{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T19:12:31Z","timestamp":1788894751416,"version":"build-2803163510"},"reference-count":38,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,2,10]],"date-time":"2025-02-10T00:00:00Z","timestamp":1739145600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"funder":[{"name":"Host Switching Pathogens, Infectious Outbreaks and Zoonosis"},{"DOI":"10.13039\/501100000780","name":"European Union Horizon","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100014814","name":"Innovative Training Networks","doi-asserted-by":"publisher","award":["721367"],"award-info":[{"award-number":["721367"]}],"id":[{"id":"10.13039\/501100014814","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001659","name":"Deutsche Forschungsgemeinschaft","doi-asserted-by":"publisher","award":["KR 1293\/9-1"],"award-info":[{"award-number":["KR 1293\/9-1"]}],"id":[{"id":"10.13039\/501100001659","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,7,30]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>The etiology of fever of unknown origin (FUO) in sub-Saharan Africa often remains unexplained.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We performed a retrospective laboratory-based observational study of 550 Guinean patients with FUO testing negative for Ebola virus from March to December 2014. Blood-borne pathogens were diagnosed by polymerase chain reaction (PCR) or reverse transcription\u2013PCR (RT-PCR), serologic tests, and targeted and unbiased high-throughput sequencing (HTS).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In 275 of 550 individuals, we found evidence of \u22651 pathogen by molecular methods. We identified Plasmodium in 35.6% of patients via PCR, with P falciparum constituting 96.4% of these cases. Pathogenic bacteria, including Salmonella and Klebsiella, were detected in 18.4% of patients through PCR and HTS. Resistance determinants against first-line antibiotics were found in 26.9% of pooled sera by HTS. Yellow fever, Lassa, and Ebola viruses were detected in 5.8% of patients by RT-PCR; HTS-guided RT-PCR confirmed Orungo virus infection in 1 patient. Phylogenetic analyses revealed that the viral genomes matched the available genomic data in terms of location and time. Indirect immunofluorescence assays revealed immunoglobulin M antibodies against yellow fever, Ebola, dengue, West Nile, and Crimean Congo hemorrhagic fever viruses in 11 of 100 patients who were PCR or RT-PCR negative. One in 5 patients who were infected presented coinfections, predominantly malaria associated with sepsis-causing bacteria, in adults (12.1%) and children (12.5%), whereas viral coinfections were rare. Patients presented fever (74.7%), asthenia (67.7%), emesis (38.2%), diarrhea (28.3%), and hemorrhage (11.8%), without clear etiology associations.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>An exhaustive laboratory investigation elucidated infectious causes of FUO in 52.3% of patients. Quality control and strengthening laboratory capacities in sub-Saharan Africa are essential for patient care, outbreak response, and regionally appropriate diagnostics.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/infdis\/jiae637","type":"journal-article","created":{"date-parts":[[2025,2,10]],"date-time":"2025-02-10T10:51:13Z","timestamp":1739184673000},"page":"101-112","source":"Crossref","is-referenced-by-count":6,"title":["Elucidating Infectious Causes of Fever of Unknown Origin: A Laboratory-Based Observational Study of Patients with Suspected Ebola Virus Disease, Guinea, 2014"],"prefix":"10.1093","volume":"232","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9083-4102","authenticated-orcid":false,"given":"Ignacio","family":"Postigo-Hidalgo","sequence":"first","affiliation":[{"name":"Charit\u00e9\u2013Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Institute of Virology ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"N\u2019Faly","family":"Magassouba","sequence":"additional","affiliation":[{"name":"Laboratoire des Fi\u00e8vres H\u00e9morragiques Virales de Guin\u00e9e, Conakry, Guin\u00e9e"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadine","family":"Kr\u00fcger","sequence":"additional","affiliation":[{"name":"Charit\u00e9\u2013Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Institute of Virology ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie Louise","family":"Guilavogui","sequence":"additional","affiliation":[{"name":"Service des Maladies Infectieuses et Tropicales CHU Donka , Conakry ,","place":["Guin\u00e9e"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Detlev H","family":"Kruger","sequence":"additional","affiliation":[{"name":"Charit\u00e9\u2013Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Institute of Virology ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6931-1224","authenticated-orcid":false,"given":"Boris","family":"Klempa","sequence":"additional","affiliation":[{"name":"Biomedical Research Center of the Slovak Academy of Sciences , Bratislava ,","place":["Slovak Republic"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3509-0232","authenticated-orcid":false,"given":"Jan Felix","family":"Drexler","sequence":"additional","affiliation":[{"name":"Charit\u00e9\u2013Universit\u00e4tsmedizin Berlin, Corporate Member of Freie Universit\u00e4t Berlin and Humboldt-Universit\u00e4t zu Berlin, Institute of Virology ,","place":["Germany"]},{"name":"German Centre for Infection Research , Berlin ,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,2,10]]},"reference":[{"key":"2025073007430507000_jiae637-B1","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1056\/NEJMra2111003","article-title":"Fever of unknown origin","volume":"386","author":"Haidar","year":"2022","journal-title":"N Engl J Med"},{"key":"2025073007430507000_jiae637-B2","doi-asserted-by":"crossref","first-page":"653","DOI":"10.1186\/s12879-019-4285-8","article-title":"Fever of unknown origin (FUO): which are the factors influencing the final diagnosis? 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