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Ratti N, Ly KH, Dumonteil S, François M, Sailler L, Lambert M, Hot A, Gondran G, Palat S, Bezanahary H, Desvaux E, Aslanbekova N, Parreau S, Fauchais AL, Sève P, Liozon E. Recurrent (or episodic) fever of unknown origin (FUO) as a variant subgroup of classical FUO: a French Multicenter Retrospective study of 170 patients. Clin Med (Lond) 2024:100202. [PMID: 38642612 DOI: 10.1016/j.clinme.2024.100202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 02/23/2024] [Indexed: 04/22/2024]
Abstract
BACKGROUND Recurrent-FUO (fever of unknown origin) is a rare subtype of FUO for which diagnostic procedures are ill-defined and outcome data are lacking. METHODS We performed a retrospective multicentre study of patients with recurrent-FUO between 1995 and 2018. By multivariate analysis, we identified epidemiological, clinical, and prognostic variables independently associated with final diagnosis and mortality. RESULTS Of 170 patients, 74 (44%) had a final diagnosis. Being ≥ 65 years of age (OR=5.2; p<0.001), contributory history (OR=10.4; p < 0.001), and abnormal clinical examination (OR=4.0; p=0.015) independently increased the likelihood of reaching a diagnosis, whereas lymph node and/or spleen enlargement decreased it (OR = 0.2; p=0.004). The overall prognosis was good; 58% of patients recovered (70% of those with a diagnosis). Twelve (7%) patients died; patients without a diagnosis had a fatality rate of 2%. Being ≥ 65 years of age (OR = 41.3; p < 0.001) and presence of skin signs (OR = 9.5; p = 0.005) significantly increased the risk of death. CONCLUSION This study extends the known yield of recurrent-FUO and highlights the importance of repeated complete clinical examinations to discover potential diagnostic clues during follow- up. Moreover, their overall prognosis is excellent.
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Affiliation(s)
- N Ratti
- Departments of Internal Medicine, University Hospitals of Limoges (Dupuytren)
| | - K H Ly
- Departments of Internal Medicine, University Hospitals of Limoges (Dupuytren)
| | - S Dumonteil
- Departments of Internal Medicine, University Hospitals of Limoges (Dupuytren).
| | - M François
- Departments of Internal Medicine, University Hospitals of Lyon Sud (Pierre-Bénite)
| | - L Sailler
- Departments of Internal Medicine, University Hospitals of Toulouse (Purpan)
| | - M Lambert
- Departments of Internal Medicine, University Hospitals of Lille (Claude Huriez)
| | - A Hot
- Departments of Internal Medicine, University Hospitals of Lyon (Édouard Herriot)
| | - G Gondran
- Departments of Internal Medicine, University Hospitals of Limoges (Dupuytren)
| | - S Palat
- Departments of Internal Medicine, University Hospitals of Limoges (Dupuytren)
| | - H Bezanahary
- Departments of Internal Medicine, University Hospitals of Limoges (Dupuytren)
| | - E Desvaux
- Departments of Internal Medicine, University Hospitals of Limoges (Dupuytren)
| | - N Aslanbekova
- Departments of Internal Medicine, University Hospitals of Limoges (Dupuytren)
| | - S Parreau
- Departments of Internal Medicine, University Hospitals of Limoges (Dupuytren)
| | - A L Fauchais
- Departments of Internal Medicine, University Hospitals of Limoges (Dupuytren)
| | - P Sève
- Departments of Internal Medicine, University Hospitals of Lyon (La Croix-Rousse)
| | - E Liozon
- Departments of Internal Medicine, University Hospitals of Limoges (Dupuytren)
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Erdem H, Al-Tawfiq JA, Abid M, Yahia WB, Akafity G, Ramadan ME, Amer F, El-Kholy A, Hakamifard A, Rahimi BA, Dayyab F, Caskurlu H, Khedr R, Tahir M, Zambrano L, Khan MA, Raza A, El-Sayed NM, Baymakova M, Yalci A, Cag Y, Elbahr U, Ikram A. Infectious causes of fever of unknown origin in developing countries: An international ID-IRI study. J Intensive Med 2024; 4:94-100. [PMID: 38263972 PMCID: PMC10800762 DOI: 10.1016/j.jointm.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/02/2023] [Accepted: 07/04/2023] [Indexed: 01/25/2024]
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.
