Systematic review of fever of unknown origin in Turkey

Abstract number: r2096

Sipahi  O., Senol  S., Arsu  G., Pullukcu  H., Tasbakan  M., Yamazhan  T., Arda  B., Ulusoy  S.

Objectives: 

In this study it was aimed to review the adult fever of unknown origin literature from Turkey systematically.

Methods: 

To find out the published series three national databases (Ulakbim Turkish Medical Literature database, http://www.turkishmedline.com, http://medline.pleksus.com.tr) and two international databases [Pubmed and Science Citation Index (SCI)] were searched. Keywords for national databases were "nedeni bilinmeyen ateþ" or "nba" or "fever of unknown origin" or "pyrexia of unknown origin" or "fuo" or "puo". Keywords for Index Medicus and SCI were ("fever of unknown origin" or "fuo" or "pyrexia of unknown origin" or "puo") and Turkey. In addition articles, which were cited by the extracted published articles were included in the study. In case of presentations from a single study with intersecting periods, the one with longer period was chosen. Articles published before 1990, paediatric series, series below 5 patients were excluded. Fever of unknown origin (FUO) was defined as fever over 38.3°C, that continues at least for 3 weeks, with no diagnosis reached after 1 week of inpatient investigation in all series (Petersdorf and Beason criteria).

Results: 

Data for 726 patients with the diagnosis of fever of unknown origin were obtained from 11 articles. Infections, collagen vascular diseases and neoplasms were found to be the reason of fever in 345 (%47.5), 114 (%15.7) and 110 (%15.1) of 726 patients. The most common infectious disease was tuberculosis (131/345, %37.9) followed by brucellosis (52/345, %15.0) and infective endocarditis (27/345, %7.8). The most common collagen vascular disease was adult-onset Still's Disease (46/114, %40.3), followed by vasculitic syndromes (22/114, %19.2) and SLE (18/114, %15.7). The most common neoplasm was Hodgkin's disease (29/110, %26.3), followed by non- Hodgkin Lymphoma (28/110, %24.5) and solid tumours (12/110, %10.9). Reason of fever could not be defined in 116/726 (%15.9) patients. The invasive procedures helped diagnosis in (234/726, %32.2) patients.

Conclusion: 

An infectious disease, especially tuberculosis and brucellosis, remains a common cause of FUO, in Turkey. Although several diseases may lead to FUO, lymphomas, Adult-Onset Still's Disease and particularly tuberculosis should be considered in the differential diagnosis of a patient admitted with FUO. Biopsy, aspiration, serology, bacteriology, radiology and observation of the clinical course were the most useful diagnostic procedures.