■发展中国家的不明原因(FUO)发烧是一个重要的难题,需要进一步研究以阐明FUO的传染性原因。
■针对中低收入国家(LMIC)和低收入国家(LIC)的FUO感染原因的多中心研究于2018年1月1日至2023年1月1日进行。总的来说,来自七个不同国家的15个参与中心提供了数据,通过传染病-国际研究倡议平台收集。仅将确诊感染为FUO病因的成年患者纳入研究。严重程度参数为快速序贯器官衰竭评估(qSOFA)≥2,重症监护病房(ICU)入院,血管加压药的使用,有创机械通气(IMV)。
■共有160名感染性FUO患者被纳入研究。总的来说,148例(92.5%)患者发生社区获得性感染,12例(7.5%)发生医院获得性感染。最常见的感染综合征是结核病(TB)(n=27,16.9%),感染性心内膜炎(n=25,15.6%),疟疾(n=21,13.1%),布鲁氏菌病(n=15,9.4%),和伤寒(n=9,5.6%)。恶性疟原虫,结核分枝杆菌,布鲁氏菌,金黄色葡萄球菌,伤寒沙门氏菌,立克次体和立克次体是本研究中主要的感染因子。共有56例(35.0%)采用侵入性诊断方法。平均qSOFA评分为0.76±0.94{中位数(四分位距[IQR]):0(0-1)}。入住ICU(n=26,16.2%),使用血管升压药(n=14,8.8%),IMV(n=10,6.3%)并不罕见。总的来说,38例(23.8%)患者具有至少一种严重程度参数。死亡率为15(9.4%),死亡率可归因于12例(7.5%)患者的FUO感染。
■在LMIC和LIC中,肺结核和心脏感染是引起FUO的最严重和最主要的感染。
UNASSIGNED: Fever of unknown origin (FUO) in developing countries is an important dilemma and further research is needed to elucidate the infectious causes of FUO.
UNASSIGNED: 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).
UNASSIGNED: 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) (n=27, 16.9%), infective endocarditis (n=25, 15.6%), malaria (n=21, 13.1%), brucellosis (n=15, 9.4%), and typhoid fever (n=9, 5.6%). Plasmodium falciparum, Mycobacterium tuberculosis, Brucellae, Staphylococcus aureus, Salmonella typhi, 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 (n=26, 16.2%), vasopressor use (n=14, 8.8%), and IMV (n=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.
UNASSIGNED: In LMIC and LIC, tuberculosis and cardiac infections were the most severe and the leading infections causing FUO.