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Affiliation(s)
- Hakan Erdem
- Department of Infectious Diseases & Clinical Microbiology, Gulhane School of Medicine, Turkish Health Sciences University, Ankara, Turkey
| | - Jaffar A. Al-Tawfiq
- Specialty Internal Medicine and Quality and Patient Safety Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
- Division of Infectious Diseases, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Maha Abid
- Department of Infectious Diseases, Farhat Hached University Hospital, Ibn El Jazzar Medical School, University of Sousse, Sousse, Tunisia
| | - Wissal Ben Yahia
- Internal Medicine Department, Farhat Hached University Hospital, Ibn El Jazzar Medical School, University of Sousse, Sousse, Tunisia
| | | | | | - Fatma Amer
- Department of Medical Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Amani El-Kholy
- Department of Clinical Pathology, Faculty of Medicine, Cairo University, Giza, Egypt
| | - Atousa Hakamifard
- Department of Infectious Diseases, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Bilal Ahmad Rahimi
- Department of Infectious Diseases, Kandahar University Medical Faculty, Teaching Hospital, Kandahar, Afghanistan
| | - Farouq Dayyab
- Department of Infectious Diseases, Mohammed Bn Khalifa Bn Salman Alkhalifa Specialist Cardiac Center, Awali, Bahrain
| | - Hulya Caskurlu
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Reham Khedr
- Department of Pediatric Oncology, National Cancer Institute – Cairo University, Children Cancer Hospital Egypt, Cairo, Egypt
| | - Muhammad Tahir
- Department of Medicine, Federal General Hospital, Islamabad, Pakistan
| | - Lysien Zambrano
- Institute for Research in Medical Sciences and Right to Health (ICIMEDES), Scientific Research Unit (UIC), Faculty of Medical Sciences (FCM), National Autonomous University of Honduras (UNAH), Tegucigalpa, Honduras
| | | | - Aun Raza
- Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | | | - Magdalena Baymakova
- Department of Infectious Diseases, Military Medical Academy, Sofia, Bulgaria
| | - Aysun Yalci
- Department of Infectious Diseases & Clinical Microbiology, Gulhane School of Medicine, Turkish Health Sciences University, Ankara, Turkey
| | - Yasemin Cag
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Umran Elbahr
- Department of Infectious Diseases, Bahrain Oncology Center, King Hamad University Hospital, Al Muharraq, Bahrain
| | - Aamer Ikram
- National Institute of Health, Islamabad, Pakistan
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Tanoglu A, Erdem H, Friedland JS, Ankaralı H, Garcia-Goez JF, Albayrak A, El-Kholy A, Ceviker SA, Amer F, Erol S, Darazam IA, Rabiei MM, Sarwar MZ, Zeb M, Nawaz H, Ceylan MR, Cernat R, Tasbakan M, Ayoade F, Ruch Y, Tigen ET, Angioni G, Rajani DP, Akhtar N, Surme S, Sengoz G, Karlıdag GE, Marino A, Ripon RK, Çağ Y, Aydın Ö, Akkoyunlu Y, Seyman D, Angamuthu K, Cascio A, Popescu CP, Sirmatel F, Eren E, Dar RE, Munu FU, Tanoglu EG, Echeverry E, Velez JD, Artuk C, Balin SO, Pandya N, Erdem A, Demiray EKD, Aypak A. Clinicopathological profile of peritoneal tuberculosis and a new scoring model for predicting mortality: an international ID-IRI study. Eur J Clin Microbiol Infect Dis 2023:10.1007/s10096-023-04630-9. [PMID: 37318601 DOI: 10.1007/s10096-023-04630-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/03/2023] [Indexed: 06/16/2023]
Abstract
Existing literature about peritoneal tuberculosis (TBP) is relatively insufficient. The majority of reports are from a single center and do not assess predictive factors for mortality. In this international study, we investigated the clinicopathological characteristics of a large series of patients with TBP and determined the key features associated with mortality. TBP patients detected between 2010 and 2022 in 38 medical centers in 13 countries were included in this retrospective cohort. Participating physicians filled out an online questionnaire to report study data. In this study, 208 patients with TBP were included. Mean age of TBP cases was 41.4 ± 17.5 years. One hundred six patients (50.9%) were females. Nineteen patients (9.1%) had HIV infection, 45 (21.6%) had diabetes mellitus, 30 (14.4%) had chronic renal failure, 12 (5.7%) had cirrhosis, 7 (3.3%) had malignancy, and 21 (10.1%) had a history of immunosuppressive medication use. A total of 34 (16.3%) patients died and death was attributable to TBP in all cases. A pioneer mortality predicting model was established and HIV positivity, cirrhosis, abdominal pain, weakness, nausea and vomiting, ascites, isolation of Mycobacterium tuberculosis in peritoneal biopsy samples, TB relapse, advanced age, high serum creatinine and ALT levels, and decreased duration of isoniazid use were significantly related with mortality (p < 0.05). This is the first international study on TBP and is the largest case series to date. We suggest that using the mortality predicting model will allow early identification of high-risk patients likely to die of TBP.
