Fever of Unknown Origin

A Fever of Unknown Origin is an attempt of studying the cause of unexplained fever that
patient suffered in hospital. Fever of Unknown origin can be defined as a temperature of more
than 38.3 C or higher with a minimum of three weeks without established diagnosis after
intensive investigation at the hospital. Furthermore a doctor can’t immediately determine the
cause of the fever at first, a further diagnosis is required in order to cure it. According to
William F. Wright and Paul G. Auwaerter Fever of Unknown Origin can be classified into 4 type
which is :

 Classic Fever, it is a type of fever that lasted for more than 3 weeks despite several
medical visit and stays in the hospital. The cause of the fever itself is unexplained and
patient suffer an increase in body temperature of more than 38,3 C.
 Nosocomial fever is a healthcare-associated fever that hospitalized patient or visiting
people caught while at the hospital. The reason for such fever is the spread of bacteria
of virus amongs medical personel.
 Neutropenic fever is caused by the low amount of white blood cell (Neutrophil) with
less than 500/uL circulating in the body or expected to reach that or less number in 1-2
days. It is accompany by high fever of more than 109 F. The common cause of such
fever are cancer treatment such as chemotherapy and hematopoietic stem cell
transplant (HSCT). Diagnosis of this fever involves clinical examination such as cultures
that require at least 2 days of incubation.
 HIV-associated fever on several occasion can be found over patients over 4 weeks or 3
days for hospitalized patient with HIV infection. This diagnosis can be considered
appropriate if an investigation occurs over 3 days including of 2 days of incubation
culture, reveals no source of the fever.

The primary objective of this investigation is to identify the etiology and to characterize
acute febrile illness in patients visiting Primary Health Facilities and Secondary Reference
Hospital.

Inclusion of this investigation are :

 Fever > 38 C or history of fever with onset < 7 days

 Above 6 months of age
 Clinically diagnosed as Acute Febrile Illness Exclusion
 Clinically diagnosed as acute respiratory infection or acute gastrointestinal infection

The sample used are EDTA Blood and Non Coagulant Blood which will be tested routine
hematology or rapid diagnostic test (RDT)
 The background of this investigation is the lack of circulating pathogen data in Makassar
and unsatisfied report in Primary Health Care and hospital.

Testing algorithm of infected acute serum/ plasma/ whole blood can be done by on site
test (HUMRC/Hospital/Health Service) by routine hematology test or rapid diagnostic test. A
further accurate tests are done on Eikman Institute of Molecular Biology which analyze the
molecular virus panel and molecular bacterial panel.

Based on the number of enrollment AFI Patients from May 2017 to July 2022, we can
see the spike increase of AFI patients toward the end of the year and decrease of patient during
mid year.

Dengue viral infection in Indonesia: epidemiology, diagnostic challenges, and mutations

from an observational cohort study..

Dengue virus (DENV) infection is a major cause of acute febrille illnes in Indonesia. Total of 468
(31,9%) cases of DENV infection were confirmed ny reference laboratory assays. Mortality of
DENV infection was low (0,6%). DENS is a common etiology of acute feebrille ilness requiring
hospitalization in Indonesia.

Conclusion

 Etiology of fever was identified

At Puskesmas 1st Health Facilities (12-20%)

At type B Hospital (2nd facilities): 29-36,5%

 Dengue is still the major etiology

At Puskesmas 1st Health Facilities (10-17%)

At type B Hospital (2nd facilities): 23-26,5%

 Leptospirosis, chikungunya, and rickettsiosis > found < 2%

 FUO > 70-75% from this study and still undiagnosed > need metagenomic NGS