发展中国家不明原因发热的感染性病因：一项国际感染病-国际研究学会研究。

Infectious causes of fever of unknown origin in developing countries: An international ID-IRI study.

作者信息

Erdem Hakan, Al-Tawfiq Jaffar A, Abid Maha, Yahia Wissal Ben, Akafity George, Ramadan Manar Ezzelarab, Amer Fatma, El-Kholy Amani, Hakamifard Atousa, Rahimi Bilal Ahmad, Dayyab Farouq, Caskurlu Hulya, Khedr Reham, Tahir Muhammad, Zambrano Lysien, Khan Mumtaz Ali, Raza Aun, El-Sayed Nagwa Mostafa, Baymakova Magdalena, Yalci Aysun, Cag Yasemin, Elbahr Umran, Ikram Aamer

机构信息

Department of Infectious Diseases & Clinical Microbiology, Gulhane School of Medicine, Turkish Health Sciences University, Ankara, Turkey.

Specialty Internal Medicine and Quality and Patient Safety Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.

出版信息

J Intensive Med. 2023 Sep 28;4(1):94-100. doi: 10.1016/j.jointm.2023.07.004. eCollection 2024 Jan.

DOI:10.1016/j.jointm.2023.07.004

PMID:38263972

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10800762/

Abstract

BACKGROUND

Fever of unknown origin (FUO) in developing countries is an important dilemma and further research is needed to elucidate the infectious causes of FUO.

METHODS

A multi-center study for infectious causes of FUO in lower middle-income countries (LMIC) and low-income countries (LIC) was conducted between January 1, 2018 and January 1, 2023. In total, 15 participating centers from seven different countries provided the data, which were collected through the Infectious Diseases-International Research Initiative platform. Only adult patients with confirmed infection as the cause of FUO were included in the study. The severity parameters were quick Sequential Organ Failure Assessment (qSOFA) ≥2, intensive care unit (ICU) admission, vasopressor use, and invasive mechanical ventilation (IMV).

RESULTS

A total of 160 patients with infectious FUO were included in the study. Overall, 148 (92.5%) patients had community-acquired infections and 12 (7.5%) had hospital-acquired infections. The most common infectious syndromes were tuberculosis (TB) (=27, 16.9%), infective endocarditis (=25, 15.6%), malaria (=21, 13.1%), brucellosis (=15, 9.4%), and typhoid fever (=9, 5.6%). , Brucellae, , and Rickettsiae were the leading infectious agents in this study. A total of 56 (35.0%) cases had invasive procedures for diagnosis. The mean qSOFA score was 0.76±0.94 {median (interquartile range [IQR]): 0 (0-1)}. ICU admission (=26, 16.2%), vasopressor use (=14, 8.8%), and IMV (=10, 6.3%) were not rare. Overall, 38 (23.8%) patients had at least one of the severity parameters. The mortality rate was 15 (9.4%), and the mortality was attributable to the infection causing FUO in 12 (7.5%) patients.

CONCLUSIONS

In LMIC and LIC, tuberculosis and cardiac infections were the most severe and the leading infections causing FUO.

摘要

背景

发展中国家不明原因发热（FUO）是一个重要难题，需要进一步研究以阐明FUO的感染原因。

方法

在2018年1月1日至2023年1月1日期间，对中低收入国家（LMIC）和低收入国家（LIC）中FUO的感染原因进行了一项多中心研究。共有来自七个不同国家的15个参与中心提供了数据，这些数据是通过传染病国际研究倡议平台收集的。该研究仅纳入确诊感染为FUO病因的成年患者。严重程度参数包括快速序贯器官衰竭评估（qSOFA）≥2、入住重症监护病房（ICU）、使用血管活性药物和有创机械通气（IMV）。

结果

本研究共纳入160例感染性FUO患者。总体而言，148例（92.5%）患者为社区获得性感染，12例（7.5%）为医院获得性感染。最常见的感染综合征为结核病（TB）（27例，16.9%）、感染性心内膜炎（25例，15.6%）、疟疾（21例，13.1%）、布鲁氏菌病（15例，9.4%）和伤寒热（9例，5.6%）。布鲁氏菌属、巴尔通体属和立克次体属是本研究中的主要感染病原体。共有56例（35.0%）病例进行了侵入性诊断操作。qSOFA评分均值为0.76±0.94{中位数（四分位间距[IQR]）：0（0 - 1）}。入住ICU（26例，16.2%）、使用血管活性药物（14例，8.8%）和有创机械通气（10例，6.3%）并不少见。总体而言，38例（23.8%）患者至少有一项严重程度参数。死亡率为15例（9.4%），其中12例（7.5%）患者的死亡归因于导致FUO的感染。