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Affiliation(s)
- Alpaslan Tanoglu
- Department of Internal Medicine and Gastroenterology, Sancaktepe Sehit Prof Dr Ilhan Varank Training and Research Hospital, University of Health Sciences, 34785, Istanbul, Turkey.
| | - Hakan Erdem
- Department of Infectious Diseases & Clinical Microbiology, Gulhane School of Medicine, University of Health Sciences, Ankara, Turkey
- MKCC Cardiac Centre, Awali, Bahrain
| | | | - Handan Ankaralı
- Department of Biostatistics and Medical Informatics, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
| | - Jose Fernando Garcia-Goez
- Infectious Disease Service Hospital Universitario Fundacion Valle del Lili Colombia, Facultad de Medicina Universidad Icesi, Cali, Colombia
| | - Ayse Albayrak
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Amani El-Kholy
- Department of Clinical Pathology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Sevil Alkan Ceviker
- Department of Infectious Diseases, Faculty of Medicine, Canakkale Onsekiz Mart University, Canakkale, Turkey
| | - Fatma Amer
- Department of Medical Microbiology and Immunology, Zagazig Faculty of Medicine, Zagazig, Egypt
| | - Serpil Erol
- Department of Infectious Diseases, Haydarpasa Numune Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | | | | | | | - Misbah Zeb
- Department of Infectious Diseases, Mayo Hospital, Lahore, Pakistan
| | - Hassan Nawaz
- Department of Infectious Diseases, Mayo Hospital, Lahore, Pakistan
| | | | - Roxana Cernat
- Department of Infectious Diseases, Clinical Hospital for Infectious Diseases, Constanta, Romania
| | - Meltem Tasbakan
- Department of Infectious Diseases, Ege University, Izmir, Turkey
| | - Folusakin Ayoade
- Department of Infectious Diseases, University of Miami, Miami, FL, USA
| | - Yvon Ruch
- Department of Infectious Diseases, Strasbourg University, Strasbourg, France
| | - Elif Tükenmez Tigen
- Department of Infectious Diseases, Pendik Training and Research Hospital, Marmara University, Istanbul, Turkey
| | - Goffredo Angioni
- Department of Infectious Diseases, Hospital SS Trinità, Borgomanero, Italy
| | - Dhanji P Rajani
- Microcare Laboratory & Tuberculosis Research Centre, Surat, Gujarat, India
| | - Nasim Akhtar
- Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - Serkan Surme
- Department of Infectious Diseases, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Gonul Sengoz
- Department of Infectious Diseases, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Gulden Eser Karlıdag
- Department of Infectious Diseases, Elazig Fethi Sekin City Hospital, University of Health Sciences, Elazig, Turkey
| | - Andrea Marino
- Unit of Infectious Diseases, Department of Clinical and Experimental Medicine, ARNAS Garibaldi Hospital, University of Catania, Catania, Italy
| | - Rezaul Karim Ripon
- Department of Public Health and Informatics, Jahangirnagar University, Savar Union, Bangladesh
| | - Yasemin Çağ
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Özlem Aydın
- Department of Infectious Diseases and Clinical Microbiology, Istanbul Medeniyet University Goztepe Training and Research Hospital, Istanbul, Turkey
| | - Yasemin Akkoyunlu
- Department of Infectious Diseases, Bezmialem Vakif University, Istanbul, Turkey
| | - Derya Seyman
- Department of Infectious Diseases, Antalya Education and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Kumar Angamuthu
- Department of Infectious Diseases, Almana General Hospitals, Dammam, Saudi Arabia
| | - Antonio Cascio
- Infectious Disease Unit, Policlinico "P. Giaccone", University of Palermo, Palermo, Italy
| | - Corneliu Petru Popescu
- Department of Infectious Diseases, Dr. Victor Babes Clinical Hospital of Infectious and Tropical Diseases, Bucharest, Romania
| | - Fatma Sirmatel
- Department of Infectious Diseases, Bolu Abant Izzet Baysal University Medical Faculty, Bolu, Turkey
| | - Esma Eren
