Background
Methods
Search strategy
Data selection
Statistical methodology
Results
Results of data selection
Characteristics of selected studies
Ref | First Author | Year | Quality assessment (range 0–5) | Country | Geographical area | Country income classification | Model of study a | FUO criteria b | Study period | Number of patients | M/F ratio | Mean age (range) | Minimal diagnostic work-up |
---|---|---|---|---|---|---|---|---|---|---|---|---|---|
[11] | Yu | 2014 | 3 | China | Far East | Upper- medium | 1 | 1 | 2010–2011 | 107 | 54/53 | 48 (15–94) | No |
[12] | Mir | 2014 | 5 | India | Southern Asia | Lower- medium | 2 | 1 | 2010–2012 | 91 | 62/29 | NA (16–80) | No |
[13] | Naito | 2013 | 4 | Japan | Far East | High | 1 | 1 | 2011 | 121 | 69/52 | 59 (19–94) | No |
[14] | Robine | 2014 | 5 | France | Europe | High | 1 | 1 | 2002–2012 | 103 | 54/49 | 57 (19–84) | Yes |
[15] | Vanderschueren | 2014 | 5 | Belgium | Europe | High | 1 | 3 | 2000–2010 | 436 | NA | 50 (NA) | Yes |
[16] | Alavi | 2013 | 3 | Iran | Middle East | Upper -medium | 1 | 3 | 2007–2011 | 106 | 57/49 | 50 (18–76) | NA |
[17] | Mahmood | 2013 | 3 | Pakistan | Southern Asia | Lower- medium | 1 | 1 | 2006–2011 | 205 | 111/94 | 38 (NA) | No |
[18] | Shi | 2013 | 5 | China | Far East | Upper -medium | 1 | 2 | 2004–2010 | 997 | 466/531 | 43 (14–85) | No |
[19] | Mete | 2012 | 3 | Turkey | Middle East | Upper -medium | 1 | 1 | 2001–2009 | 100 | 53/47 | 45 (16–82) | Yesc |
[20] | Pedersen | 2012 | 4 | Denmark | Europe | High | 1 | 1 | 2005–2010 | 52 | 36/16 | 48 (34–64) | No |
[21] | Ali-Eldin | 2011 | 3 | Egypt | Middle East | Lower- medium | 2 | 3 | 2009–2010 | 93 | 45/48 | 34 (NA) | No |
[22] | Bandyopadhyay | 2011 | 4 | India | Southern Asia | Lower- medium | 2 | 1 | 2008–2009 | 164 | 82/82 | 42 (NA) | No |
[23] | Adil Khalil | 2010 | 4 | Iraq | Middle East | Upper -medium | 2 | 1 | 2002–2009 | 55 | 27/28 | 43 (10–76) | No |
[24] | Hu | 2008 | 3 | China | Far East | Upper -medium | NA | 2 | 2002–2003 | 142 | 69/73 | 49 (14–81) | Yesc |
[25] | Kucukardali | 2007 | 4 | Turkey | Middle East | Upper -medium | 2 | 1 | 2003–2004 | 154 | 83/71 | 42 (17–75) | No |
[3] | Bleeker-Rovers | 2007 | 5 | Netherland | Europe | High | 2 | 3 | 2003–2005 | 73 | 33/40 | 54 (26–87) | Yes |
[26] | Colpan | 2007 | 4 | Turkey | Middle East | Upper -medium | NA | 3 | 2001–2004 | 71 | 40/31 | 42 (16–80) | No |
[27] | Chin | 2006 | 5 | Taiwan | Far East | High | 2 | 1 | 2001–2002 | 94 | 57/37 | 56 (18–86) | Yes |
Use of a minimal diagnostic work-up to qualify a fever as FUO
Diagnostic outcomes
Ref | First Author | Year | Number of patients | Infectious Diseases (%) | Neoplasm (%) | NIID (%) | Other (%) | No diagnosis (%) |
---|---|---|---|---|---|---|---|---|
[11] | Yu | 2014 | 107 | 29.9 | 17.8 | 16.8 | 14.0 | 21.5 |
[12] | Mir | 2014 | 91 | 44.0 | 12.0 | 12.0 | 5.0 | 27.0 |
[13] | Naito | 2013 | 121 | 23.1 | 10.7 | 30.6 | 12.4 | 23.1 |
