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[Fever of intermediate duration]
Antonio Rivero1, José Luis Zambrana, Jerónimo Pachón
1Sección de Enfermedades Infecciosas. Hospital Universitario Reina Sofía. Córdoba, España.
Abstract:
Fever of intermediate duration (FID) is defined as non-localized fever occurring in the community, lasting from one to four weeks, and having no diagnostic orientation after basic clinical, analytical and radiological evaluations are completed. These may include careful recording of clinical history, physical examination, hemogram, plasma creatinine determination, urinalysis, and chest radiography. The etiology of FID is still not completely defined. In our country, 70% of cases are caused by systemic infectious diseases (rickettsiosis, brucellosis, and mononucleosis syndrome) and 7.7% by localized infections; vasculitis and neoplasms account for less than 2%. In most cases FID can be attended on an outpatient basis, with the guarantee of the easy accessibility. In cases without social support or when there is digestive intolerance or criteria of severe disease, hospital care is required. For the diagnostic approach, it is useful to establish basic rules and to organize the study in several stages, taking into account the most frequent etiologies. The first visit would include elaboration of the clinical history, a hemogram, biochemistry analyses, blood cultures, urine culture, serological studies for the most frequent etiologies, a chest radiograph, and other examinations, as indicated by the clinical history data. The care provided and subsequent diagnostic studies performed will depend on the patient's progression and findings from additional studies. Further works conducted in various geographic settings are necessary to define the complete etiological spectrum of FID.
Insights
Fever of intermediate duration (FID) is a fever lasting 1-4 weeks without clear cause after initial tests. Systemic infections like rickettsiosis are common causes, guiding diagnostic approaches.
Area of Science:
- Internal Medicine
- Infectious Diseases
- Clinical Diagnostics
Background:
- Fever of intermediate duration (FID) is defined as a non-localized fever lasting 1-4 weeks.
- Initial clinical, analytical, and radiological evaluations often fail to identify the cause of FID.
- The etiology of FID remains incompletely understood, necessitating further investigation.
Purpose of the Study:
- To define Fever of intermediate duration (FID) and outline its common etiologies.
- To propose a staged diagnostic approach for FID, prioritizing frequent causes.
- To highlight the need for broader geographical studies to define the full etiological spectrum of FID.
Main Methods:
- Review of clinical history, physical examination, hemogram, biochemistry, urinalysis, and chest radiography.
- Inclusion of blood cultures, urine culture, and serological studies for common etiologies in initial workup.
- Staged diagnostic approach based on patient progression and initial findings.
Main Results:
- In the studied region, 70% of FID cases are attributed to systemic infectious diseases (rickettsiosis, brucellosis, mononucleosis syndrome).
- Localized infections account for 7.7% of FID cases, while vasculitis and neoplasms are less than 2%.
- Most FID cases can be managed on an outpatient basis, with hospitalization reserved for specific indications.
Conclusions:
- Systemic infectious diseases are the predominant cause of FID in the region studied.
- A structured, staged diagnostic approach is crucial for efficiently evaluating FID patients.
- Further multi-center and multi-geographic research is essential to fully elucidate the causes of FID worldwide.
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