Fever is one of the major clinical challenges facing practicing physicians. But while infections are responsible for about half of all fevers, they can also be caused by other, non-infectious conditions such, as malignancies, drugs or trauma. It is difficult to distinguish between these conditions and the ability to do so depends largely on the physician’s clinical judgment. The results of microbiological tests are usually not yet available when a decision about treatment has to be made. Conventional laboratory markers typical for systemic inflammation, such as leucocytes and erythrocyte sedimentation rate, cannot differentiate with enough specificity between infectious- and non-infectious causes of fever.

The Amsterdam Fever study (TAF)

Prediction of infection in patients with fever in the emergency room and in the ICU department. In this study a clinical decision rule has been established that will be validated in a follow-up study.

The aims of the Fever Studies are:

1. to find a combination of old and new biomarkers to distinguish patients with different causes of fever
2. sero-epidemiology studies for infectious diseases in the Fever cohort 

The International Fever Studies (INVEST)

In this study we are screening patients with fever symptoms and seeking to validate routine and novel biomarkers. In a first Dutch cohort (TAF), a decision rule has been established which serves as a predictor for bacterial infection being the cause of the fever. INVEST has been set up to validate this decision rule in other populations all over the world. At the moment, patients in St. Elisabeth Hospital, Curacao are being screened. In the near future, this screening will be extended to Indonesia (University of Indonesia, Jakarta), thereby covering different continents with different patient groups and different clinical facilities.

Tel Aviv Amsterdam Familial Mediterranean Fever Studies (TAF-MF)

Familial Mediterranean Fever (FMF) is a hereditary disease, characterized by recurrent episodes of fever and severe abdominal pain caused by sterile inflammation. FMF thus serves as an elegant human model of inflammation, with the advantage of episodic inflammation and recovery. Clarifying the immunological mechanism of FMF might provide clues for inflammation in general. This project is conducted in collaboration with the University of Tel Aviv, Israel.

Biomarkers in Rheumatoid Arthritis (TARA study)

Rheumatoid arthritis is a well-characterized systemic auto-immune disease in which inflammation plays a key role. An increasing body of evidence indicates that abnormalities can be found in the blood of future rheumatoid arthritis patients many years before arthritic complaints actually start. This study focuses on the early changes in the blood of patients with an increased risk of developing rheumatoid arthritis. The aim of the study is to find immunological parameters that predict the transition to rheumatoid disease and to elucidate the pathophysiology of this transition.

Project:

• Collaboration Slotervaart Hospital/Erasmus University Rotterdam Dept. of virology/Academic Medical Centre, Dept. of experimental medicine/VU Medical Centre/Sanquin/Jan van Breemen institute/University of Leiden/University of Maastricht.
  
  PhD programs Martijn de Kruif, PhD 2008, Amsterdam (completed), Maarten Limper expected PhD 2011