Classical fever of unknown origin in 21 countries with different economic development: an international ID-IRI study

Erdem H. Baymakova M. Alkan S. Letaief A. Yahia W.B. Dayyab F. Kolovani E. Grgic S. Cosentino F. Hasanoglu I. Khedr R. Marino A. Pekok A.U. Eser F. Arapovic J. Guner H.R. Miftode I.-L. Poposki K. Sanlidag G. Tahmaz A. Sipahi O.R. Miftode E.G. Oncu S. Cagla-Sonmezer M. Addepalli S.K. Darazam I.A. Kumari H.P. Koc M.M. Kumar M.R. Sayana S.B. Wegdan A.A. Amer F. Ceylan M.R. El-Kholy A. Onder T. Tehrani H.A. Hakamifard A. Kayaaslan B. Shehata G. Caskurlu H. El-Sayed N.M. Mortazavi S.E. Pourali M. Elbahr U. Kulzhanova S. Yetisyigit T. Saad S.A. Cag Y. Eser-Karlidag G. Pshenichnaya N. Belitova M. Akhtar N. Al-Majid F. Ayhan M. Khan M.A. Lanzafame M. Makek M.J. Nsutebu E. Cascio A. Dindar-Demiray E.K. Evren E.U. Kalas R. Kalem A.K. Baljić R. Ikram A. Kaya S. Liskova A. Szabo B.G. Rahimi B.A. Mutlu-Yilmaz E. Sener A. Rello J.
April 2023 Springer Science and Business Media Deutschland GmbH

European Journal of Clinical Microbiology and Infectious Diseases
2023 #42 Issue 4 387 - 398 pp.

Fever of unknown origin (FUO) is a serious challenge for physicians. The aim of the present study was to consider epidemiology and dynamics of FUO in countries with different economic development. The data of FUO patients hospitalized/followed between 1st July 2016 and 1st July 2021 were collected retrospectively and submitted from referral centers in 21 countries through ID-IRI clinical research platform. The countries were categorized into developing (low-income (LI) and lower middle-income (LMI) economies) and developed countries (upper middle-income (UMI) and high-income (HI) economies). This research included 788 patients. FUO diagnoses were as follows: infections (51.6%; n = 407), neoplasms (11.4%, n = 90), collagen vascular disorders (9.3%, n = 73), undiagnosed (20.1%, n = 158), miscellaneous diseases (7.7%, n = 60). The most common infections were tuberculosis (n = 45, 5.7%), brucellosis (n = 39, 4.9%), rickettsiosis (n = 23, 2.9%), HIV infection (n = 20, 2.5%), and typhoid fever (n = 13, 1.6%). Cardiovascular infections (n = 56, 7.1%) were the most common infectious syndromes. Only collagen vascular disorders were reported significantly more from developed countries (RR = 2.00, 95% CI: 1.19–3.38). FUO had similar characteristics in LI/LMI and UMI/HI countries including the portion of undiagnosed cases (OR, 95% CI; 0.87 (0.65–1.15)), death attributed to FUO (RR = 0.87, 95% CI: 0.65–1.15, p-value = 0.3355), and the mean duration until diagnosis (p = 0.9663). Various aspects of FUO cannot be determined by the economic development solely. Other development indices can be considered in future analyses. Physicians in different countries should be equally prepared for FUO patients.

