Epidemiological, clinical and laboratory studies on parasitic infections as a cause of fever of undetermined origin in Dakahlia Governorate, Egypt.

Forty-three patients who fulfilled the international criteria for prolonged fever were exposed to thorough history taking, clinical and laboratory investigations. The latter included urine and stool examination, urine and blood culture, haemogram, liver and renal function tests, chest X-ray, tuberculin test, bone marrow, liver biopsy, blood films, serological tests including ELISA, IHA and IFA for detection of schistosomiasis, toxoplasmosis and malaria. Parasitic infections were detected in 30/43 (69.7%), 55.8% of whom had pure parasitic infection and 14% had in addition other causes. The majority of cases with positive etiology were coming from rural areas. The pattern of fever was predominantly intermittent especially with malaria and schistosomal cases. Fever of 21-41 days duration was noted in 70% of patients and 23.3% lasted up to more than 56 days. Visceromegaly (hepatomegaly and/or splenomegaly) was observed in all patients except one case. Lymphadenopathy was detected in ten cases, six of whom were visceral leishmaniasis. The IHA test for leishmaniasis detected ten cases at titres of 256, 512 and 1024 reciprocally. The dot-ELISA gave seropositivity in only 8/10 cases diagnosed by IHA test. So eight cases of VL were diagnosed by two serological tests at high titres. The detection of seropositive cases of visceral leishmaniasis in the studied area, suggests a focus or foci and warrants epidemiological study to establish the actual situation. Generally speaking, parasitic aetiology should be in mind in any case of FUO in Dakahlia. Serological tests are valuable, simple and safe tools for conforming the diagnosis of schistosomiasis, leishmaniasis, toxoplasmosis and malaria.