Different Causes of Acute and Prolonged Febrile Illness in Military Fever Hospital in the Period between 1/1/2014 – 1/1/2015

Abstract

Fever is one of the most common medical signs and is characterized by an elevation of body temperature above the normal range (36.5–37.5 °C) due to an increase in the temperature regulatory set-point (Karakitsos and Karabinis, 2008). Acute undifferentiated febrile illness is a common clinical syndrome among patients seeking hospital care in Egypt. The main causes and patterns of acute febrile illness (AFI) are not well characterized and many patients with AFI are empirically diagnosed as having typhoid fever, one of the most frequently reported communicable diseases in Egypt. Although not routinely diagnosed, brucellosis is reported in all domestic animals in the Near East region, including Egypt (Refai, 2002). Fever of unknown origin remain one of the most common and difficult diagnostic problems faced daily by clinicians (Petersdorf and Beeson, 1961). The prevalence of FUO among adult hospitalized patients is reported to be 2.9% (Tabak. et al, 2003). The spectrum of FUO etiology may include more than 200 diseases (Gaeta. et al, 2006). The causes of FUO have traditionally been grouped into four categories: infectious, malignant, inflammatory and undetermined (Kazanjian, 1992) & (Agarwal and Gogia, 2004). This study was conducted trying to achieve the current common causes of acute and prolonged febrile illness in Military Fever Hospital for proper diagnosis and perfect treatment to the diseases causing fever. In order to fulfill aims of this study, 1771 patients with fever were included. Regarding the results in present study, there were 1542 patients presented by AFI and 299 patients were presented by PFI. - All included patients were subjected to: 1. Complete History taking: with special stress on past history, family history of similar conditions, duration and pattern of fever, travel and drug history. 2.Thorough clinical assessment including: General examination. Abdominal, cardiological, pulmonary, neurological, locomotor and dermatological examinations were reviewed. - For documenting the fever pattern, body temperature was measured every four hours and fever chart was drawn. 3. Investigations:

- All patients underwent routine laboratory and image investigation as the following: g. Complete blood picture (CBC): haemoglobin concentration (Hb%), red blood cells (RBCs), white blood cells (WBCs) and platelet count . h. Erythrocyte Sedimentation Rate (ESR). i. Complete Urine analysis. j. Stool analysis. k. Liver profile: alanine aminotransferase (ALT), aspartate aminotransferase(AST), total and direct bilirubin and serum Albumin. l. Renal profile: serum blood urea nitrogen (BUN), serum creatinine.

- Some patients underwent more investigations when needed as the following: 1. Widal test, Brucella Ab. (ELISA) test. 2. Urine and Stool cultures whenever required. 3. Blood culture. 4. Chest X-ray whenever required. 5. Abdominal Ultrasound whenever required. 6. Serological tests: For CMV, EBV, toxoplasmosis whenever required. 7. Blood film whenever required. 8. HIV Ab. by ELISA then confirmed by Westren Blot Ab. for HIV for suspected patients with HIV (AIDS). 9. PCR for H1N1whenever suspected. 10. Quanti FERON-TB Gold in suspected cases of T.B. 11. Ascietic Fluid analysis if present. 12. Autoimmune profile: Antinuclear antibodies (ANA), R.F., anti-ds-DNA , anti-SMA antibodies for patients suspected to had collagen-vascular diseases. 13. Tumor markers whenever required as: α-fetoprotein, CA19, 9, CEA, PSA. 14. DNA genotyping for MEFV gene in diagnosis of FMF. 15. Serum Ferritin level. 16. Cerebro-spinal Fluid (C.S.F) for patients suspected to have neurological infections. 17. C.T. abdomen, chest and pelvis. 18. Liver, lymph node, bone marrow or tissue biopsy.

According to the results of present study there were 2 groups: Group I: patients presented by acute febrile illness were 1542 patients (87%). Group II: patients presented by prolonged febrile illness were 229 patients (13%). Results of patients presented by AFI showed that infectious diseases were the most common cause of fever and represents (98.8%). The most common infectious diseases in the current study were mumps, respiratory tract infections and GIT infections. In the present study respiratory tract infections was the most common type of infection and represents (27.9%) of cases of acute febrile illness. Unusual infections (malaria) that are not endemic in Egypt were noticed in the current study in those retuning from endemic area (as peace keeping forces in Africa). Cutaneous Leishmaniasis which is not a common infection in Egypt was noticed in the present study in 48 cases (3.1%) of cases with AFI. This can be explained as all cases were soldier worked in Sinai (which considers an endemic area for sand fly). Among patients with prolonged febrile illness, infectious causes were the most common cause and represented by 85.6% of patients followed by collagen vascular diseases 3.9%, then neoplasm 3.5%, then miscellaneous causes which represented by 3.1%, while 3.9% patients of all the patients in the study remains undiagnosed. In the present study, Brucellosis (41%) and Typhoid fever (26.6%) were the most common infectious causes of FUO. Infectious Mononucleosis (IMN) represents 10.9% of cases of PFI in our study, urinary tract infection represented by 4.8%, extra-pulmonary tuberculosis 1.3%, HIV seroconversion illness 0.44% and trichenlla spiralis represented by 0.44 %. However fulfilling all investigations and imaging in the present study, it was found that 9 patients (3.9%) remained undiagnosed.