Epidemiology and diagnostic challenges of fever of unknown origin (FUO) among adults: A multicenter retrospective study in Northern Italy

IF 4.7 3区医学 Q1 INFECTIOUS DISEASES

Journal of Infection and Public Health Pub Date : 2025-05-15 DOI:10.1016/j.jiph.2025.102824

Alessandra Mistral De Pascali , Ludovica Ingletto , Arianna Succi , Martina Brandolini , Laura Dionisi , Claudia Colosimo , Giulia Gatti , Giorgio Dirani , Silvia Zannoli , Valeria Frassineti , Giulia Silvestrini , Carlo Biagetti , Francesco Cristini , Paolo Bassi , Monica Cricca , Vittorio Sambri , Alessandra Scagliarini

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引用次数: 0

Abstract

Background

Fever of Unknown Origin (FUO) is broadly defined as a fever with an unidentified cause despite a minimum set of diagnostic investigations. The variability of FUO etiologies across geographic areas, age groups, and decades makes diagnosis challenging and complicates the adoption of a standardized diagnostic approach. Global warming and changing interactions between humans, animals, and the environment are contributing to the emergence and re-emergence of zoonotic infections. Emerging Vector-Borne Disease (VBD) pathogens circulate in Northern Italy, but their prevalence and impact on febrile illnesses remain poorly understood. This study investigated FUO epidemiology, diagnosis, and treatment in three hospitals in Emilia-Romagna (northeastern Italy).

Methods

The medical records from 652 patients who were discharged with the International Classification of Diseases, Ninth Revision (ICD-9) codes “780.6 Fever of unknown origin” and “087.9 Relapsing fever, unspecified” between January 2017 and December 2023 were analysed. Results: Among patients discharged with FUO between 2017 and 2023, the mean age was 58 years, and 45 % older than 65 years. Comorbidities were present in 75 %, and 26 % had active cancer. A diagnostic hypothesis was present in 32 % of cases. Diagnostic tests were mainly laboratory-based; 5.9 % had confirmed infections. Antibiotics were used in 62 % of patients mostly penicillin/beta-lactamase inhibitors. FUO discharges peaked in summer.

Conclusion

Active hospital-based surveillance are crucial to deepen our current understanding on FUO epidemiology and possible contribution of VBD pathogens while refining the use of antibiotics in the clinical practice.

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成人不明原因发热（FUO）的流行病学和诊断挑战：意大利北部一项多中心回顾性研究

背景不明原因发热（FUO）被广泛定义为尽管进行了最低限度的诊断调查，但原因不明的发热。FUO病因在地理区域、年龄组和几十年之间的可变性使得诊断具有挑战性，并使标准化诊断方法的采用复杂化。全球变暖和人类、动物和环境之间不断变化的相互作用正在导致人畜共患感染的出现和再次出现。新出现的媒介传播疾病（VBD）病原体在意大利北部流行，但其流行程度和对发热性疾病的影响仍然知之甚少。本研究调查了意大利东北部艾米利亚-罗马涅三家医院的FUO流行病学、诊断和治疗情况。方法对2017年1月至2023年12月以《国际疾病分类第九版》（ICD-9）编码“780.6不明原因发热”和“087.9不明原因回归热”出院的652例患者的病历进行分析。结果：2017 - 2023年FUO出院患者的平均年龄为58岁，年龄大于65岁的患者占45% %。75% %存在合并症，26% %存在活动性癌症。32 %的病例存在诊断假设。诊断测试主要以实验室为基础；5.9% %确诊感染。62% %的患者使用抗生素，主要是青霉素/ β -内酰胺酶抑制剂。FUO排放量在夏季达到峰值。结论积极开展以医院为基础的监测对加深我们对FUO流行病学的认识和VBD病原体的可能贡献，同时在临床实践中改进抗生素的使用至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Infection and Public Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -INFECTIOUS DISEASES

CiteScore

13.10

自引率

1.50%

发文量

203

审稿时长

96 days

期刊介绍： The Journal of Infection and Public Health, first official journal of the Saudi Arabian Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences and the Saudi Association for Public Health, aims to be the foremost scientific, peer-reviewed journal encompassing infection prevention and control, microbiology, infectious diseases, public health and the application of healthcare epidemiology to the evaluation of health outcomes. The point of view of the journal is that infection and public health are closely intertwined and that advances in one area will have positive consequences on the other. The journal will be useful to all health professionals who are partners in the management of patients with communicable diseases, keeping them up to date. The journal is proud to have an international and diverse editorial board that will assist and facilitate the publication of articles that reflect a global view on infection control and public health, as well as emphasizing our focus on supporting the needs of public health practitioners. It is our aim to improve healthcare by reducing risk of infection and related adverse outcomes by critical review, selection, and dissemination of new and relevant information in the field of infection control, public health and infectious diseases in all healthcare settings and the community.