Economic development , Fever , Fever of unknown origin , FUO , ID-IRI

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Department of Infectious Diseases & Clinical Microbiology, Gulhane School of Medicine, Turkish Health Sciences University, Ankara, Turkey
Department of Infectious Diseases, Military Medical Academy, Sofia, Bulgaria
Department of Infectious Diseases and Clinical Microbiology, Onsekiz Mart University School of Medicine, Canakkale, Turkey
Department of Infectious Diseases, Farhat Hached University Hospital, Ibn El Jazzar Medical School, University of Sousse, Sousse, Tunisia
Department of Internal Medicine, King Hamad University Hospital, Al Sayh, Manama, Bahrain
Infectious Disease Clinic, University Hospital Center ‘Mother Theresa’, Tirana, Albania
Department of Infectious Diseases, University Clinical Hospital Mostar, Mostar, Bosnia and Herzegovina
Department of Clinical and Experimental Medicine, Unit of Infectious Diseases, ARNAS Garibaldi Hospital, University of Catania, Catania, Italy
Department of Infectious Diseases & Clinical Microbiology, Ankara City Hospital, Ankara, Turkey
Department of Pediatric Oncology, National Cancer Institute - Cairo University, Children Cancer Hospital Egypt, Cairo, Egypt
VM Medical Park, Pendik Hospital, Istanbul, Turkey
St. Parascheva Clinical Hospital of Infectious Diseases, Iasi, Romania
Faculty of Medicine, University Clinic for Infectious Diseases and Febrile Conditions, Skopje, North Macedonia
Department of Infectious Diseases & Clinical Microbiology, Ege School of Medicine, Izmir, Turkey
Department of Infectious Diseases & Clinical Microbiology, Antalya Training and Research Hospital, Antalya, Turkey
Department of Infectious Diseases & Clinical Microbiology, School of Medicine, Adnan Menderes University, Aydin, Turkey
Department of Infectious Diseases & Clinical Microbiology, Hacettepe School of Medicine, Hacettepe University, Ankara, Turkey
Department of Pharmacology, GITAM Institute of Medical Sciences and Research, Andhra Pradesh, Visakhapatnam, India
Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Department of Microbiology, GITAM Institute of Medical Sciences and Research, Andhra Pradesh, Visakhapatnam, India
Department of Infectious Diseases & Clinical Microbiology, School of Medicine, Bezmialem Vakif University, Istanbul, Turkey
Department of Pharmacology, Government Medical College &, Government General Hospital, Telangana, Suryapet, India
Department of Pharmacology, Government Medical College, Telangana, Suryapet, India
Department of Medical Microbiology and Immunology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
Department of Medical Microbiology and Immunology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
Department of Infectious Diseases & Clinical Microbiology, School of Medicine, Harran University, Sanliurfa, Turkey
Department of Clinical Pathology, Faculty of Medicine, Cairo University, Giza, Egypt
Department of Hematology and Medical Oncology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Department of Neurology, Assiut University, Assiut, Egypt
Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Istanbul Medeniyet University, Istanbul, Turkey
Medical Parasitology Department, Research Institute of Ophthalmology, Giza, Egypt
Department of Infectious Diseases, Bahrain Oncology Center, King Hamad University Hospital, Busaiteen, Bahrain
Department of Infectious Diseases, Astana Medical University, Nur-Sultan, Kazakhstan
Department of Oncology, Bahrain Oncology Center, King Hamad University Hospital, Busaiteen, Bahrain
Department of Rheumatology, King Hamad Univesity Hospital, Al Sayh, Bahrain
Department of Infectious Diseases and Clinical Microbiology, University of Health Sciences, Elazig Fethi Sekin City Hospital, Elazig, Turkey
Central Research Institute of Epidemiology, Moscow, Russian Federation
Medical University of Sofia, Sofia, Bulgaria
Pakistan Institute of Medical Sciences, Islamabad, G-8/3, Pakistan
Department of Medicine, Infectious Diseases Division, King Saud University, Riyadh, Saudi Arabia
National Institute of Health, Islamabad, Pakistan
Unit of Infectious Diseases, Santa Chiara Hospital, Trento, Italy
School of Medicine, University Hospital Center Zagreb, Zagreb, Croatia
Tropical and Infectious Diseases Division, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE) - Infectious Disease Unit, Policlinico ‘P. Giaccone’, University of Palermo, Palermo, Italy
Department of Infectious Diseases and Clinical Microbiology, Bitlis Public Hospital, Bitlis, Turkey
Department of Infectious Diseases and Clinical Microbiology, School of Medicine, University of Kyrenia, Kyrenia, Cyprus
Internal Medicine Division, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
KCU Sarajevo, Sarajevo, Bosnia and Herzegovina
National Institutes of Health, Islamabad, Pakistan
Department of Infectious Diseases and Clinical Microbiology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
Hospital Nitra, St. Elisabeth University of Health Care and Social Work, Bratislava, Slovakia
South Pest Central Hospital, National Institute of Hematology and Infectious Diseases, Budapest, Hungary
Department of Infectious Diseases, Kandahar University Medical Faculty, Teaching Hospital, Kandahar, Afghanistan
Department of Infectious Diseases & Clinical Microbiology, Samsun Training and Research Hospital, Samsun, Turkey
Clinical Research and Epidemiology in Pneumonia and Sepsis, Vall d’Hebron Institute of Research (VHIR), Barcelona, Spain
Clinical Research, CHRU Nîmes, Nîmes, France

Department of Infectious Diseases & Clinical Microbiology
Department of Infectious Diseases
Department of Infectious Diseases and Clinical Microbiology
Department of Infectious Diseases
Department of Internal Medicine
Infectious Disease Clinic
Department of Infectious Diseases
Department of Clinical and Experimental Medicine
Department of Infectious Diseases & Clinical Microbiology
Department of Pediatric Oncology
VM Medical Park
St. Parascheva Clinical Hospital of Infectious Diseases
Faculty of Medicine
Department of Infectious Diseases & Clinical Microbiology
Department of Infectious Diseases & Clinical Microbiology
Department of Infectious Diseases & Clinical Microbiology
Department of Infectious Diseases & Clinical Microbiology
Department of Pharmacology
Infectious Diseases and Tropical Medicine Research Center
Department of Microbiology
Department of Infectious Diseases & Clinical Microbiology
Department of Pharmacology
Department of Pharmacology
Department of Medical Microbiology and Immunology
Department of Medical Microbiology and Immunology
Department of Infectious Diseases & Clinical Microbiology
Department of Clinical Pathology
Department of Hematology and Medical Oncology
Department of Neurology
Department of Infectious Diseases and Clinical Microbiology
Medical Parasitology Department
Department of Infectious Diseases
Department of Infectious Diseases
Department of Oncology
Department of Rheumatology
Department of Infectious Diseases and Clinical Microbiology
Central Research Institute of Epidemiology
Medical University of Sofia
Pakistan Institute of Medical Sciences
Department of Medicine
National Institute of Health
Unit of Infectious Diseases
School of Medicine
Tropical and Infectious Diseases Division
Department of Health Promotion Sciences
Department of Infectious Diseases and Clinical Microbiology
Department of Infectious Diseases and Clinical Microbiology
Internal Medicine Division
KCU Sarajevo
National Institutes of Health
Department of Infectious Diseases and Clinical Microbiology
Hospital Nitra
South Pest Central Hospital
Department of Infectious Diseases
Department of Infectious Diseases & Clinical Microbiology
Clinical Research and Epidemiology in Pneumonia and Sepsis
Clinical Research

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