[14] | Robine | 2014 | 103 | 23.5 | 2.9 | 30.1 | 4.9 | 50.5 |
[15] | Vanderschueren | 2014 | 436 | 17.0 | 11.0 | 24.0 | 9.9 | 39.0 |
[16] | Alavi | 2013 | 106 | 44.3 | 12.3 | 17.9 | 10.4 | 15.0 |
[17] | Mahmood | 2013 | 205 | 48.8 | 12.7 | 18.6 | 3.4 | 16.6 |
[18] | Shi | 2013 | 997 | 48.0 | 7.9 | 16.9 | 7.1 | 16.6 |
[19] | Mete | 2012 | 100 | 26.0 | 14.0 | 38.0 | 2.0 | 20.0 |
[20] | Pedersen | 2012 | 52 | 32.0 | 13.0 | 55.0 | 0.0 | 21.0 |
[21] | Ali-Eldin | 2011 | 93 | 41.9 | 30.1 | 15.0 | 0.0 | 12.9 |
[22] | Bandyopadhyay | 2011 | 164 | 54.9 | 22.0 | 11.0 | 0.0 | 12.2 |
[23] | Rami | 2010 | 55 | 32.7 | 16.4 | 25.4 | 5.4 | 20.0 |
[24] | Hu | 2008 | 142 | 35.9 | 12.7 | 32.4 | 4.9 | 14.9 |
[25] | Kucukardali | 2007 | 154 | 34.4 | 14.3 | 30.5 | 5.2 | 15.6 |
[3] | Bleeker-Rovers | 2007 | 73 | 16.0 | 7.0 | 22.0 | 4.0 | 51.0 |
[26] | Colpan | 2007 | 71 | 45.1 | 14.1 | 26.8 | 5.6 | 8.5 |
[27] | Chin | 2006 | 94 | 57.4 | 8.5 | 7.4 | 8.5 | 18.1 |
Total | 3164 | 37.8 | 11.6 | 20.9 | 6.5 | 23.2 |
Diagnosis | N° (%) | N° of case-series including the diagnosis |
---|---|---|
Infectious Diseases (out of 1197 cases from 18 case-series where details are available) | ||
Mycobacterial diseases | 440 (36.8%) | 17 |
Endocarditis | 119 (9.9%) | 15 |
Brucellosis | 58 (4.8%) | 9 |
Internal abscesses | 49 (4.1%) | 11 |
Salmonellosis | 43 (3.6%) | 9 |
CMV infections | 43 (3.6%) | 7 |
Urinary tract infections | 40 (3.3%) | 11 |
Sepsis | 20 (1.7%) | 4 |
HIV/AIDS | 20 (1.7%) | 4 |
Osteoarticular infections | 18 (1.5%) | 5 |
Neoplasms (out of 289 cases from 15 case-series where details are available) | ||
Lynphomas (including Hodgkin, Non-Hodgkin, not specified) | 169 (58.5%) | 9 |
Solid tumors (not specified) | 25 (8.7%) | 4 |
Leukemias | 17 (5.9%) | 7 |
Other cancers (not specified) | 14 (4.8%) | 5 |
Myelodysplastic syndrome | 11 (3.8%) | 7 |
Colon cancers | 10 (3.5%) | 5 |
Multiple mieloma | 8 (2.8%) | 6 |
Gastric cancers | 5 (1.7%) | 3 |
Mesotheliomas | 5 (1.7%) | 3 |
Castleman’s diseases | 4 (1.4%) | 3 |
NIIDs (out of 642 cases from 17 case-series where details are available) | ||
Adult-onset Still’s disease | 177 (27. 6%) | 15 |
Systemic Lupus Erythematosus | 71 (11.1%) | 14 |
Vasculitis | 63 (9.8%) | 8 |
Rheumatic Polymyalgia | 44 (6.9%) | 8 |
Giant Cells Arteritis | 32 (5.0%) | 6 |
Mixed connective diseases (not specified) | 31 (4.8%) | 5 |
Sarcoidosis | 21 (3.3% | 7 |
Rheumatoid Arthritis | 17 (2.6%) | 6 |
Wegener Granulomatosis | 14 (2.2%) | 4 |
Polyarteritis nodosa | 13 (2.0%) | 5 |
Old case-series (1995–2004) | New case-series (2006–2014) | p-value | |
---|---|---|---|
N° of patients | 1488 | 3164 | – |
Male (%) | 56,2 | 49,6 | – |
Mean age | 40,6 | 45,8 | – |
Infectious Diseases | 545 (37%) | 1197 (38%) | 0,428 |
Neoplasm | 167 (11%) | 366 (12%) | 0,731 |
NIID | 236 (16%) | 661 (21%) |
< 0,001
|
Others | 155 (10%) | 206 (7%) |
< 0,001
|
No diagnosis | 385 (26%) | 734 (23%) | 0,051 |