Issue: Vojnosanit Pregl 2016; Vol. 73 (No. 6)
Fever of unknown origin − diagnostic methods in a European developing country
Authors:
Mile Bosilkovski, Marija Dimzova, Milena Stevanović, Vesna Semenakova Cvetkovska, Maja Vasileva Duganovska
Background/Aim. Fewer of unknown origin (FUO) remainsamongst the most difficult diagnostic dilemmas in contemporary
medicine. The aim of this study was to determine the
causes of FUO and to identify the methods of diagnosis in patients
with FUO in a tertiary care setting in the Republic of
Macedonia. Methods. Retrospectively histories of 123 immunocompetent
patients older than 14 years with classical
FUO that had been examined at the University Hospital for Infectious
Diseases and Febrile Conditions in the city of Skopje,
during the period 2006−2012 were evaluated. FUO was defined
as axillary fever of ≥ 37.5°C on several occasions, fever
duration of more than 21 days and failure to reach the diagnosis
after the initial diagnostic workup comprised of several defined
basic investigations. Results. Infections were the cause
of FUO in 51 (41.5%) of the patients, followed by noninfective
inflammatory disorders (NIID) in 28 (22.8%), miscellaneous
in 12 (9.7%) and neoplasm in 11 (8.9%) of the patients.
Twenty one of the patients (17.1%) remained undiagnosed.
The most common causes for FUO were visceral leishmaniasis,
abscesses, urinary tract infections, subacute endocarditis, polymyalgia
rheumatica and adult onset of Still disease. The final diagnosis
was reached with histology in 24 (23.5%), imaging and
endoscopic procedures in 21 (20.6%), clinical course and empiric
therapy response in 20 (19.6%), serology in 18 (17.6%)
and cultures in 16 (15.7%) of the cases. Conclusion. In the
Republic of Macedonia infections are the leading cause of
FUO, predominately visceral leishmaniasis. In the future in patients
with prolonged fever, physicians should think more often
of this disease, as well as of the possibility of atypical presentation
of the common classical causes of FUO.
