All human studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and all subsequent revisions. This study was carried out after approval of Research and Ethics Committee of Ain Shams University, Cairo, Egypt in accordance with local research governance requirements. Dr Iman Montasser: data analysis, wrote and submitted the manuscript, Dr Ahmed El Khouly: Data collection, statistical analysis. Prof Nadia Abdelaaty: follow up data collection, revise the results and wrote the manuscript. Prof Mohamed Fawzy Montasser: Chosen the research idea and revised the results Ass. Accordingly, reporting local cases is important in informing clinicians about the epidemiologic pattern. Finally, clinicians must be aware that the etiology of FUO varies across demographics, geography, and time. The proportion of undiagnosed cases of FUO seems to be lower than what it was in the past due to advances in diagnostic technologies. Infections remain the predominant cause of FUO in Egypt however, the causative agents have changed over the last 40 years. Salmonella infection was diagnosed in 23 of 248 cases of infection, while brucellosis accounted for 22 cases. 60% in 1974) however, the percentage of undiagnosed cases has dropped from 12% to 7.8%. Among the non-infection patients, 49 (13.1%) were categorized in the miscellaneous group, and 29 (7.8%) were discharged without a final diagnosis ( Table 1)Ĭomparing the findings of the present study with a similar study conducted in 1974 that examined 129 patients with FUO in the same hospital, 4 we found that infections still represent the main cause of FUO in Egypt (66.3% vs. Of these patients, 46 had cytomegalovirus infection (CMV). With regard to the final diagnosis, 248 patients (66.3%) were diagnosed with an infection etiology for FUO.
coli, Klebsiella and Enterobacter while Gram-positive cocci were only S. Also, in urine cultures Gram-negative organisms were dominant including E. Six patients (1.6%) had relapsing fever.īlood cultures grew Gram-negative organisms in only nine cases (2.4%) and Gram-positive in eight cases (2.1%). Further, 240 patients (64.2%) lived in urban areas, while 134 (35.8%) lived in rural areas.Ī continuous pattern of fever was found in 211 patients (58.3%), while 58 patients (16%) presented with a remittent pattern, and 87 patients (23.2%) showed intermittent fever symptoms. The patient population comprised 217 (58%) male patients, with a mean age of 40.2 ± 14.5 years. 5 Data were obtained from admission files. 4 We retrospectively reviewed 374 adult patients with FUO admitted to the Abbassia Fever Hospital under the definition outlined by Durack and Street (1991). We outlined changes in causes of classic FUO according to the latest definition and compare the causes with those of a previous study conducted at the same hospital in 1974.
1 The modern definition of FUO is based on modifications of these criteria taking into account four specific patient subtypes: classic, nosocomial, immunedeficient (neutropenic), and HIV-associated FUO. FUO was first described in 1961 by Petersdorf and Beeson when they established the three criteria that define FUO: a minimum measured temperature of 38.3 ☌, febrile states occurring on several occasions over a period of at least three weeks, and a minimum of one week of investigations being required. Prehospital healthcare facilities vary between countries, and even within the same country. Some cases of fever remain a mystery and patients are discharged without knowing the cause. Infections remain the most frequent cause of fever of unknown origin (FUO) in developing countries.
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