ABSTRACT

Introduction: The research entitled Prevalence of Fever of unknown origin, is an important health problem which needs to be looked into. Prevalence of Fever of unknown origin was previously defined by Petersdorf and Beeson as an illness of more than 3 weeks’ duration, with fever greater than 38.3oc ( 101of) on several occasions, the cause of which is uncertain after 1 week of in hospital investigations. (Petersdorf and Beeson 1961). Aim: The aim of this study was meant to know the prevalence of FUO, the management approaches by health practitioners, and the clinical outcome of FUO. Method: A cros- sectional design was used to carry out this research, and a retrospective approach carried out on past in patients files for the year of 2022, with a well data structured data capture sheet to extract all important data from patients files. And an interview equally carried out on health personnels to know their management approaches towards overcoming FUO. And at the end of the study,the data collected was coded and entered into the computer using Microsoft excel spreadsheet. Results: According to the study carried out, Out of the 99 participants whose files were studied, 14 were found to have FUO, 2 out of the 14 died giving a percentage of 14.3% and 2 out the 14 disabled giving a percentage of 14.3%. Management was based on broad-spectrum antibiotics and continuous lab investigations when the first line lab investigations had failed. This included test such as hemoculture. Conclusion: However, what is very important is that health care practitioners should have a sound and good knowledge background of FUO in order to enable them prioritize actions towards overcoming FUO.

CHAPTER ONE

INTRODUCTION

1.1 Background

Fever is the temporary increase in the body’s temperature of about 37.5°c in response to a disease or infection. Although in a developing country infectious disease remains the most important cause of fever, the non-communicable causes, like malignancy, are also becoming important (Mete et al., 2012). Preliminary investigations fail to find the etiology in many cases. This comprises a large group called “fever of unknown origin”, which can be a perplexing clinical puzzle. However, in many cases the cause for failure of diagnosis is lack of a proper protocol for investigation. If the investigation is based on the clinical findings, most of the cases can be easily diagnosed. The causes of fever change with the geographical distribution as also with time (Mahmood et al., 2013).

Fever of unknown origin (FUO) was originally defined by Petersdorf and Beeson as an illness of more than 3 weeks’ duration, with fever greater than 38.3°C (101°F) on several occasions, the cause of which is uncertain after 1 week of in-hospital investigations (Petersdorf and Beeson, 1961). To meet the evolution of diagnostic capabilities, some modifications in the definition of FUO occurred through the years: in 1991, Durak and Street proposed that there be a distinction between classical FUO and three other types, namely nosocomial, neutropenic and HIV-associated FUO; moreover, they reduced the duration of investigation, before defining a FUO, to at least 3 days in hospital or at least 3 outpatient visits (Durak and Street, 1991). In recent years, some authors proposed to change the quantitative criterion (diagnosis uncertain after 1 week or 3 days of investigation) with the qualitative requirement that fever remained undiagnosed after a minimal diagnostic work-up had been performed; however, investigations that should be included in the work-up remain a matter of debate (Knockaert et al., 2003).

The differential diagnosis of FUO is the most wide-ranging in medicine, since more than 200 conditions have been identified as the cause of FUO (Mourad et al., 2003). Infectious diseases (ID), neoplasms and non-infectious inflammatory diseases (NIID) are the main categories of diseases causing FUO. However, despite recent advances in medicine, about a quarter of FUO remains undiagnosed (Gaeta et al., 2006).

In published case-series, the spectrum of diseases causing FUO is very different, due to several factors still poorly explored. Among these factors, geographic prevalence patterns, the patient’s age, and the gap between the investigative resources of developing and developed countries may have a great significance. Clinical profile of FUO could have changed over time, in consideration of advances in diagnostic techniques, evolving socioeconomic status of the countries, development of new broad-spectrum pharmaceuticals, the emergence of new diseases and the attitude of physicians. The different methodologies among case-series (definition of FUO, retrospective or prospective model, use and composition of a minimal diagnostic work-up), may contribute to determine the final distribution of various causes of fever and the prevalence of FUO remaining without a diagnosis.

One of the most challenging clinical syndromes related to elevated body temperature is fever of unknown origin (FUO). Despite the immense expansion of medical sciences, FUO currently remains a complex clinical entity and serious diagnostic challenge (Bosilkovski et al., 2019). The true incidence and prevalence of FUO are unknown. FUO accounts for approximately 3% of hospital admissions and has a high impact on health care systems (Iikuni et al., 1994). According to a study from a university hospital in Japan, FUO occurred in 153 of 5.245 (2.9%) hospitalized patients (Iikuni et al., 1994). In another study from a community hospital in the USA, 1 of every 73 infectious disease consultations was due to FUO (Kazanjian et al., 1992). When the first-line tests are negative, practitioners are often unable to search for other causes of fever. However, infectious causes of fever, such as rickettsial and borreliosis, have a significant prevalence, but are often ignored or under-diagnosed. In Senegal, up to 13.0% of positive Borrelia spp. sera were diagnosed in patients following a FUO very often in association with the cutaneous manifestations (Parola et al., 2011).

There is a depth of information regarding FUO in Africa and Cameroon in particular. In Cameroon, most cases of FUO are linked to infectious diseases like Tb, rickettsial and borreliosis (Ndip et al., 2004). In order to determine the prevalence and identify the causes of FUO, and management approach,we will perform a cross sectional study in the Buea Regional Hospital. Inoder, to determine the clinical outcome of these patients, we measured the admission duration, management and clinical end point (death, alive and disability).

1.2 Problem Statement

Despite the immense expansion of medical sciences, FUO currently remains a complex clinical entity and serious diagnostic challenge (Bosilkovski et al., 2019). Despite all the current diagnostic and therapeutic tools, the mortality rate for FUO in Africa remains around 12-35% (Unger et al., 2016). The true incidence and prevalence of FUO are unknown in most developing countries like Cameroon where diagnostic services are sub-optimal. FUO accounts for approximately 3 – 10% of hospital admissions in Africa and has a high impact on health care systems (Parola et al., 2011). In Cameroon particular in the Regional hospital Buea, when the first-line tests are negative, practitioners are often unable to search for other causes of fever. FUO significantly increases the duration of hospitalization and the cost of healthcare for many patients in Cameroon Regional Hospital Buea. This may lead to psychological stress and discharge against medical advice.

1.3 Rationale

Despite the growing prevalence of FUO in most developing countries, there is a depth of information regarding FUO in Cameroon and Buea in particular. The true incidence and prevalence of FUO are unknown in the Buea Health District. During my clinical placement at the Regional Hospital Buea, I observed that febrile patients still spent days in the hospital without a clear diagnosis. Therefore this study aims at investigating the prevalence of FUO among in-patients of the Regional Hospital Buea.

1.4 Research questions

1. What is the prevalence of FUO among in-patients of the Regional Hospital Buea?
2. What is the management approach for FUO among in-patients at the Regional Hospital Buea?

1.5 Research objectives

1.5.1 General objective:

The main objective of this study is to determine the prevalence of FUO among in-patients in the Regional Hospital Buea in 2022.

1.5.2 Specific objectives

1. To determine the prevalence of FUO among in-patients in the Regional Hospital Buea.
2. To identify the management approach of FUO among in-patients in the Regional Hospital Buea.
3. To assess the clinical outcome of FUO among in-patients in the Regional Hospital Buea

1.6 Significance of the study