) were other frequent diseases. The aetiological spectrum did not differ in elderly people (P < .05). Infections were less frequent in Western (34.62%) compared with Eastern regions of Turkey (60.71%) (P < .001, OR: 0.31, 95% Cl: 0.19 to 0.60). The ratio of undiagnosed aetiology was significantly higher in elderly people (p: 0.046, OR: 2.34, 95% Cl: 1.00 to 5.48) and significantly lower in Western Turkey (P: .004, OR: 3.07, 95% Cl: 1.39 to 6.71). Conclusions Brucellosis, extrapulmonary tuberculosis and infective endocarditis remain to be the most frequent infective causes of FUO in Turkey. Solid tumours and lymphomas, AOSD and thyroiditis are the other common diseases. The aetiological spectrum did not differ in elderly people, on the other hand, infections were more common in Eastern Turkey. A considerable amount of aetiology remained undiagnosed despite the state‐of‐the‐art technology in healthcare services.

Risk factors for acute brucellosis in patients on the day of admission at selected hospitals of Abbottabad, Pakistan

“…This prevalence shows the high burden of disease in the local population. This prevalence is in the expected range to be found in patients with FUO (21,22). A recent study from hospitals of Abbottabad found 70% of patients SAT positive and a bias due to patient recruitment has to be assumed (33).…”

“…Consequently, it is of prominent importance to diagnose brucellosis as early as possible and set on adequate therapy. Brucellosis is also one of the most frequent infective causes of fever of unknown origin in endemic regions (21,22). Physicians working at outdoor patient departments of hospitals in Pakistan are aware of this fact nowadays and have slide serum agglutination tests based on brucellosis febrile antigens and PCR as cheap and fast diagnostic tools at hand.…”

“…These tests are considered useful for diagnosis of acute and subacute brucellosis when patients show clinical symptoms but fail to identify chronic cases (20). Hence, it may be a valuable tool in diagnosis of fever of unknown origin caused by brucellae as genus speci c PCRs exist (21,22).…”

Structured diagnostic scheme clinical experience sharing:a prospective study of 320 cases of fever of unknown origin

“…In addition, insu cient awareness of brucellosis by clinicians is also an important factor. All brucellosis patients in this study were treated with antibiotics before admission, but the diagnosis was not con rmed early limited to the physician 's level of awareness, and similar conditions occurred in other countries (12,38).…”

“…1-68.34%(8,9). Notably, some studies have shown that contagious diseases are more common among infectious diseases, e.g., tuberculosis, brucellosis, typhoid fever(8, [10][11][12]. Therefore, early diagnosis of infectious diseases not only enables patients to receive timely and reasonable treatment, but also reduces the risk of major adverse public health events.…”