Clinical spectrum of fever of intermediate duration in the south of Spain

  • J. Parra Ruiz
  • A. Peña Monje
  • C. Tomás Jiménez
  • M. I. Parejo Sánchez
  • D. Vinuesa García
  • L. Muñoz Medina
  • M. A. Martínez Pérez
  • F. Garcia Garcia
  • J. Hernández Quero
Concise Article

Abstract

Fever of intermediate duration (FID) is a new nosologic entity defined as fever higher than 38°C that has a duration of between 1 and 4 weeks and that after an initial approach has not been diagnosed. It has clinical similarities with fever of unknown origin, but because of characteristic etiologies it requires the term FID. We describe the clinical characteristics and etiology of FID in the south of Spain and create a treatment algorithm. Retrospective study of the medical charts of patients attending at our Service during 2000 and 2005 who had an initial diagnosis of FID and who had a complete follow-up until the resolution of symptoms. Two hundred and thirty-three patients met the inclusion criteria, of whom 164 were men. Median number of days before being referred to our service was 9 (range 2–28). Half of the patients had elevation of transaminases, and CRP and ESR were slightly elevated, 2.8 mg/dl (range 0.1–50) and 16 mm/h (range 1–131) respectively. A final diagnosis was made in 80 patients, with infection with coxiella (32 patients), CMV (16 patients), rickettsial species (11 patients), VEB virus (6 patients), and brucella (5 patients) being the more frequent entities. Doxycycline was the antibiotic most frequently prescribed. Among patients with Q fever, CMV, and rickettsial infection, the majority had abnormal hepatic function, (87%, 93%, and 55% respectively). In FID, a diagnosis is reached in a minority of patients, although the prognosis is excellent in most of them. In our patients the clinical picture of Q fever, CMV, and rickettsial infections included abnormal hepatic function. In addition, these three infections are the most frequently diagnosed so when treating a patient with FID, if elevation of liver enzymes is present patients should start on doxycycline.

References

  1. 1.
    Gelfand JA, Sheldon MW (1995) Fever of unknown origin. In: Mandell GL, Bennett JE, Dolin R (eds) Principles and practice of infectious diseases, 4th edn. Churchill Livingstone, New York, pp 536–549Google Scholar
  2. 2.
    Brush JL, Weinstein L (1988) Fever of unknown origin. Med Clin North Am 72:1247–1261Google Scholar
  3. 3.
    Cunha BA (2007) Fever of unknown origin: clinical overview of classic and current concepts. Infect Dis Clin North Am 21:867–915PubMedCrossRefGoogle Scholar
  4. 4.
    Viciana P, Pachon J, Cuello JA, Palomino J, Jimenez-Mejias ME (1992) Fever of intermediate duration in the community: a seven year study in the south of Spain. In: Program and abstracts of the 32nd Interscience Conference on Antimicrobial Agents and Chemotherapy, 11–14 October, Anaheim, CA. Abstract 683Google Scholar
  5. 5.
    Bernabeu-Wittel M, Del Toro MD, Nogueras MM et al (2006) Seroepidemiological study of Rickettsia felis, Rickettsia typhi, and Rickettsia conorii infection among the population of southern Spain. Eur J Clin Microbiol Infect Dis 25:375–381PubMedCrossRefGoogle Scholar
  6. 6.
    Alarcon A, Villanueva JL, Viciana P et al (2003) Q fever: epidemiology, clinical features and prognosis. A study from 1983 to 1999 in the South of Spain. J Infect 47(2):110–116PubMedCrossRefGoogle Scholar
  7. 7.
    Rivero A, Zambrana JL, Pachon J (2003) Fever of intermediate duration. Enferm Infecc Microbiol Clin 21(3):147–152PubMedGoogle Scholar
  8. 8.
    Leelarasamee A, Chupaprawan C, Chenchittikul M, Udompanthurat S (2004) Etiologies of acute undifferentiated febrile illness in Thailand. J Med Assoc Thai 87(5):464–472PubMedGoogle Scholar
  9. 9.
    Suttinont C, Losuwanaluk K, Niwatayakul K, Hoontrakul S, Intaranongpai W, Silpasakorn S et al (2006) Causes of acute, undifferentiated, febrile illness in rural Thailand: results of a prospective observational study. Ann Trop Med Parasitol 100(4):363–370PubMedCrossRefGoogle Scholar
  10. 10.
    Basrai D, Pox C, Schmiegel W (2007) Fever of intermediate duration after return from the Canary Islands. Internist (Berl) 48(4):413–419CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2008

Authors and Affiliations

  • J. Parra Ruiz
    • 1
  • A. Peña Monje
    • 1
    • 2
  • C. Tomás Jiménez
    • 1
  • M. I. Parejo Sánchez
    • 1
  • D. Vinuesa García
    • 1
  • L. Muñoz Medina
    • 1
  • M. A. Martínez Pérez
    • 1
  • F. Garcia Garcia
    • 1
    • 2
  • J. Hernández Quero
    • 1
  1. 1.Infectious Diseases ServiceHospital Clínico San CecilioGranadaSpain
  2. 2.Service of MicrobiologyHospital Clinico San CecilioGranadaSpain

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