- Department of Infectious Diseases, Kayseri City Hospital, Kayseri, Turkey
| | - Razi Even Dar
- Department of Infectious Diseases, Caemal, Haifa, Israel
| | - Foday Usman Munu
- Department of Infectious Diseases, Lakka Government Hospital, Freetown, Sierra Leone
| | - Esra Guzel Tanoglu
- Department of Molecular Biology and Genetics, University of Health Sciences, Istanbul, Turkey
| | - Esteban Echeverry
- Infectious Disease Service Hospital Universitario Fundacion Valle del Lili Colombia, Facultad de Medicina Universidad Icesi, Cali, Colombia
| | - Juan Diego Velez
- Infectious Disease Service Hospital Universitario Fundacion Valle del Lili Colombia, Facultad de Medicina Universidad Icesi, Cali, Colombia
| | - Cumhur Artuk
- Department of Infectious Diseases & Clinical Microbiology, Gulhane School of Medicine, University of Health Sciences, Ankara, Turkey
| | - Safak Ozer Balin
- Department of Infectious Diseases, Fırat University Medical Faculty, Elazig, Turkey
| | - Nirav Pandya
- Department of Infectious Diseases, Bhailal Amin General Hospital, Vadodara, India
| | - Aysegul Erdem
- Department of Pathology, Ataturk Sanatoryum Training and Research Hospital, Ankara, Turkey
| | | | - Adalet Aypak
- Department of Infectious Diseases and Clinical Microbiology, Ankara City Training and Research Hospital, Ankara, Turkey
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Santacroce L, Colella M, Charitos IA, Di Domenico M, Palmirotta R, Jirillo E. Microbial and Host Metabolites at the Backstage of Fever: Current Knowledge about the Co-Ordinate Action of Receptors and Molecules Underlying Pathophysiology and Clinical Implications. Metabolites 2023; 13:metabo13030461. [PMID: 36984901 PMCID: PMC10056708 DOI: 10.3390/metabo13030461] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 03/16/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
Fever represents an elevation of body temperature, that exerts a protective effect against pathogens. Innate immune cells and neurons are implicated in the regulation of body temperature. Pathogen-associated molecular patterns, i.e., lipopolysaccharides from Gram-negative bacteria and peptidoglycan and lipoteichoic acid from Gram-positive bacteria are exogenous pyrogens, that bind to Toll-like receptors on immune and non-immune cells. The subsequent release of pro-inflammatory cytokines [interleukin-1 (IL-1), IL-6 and Tumor necrosis factor-alpha] and their passage through the brain trigger the febrile response. In fact, neurons of the pre-optic area produce prostaglandin E2 (PGE2), that, in turn, bind to the PGE2 receptors; thus, generating fever. Apart from classical non-steroidal anti-inflammatory drugs, i.e., aspirin and acetaminophen, various botanicals are currently used as antipyretic agents and, therefore, their mechanisms of action will be elucidated.
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Affiliation(s)
- Luigi Santacroce
- Interdisciplinary Department of Medicine, Section of Microbiology and Virology, School of Medicine, University of Bari 'Aldo Moro', 70124 Bari, Italy
| | - Marica Colella
- Interdisciplinary Department of Medicine, Section of Microbiology and Virology, School of Medicine, University of Bari 'Aldo Moro', 70124 Bari, Italy
| | - Ioannis Alexandros Charitos
- CEDICLO-Interdepartmental Research Center for Pre-Latin, Latin and Oriental Rights and Culture Studies, University of Bari, 70121 Bari, Italy
| | - Marina Di Domenico
- Department of Precision Medicine, University of Campania 'Luigi Vanvitelli', 80138 Naples, Italy
| | - Raffaele Palmirotta
- Interdisciplinary Department of Medicine, Section of Microbiology and Virology, School of Medicine, University of Bari 'Aldo Moro', 70124 Bari, Italy
| | - Emilio Jirillo
- Interdisciplinary Department of Medicine, Section of Microbiology and Virology, School of Medicine, University of Bari 'Aldo Moro', 70124 Bari, Italy
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