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Fever of unknown origin (FUO) on a land on cross-roads between Asia and Europa; a multicenter study from Turkey
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  • ERCAN YENİLMEZ,
  • Deniz Kakalicoglu,
  • Fatma Bozkurt,
  • Mine Filiz,
  • Aysegul Akkol Camurcu,
  • Elif Ozge Damar Midik,
  • Hande Berk Cam,
  • Eren Arkali,
  • Seval Bilgic Atli,
  • Ahmet Sahin,
  • Sibel Yorulmaz Goktas,
  • Halil Erkan,
  • MEHMET REŞAT CEYLAN,
  • Merve Kacar Eker,
  • Hava Kaya,
  • Ersin Tural,
  • İlyas Dökmetaş,
  • Levent Gorenek,
  • Sukran Kose
ERCAN YENİLMEZ
Sultan Abdülhamid Han Training and Research Hospital
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Deniz Kakalicoglu
Sultan Abdülhamid Han Training and Research Hospital
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Fatma Bozkurt
Diyarbakir Gazi Yasargil Training and Research Hospital
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Mine Filiz
Ankara Gulhane Egitim ve Arastirma Hastanesi
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Aysegul Akkol Camurcu
İstanbul Haydarpaşa Numune Eğitim ve Araştırma Hastanesi
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Elif Ozge Damar Midik
Istanbul Dr Lufti Kirdar Kartal Egitim ve Arastirma Hastanesi
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Hande Berk Cam
Antalya Egitim ve Arastirma Hastanesi
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Eren Arkali
Tepecik Egitim ve Arastirma Hastanesi Kliniklerimiz
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Seval Bilgic Atli
Diyarbakir Gazi Yasargil Training and Research Hospital
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Ahmet Sahin
Sanliurfa Mehmet Akif Inan Training and Research Hospital
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Sibel Yorulmaz Goktas
Bursa Yuksek Ihtisas Training and Research Hospital
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Halil Erkan
Izmir Bozyaka Training and Research Hospital
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MEHMET REŞAT CEYLAN
Harran University
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Merve Kacar Eker
Fatih Sultan Mehmet Training and Research Hospital
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Hava Kaya
Adana Numune Egitim ve Arastirma Hastanesi
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Ersin Tural
Sultan Abdülhamid Han Training and Research Hospital
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İlyas Dökmetaş
Sisli Hamidiye Etfal Training and Research Hospital
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Levent Gorenek
Sultan Abdülhamid Han Training and Research Hospital
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Sukran Kose
Tepecik Training and Research Hospital Clinics
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Abstract

Aims: The differential diagnosis of Fever of Unknown Origin (FUO) is still a major clinical challenge despite the advances in diagnostic procedures. In this multicenter study, we aimed to reveal FUO etiology and factors influencing the final diagnosis of FUO in Turkey. Methods: A total of 214 patients with FUO between the years 2015-2019 from 13 tertiary training and research hospitals were retrospectively evaluated. Results: The etiologic distribution of FUO was infections (44.9%), malignancies (15.42%), autoimmune/inflammatory (11.68%) diseases, miscellaneous diseases (8.41%) and undiagnosed cases (19.62%). Brucellosis (10.25%), extrapulmonary tuberculosis (6.54%) and infective endocarditis (6.54%) were the most frequent three infective causes. Solid malignancies (7.1%) and lymphoma (5.6%), adult-onset still’s disease (6.07%) and thyroiditis (5.14%) were other frequent diseases. The etiologic spectrum did not differ in elderly (p<0.05). Infections were less frequent in Western (34.62%) compared to Eastern regions of Turkey (60.71%) (p< 0.001, OR: 0.31, 95% Cl: 0.19 to 0.60). The ratio of undiagnosed etiology was significantly higher in elderly (p: 0.046, OR: 2.34, 95% Cl: 1.00 to 5.48) and significantly lower in Western Turkey (p: 0.004, OR: 3.07, 95% Cl: 1.39 to 6.71). Conclusion: Brucellosis, extrapulmonary tuberculosis and infective endocarditis remain to be the most frequent infective causes of FUO in Turkey. Solid tumors and lymphomas, AOSD and thyroiditis are the other common diseases. The etiologic spectrum did not differ in elderly, on the other hand, infections were more common in Eastern Turkey. A considerable amount of etiology remained undiagnosed despite the state-of-the-art technology in healthcare services.

Peer review status:Published

07 Nov 2020Submitted to International Journal of Clinical Practice
11 Nov 2020Submission Checks Completed
11 Nov 2020Assigned to Editor
25 Nov 2020Reviewer(s) Assigned
01 Dec 2020Review(s) Completed, Editorial Evaluation Pending
27 Dec 20201st Revision Received
28 Dec 2020Submission Checks Completed
28 Dec 2020Assigned to Editor
28 Dec 2020Reviewer(s) Assigned
15 Jan 2021Review(s) Completed, Editorial Evaluation Pending
04 Mar 2021Editorial Decision: Accept
08 Mar 2021Published in International Journal of Clinical Practice. 10.1111/ijcp.14138