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Infectious Causes of Fever of Unknown Origin in Developing Countries: An International Id-Iri Study Publisher

Summary: Research shows tuberculosis, endocarditis, and malaria drive fever of unknown origin in developing countries, with severe outcomes in 24% of cases. #InfectiousDisease #GlobalHealth

Erdem H1 ; Altawfiq JA2, 3 ; Abid M4 ; Yahia WB5 ; Akafity G6 ; Ramadan ME7 ; Amer F8 ; Elkholy A9 ; Hakamifard A10 ; Rahimi BA11 ; Dayyab F12 ; Caskurlu H13 ; Khedr R14 ; Tahir M15 Show All Authors
Authors
  1. Erdem H1
  2. Altawfiq JA2, 3
  3. Abid M4
  4. Yahia WB5
  5. Akafity G6
  6. Ramadan ME7
  7. Amer F8
  8. Elkholy A9
  9. Hakamifard A10
  10. Rahimi BA11
  11. Dayyab F12
  12. Caskurlu H13
  13. Khedr R14
  14. Tahir M15
  15. Zambrano L16
  16. Khan MA17
  17. Raza A18
  18. Elsayed NM19
  19. Baymakova M20
  20. Yalci A1
  21. Cag Y13
  22. Elbahr U21
  23. Ikram A17

Source: Journal of Intensive Medicine Published:2024


Abstract

Background: Fever of unknown origin (FUO) in developing countries is an important dilemma and further research is needed to elucidate the infectious causes of FUO. Methods: A multi-center study for infectious causes of FUO in lower middle-income countries (LMIC) and low-income countries (LIC) was conducted between January 1, 2018 and January 1, 2023. In total, 15 participating centers from seven different countries provided the data, which were collected through the Infectious Diseases-International Research Initiative platform. Only adult patients with confirmed infection as the cause of FUO were included in the study. The severity parameters were quick Sequential Organ Failure Assessment (qSOFA) ≥2, intensive care unit (ICU) admission, vasopressor use, and invasive mechanical ventilation (IMV). Results: A total of 160 patients with infectious FUO were included in the study. Overall, 148 (92.5%) patients had community-acquired infections and 12 (7.5%) had hospital-acquired infections. The most common infectious syndromes were tuberculosis (TB) (n=27, 16.9%), infective endocarditis (n=25, 15.6%), malaria (n=21, 13.1%), brucellosis (n=15, 9.4%), and typhoid fever (n=9, 5.6%). Plasmodium falciparum, Mycobacterium tuberculosis, Brucellae, Staphylococcus aureus, Salmonella typhi, and Rickettsiae were the leading infectious agents in this study. A total of 56 (35.0%) cases had invasive procedures for diagnosis. The mean qSOFA score was 0.76±0.94 {median (interquartile range [IQR]): 0 (0–1)}. ICU admission (n=26, 16.2%), vasopressor use (n=14, 8.8%), and IMV (n=10, 6.3%) were not rare. Overall, 38 (23.8%) patients had at least one of the severity parameters. The mortality rate was 15 (9.4%), and the mortality was attributable to the infection causing FUO in 12 (7.5%) patients. Conclusions: In LMIC and LIC, tuberculosis and cardiac infections were the most severe and the leading infections causing FUO. © 2023 The Author(s)