Ercan Yenilmez1, Deniz Kakalicoglu1, Fatma Bozkurt2, Mine Filiz3, Aysegul Akkol Camurcu4, Elif Ozge Damar Midik5, Hande Berk Cam6, Eren Arkali7, Seval Bilgic Atli2, Ahmet Sahin8, Sibel Yorulmaz Goktas9, Halil Erkan10, Mehmet Resat Ceylan11, Merve Kacar Eker12, Hava Kaya13, Zehra Karacaer3, Ersin Tural1, İlyas Dokmetas14, Levent Gorenek1, Sukran Kose7. 1. Department of Infectious Diseases and Clinical Microbiology, Sultan Abdulhamid Han Training and Research Hospital, University of Health Sciences, Uskudar, Turkey. 2. Department of Infectious Diseases and Clinical Microbiology, Gazi Yasargil Training and Research Hospital, University of Health Sciences, Diyarbakir, Turkey. 3. Department of Infectious Diseases and Clinical Microbiology, Gulhane Training and Research Hospital, University of Health Sciences, Ankara, Turkey. 4. Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Training and Research Hospital, University of Health Sciences, Uskudar, Turkey. 5. Department of Infectious Diseases and Clinical Microbiology, Kartal Lutfi Kirdar City Hospital, University of Health Sciences, Uskudar, Turkey. 6. Department of Infectious Diseases and Clinical Microbiology, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey. 7. Department of Infectious Diseases and Clinical Microbiology, Tepecik Training and Research Hospital, University of Health Sciences, Konak, Turkey. 8. Department of Infectious Diseases and Clinical Microbiology, Mehmet Akif Inan Training and Research Hospital, University of Health Sciences, Sanliurfa, Turkey. 9. Department of Infectious Diseases and Clinical Microbiology, Bursa Yuksek Ihtisas Training and Research Hospital, University of Health Sciences, Bursa, Turkey. 10. Department of Infectious Diseases and Clinical Microbiology, Bozyaka Training and Research Hospital, University of Health Sciences, Konak, Turkey. 11. Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Harran University, Sanliurfa, Turkey. 12. Department of Infectious Diseases and Clinical Microbiology, Fatih Sultan Mehmet Training and Research Hospital, University of Health Sciences, Uskudar, Turkey. 13. Department of Infectious Diseases and Clinical Microbiology, Adana City Hospital, University of Health Sciences, Adana, Turkey. 14. Department of Infectious Diseases and Clinical Microbiology, Sisli Hamidiye Etfal Training and Research Hospital, University of Health Sciences, Uskudar, 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.
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.
Authors: Laiba Hassan; Shahzad Ali; Muhammad Ali Syed; Asim Ali Shah; Shahid Ahmad Abbasi; Sadia Tabassum; Usama Saeed; Falk Melzer; Aman Ullah Khan; Hosny El-Adawy; Heinrich Neubauer Journal: Front Public Health Date: 2022-01-31