Etiology and resource use of fever of unknown origin in. In previous studies, infectious disease was the most common cause of pediatric fever of unknown origin fuo. Clinical policy for wellappearing infants and children. Fever of unknown origin fuo is a wellknown pediatric presentation. Although the original definition has been modified, the assessment of broad categories of illness including infections, connective tissue disease, and malignancy as a cause of fuo remains useful. Yield of bone marrow examination in diagnosing the source of fever of unknown origin. Fever of unknown origin or fever of too many origins. Of these, 40 were found to have serious or lethal diseases, 48 had essentially. Fever of unknown origin fuo infectious diseases merck. Renal abscess is uncommon in pediatrics and is rarely a cause of fever of unknown origin. However, the cause is still usually infection, most often viral. Fever of unknown origin in childhood pediatric clinics of north. Fever of unknown origin american academy of pediatrics.
Pediatric fever without a source emergency medicine cases. Nov 08, 20 fever of unknown origin is more likely to be due to an atypical presentation of a common disease than to a typical presentation of an exotic disease. Pediatricians often confuse fever without a source and fever of unknown origin. Evaluation of fever of unknown origin fuo in children requires documentation of fever in the medical setting and repetitive reassessment of history and physical. Nevertheless, fuo remains a challenging clinical problem for even the most astute clinician that requires excellent history taking. Dec 01, 2003 fever of unknown origin fuo in adults is defined as a temperature higher than 38. Educational gap pediatricians often confuse fever without a source and fever of unknown origin. Background fever of unknown origin fuo continues to challenge clinicians to determine an etiology and the need for treatment. Aspiration yielded peptostreptococcus asaccharolyticus. Fever of unknown origin with polyarthritis imedpub. Although the traditional causes of fever of unknown origin fuo are increasingly rare, fuos are not. The presence of information on regional patterns of fuo will shorten the time for diagnosis and reduces health services costs.
The new fuos are often found among patients in intensive care units, many of whom are already r. The specific entity of fever of unknown origin fuo, as opposed to a fever without a source fws, has occupied a special place within infectious diseases since the first definition of and series about fuo by petersdorf and beeson. Normal body temperature the hypothalamus is the heatregulating center of the body the normal body temperature ranges from 37. Fever of unknown origin fuo refers to a prolonged febrile illness without an established etiology despite thorough evaluation. Etiology and clinical characteristics of fever of unknown origin in. Fever is a common presenting complaint in children, accounting for nearly onethird of pediatric outpatient visits in the united states. This descriptive study prospectively enrolledconsecutive children aged 3 months to 18 years with fuo presenting to the outpatient department. Adopt a systematic approach to evaluation and management of fever of unknown origin in patients of various ages. Pediatric fever of unknown origin american academy of. Prolonged fever of unknown origin in children jama. Fever of unknown origin is an important diagnostic challenge in pediatrics that requires a thoughtful approach. Nevertheless, fuo remains a challenging clinical problem for even the most astute clinician that requires excellent. Enteric fever, pyrexia of unknown origin, tuberculosis. Broad laboratory testing is often more harmful than helpful.
Approach to the adult patient with fever of unknown origin. There are almost no previous studies describing the etiology of fuo in children of egypt or nearby countries. Etiology of fever of unknown origin in children from. Neutropenic puo includes patients with fever as above with 38. Fever for 3 wk with no identified cause after 3 days of hospital evaluation or. The primary studies determining the causes of prolonged fever in children were performed 4 decades ago, before major advances in laboratory and diagnostic testing. Given that the distribution of diagnosed causes of adult fuo has changed in recent decades, we.
Fever of unknown origin is frustrating for patients and physicians because the diagnostic workup often involves numerous noninvasive and invasive procedures that sometimes fail to explain the fever. After 60 years of the original description of fever of unknown origin fuo by petersdorf and beeson in 1961, fuo remains among the most challenging clinical situations in diagnosis for health care providers to approach and often involves referral to subspecialists. We recently cared for a patient who presented with a 3week history of fever. Pediatric fever of unknown origin semantic scholar. Fever of unknown origin fuo is among the most conditions which poses challenge in diagnosis. Fever of unknown origin has been described as a febrile illness temperature of 101f 38. Fever of unknown origin fuo was defined in 1961 by petersdorf and beeson as the following.
Pdf clinical approach to fever of unknown origin in children. An indium scan ultimately led to the diagnosis of a renal abscess. The purpose of collecting these data is to determine. Fever of unknown origin in children world journal of pediatrics. Etiology and clinical characteristics of fever of unknown. A comprehensive evidencebased approach to fever of unknown.
A fever of unknown origin fuo is a fever of at least 101f 38. Sep 01, 2015 pediatricians often confuse fever without a source and fever of unknown origin. Powerpoint presentation powerpoint presentation scagni p, peisino mg, bianchi m, et al. Acep fever infants and children younger than 2 years. The term fever of unknown origin fuo in pediatrics has had varying definitions in the literature, with duration of fever ranging, depending on the definition, from 5 to 21 days. If the fever lasts closer to 10 days, and especially if new symptoms appear, it could be a complication of what is going around. Fever of unknown origin fuo is a relatively uncommon condition in united states children. Key questions to ask in the history in children with fever without an apparent source. Kikuchifujimoto disease is a rare cause of lymphadenopathy and fever of unknown origin in children.
Section of pediatric infectious disease, department of pediatrics, taichung. The differential for fever of unknown origin is vast, but resist the urge to order every test available in your hospital. Etiology and resource use of fever of unknown origin in hospitalized children james w. This disease has been defined as systemic arthritis by the international league of associations for rheumatology ilar classification of juvenile idiopathic arthritis jia, 2 systemic. Obviously, once you go beyond 10 days, it is a more significant clinical situation. The term fever of unknown origin fuo in pediatrics has had varying definitions in the literature, with duration of fever ranging, depending on. American academy of pediatrics textbook of pediatric care, 2nd edition. The aim of this study is to investigate the etiology, clinical characteristics and prognosis.
The value of 18ffdgpetct in identifying the cause of fever of unknown origin fuo and inflammation of unknown origin iuo. The primary studies determining the causes of prolonged. Fever for 2 to 3 weeks, without a known cause after initial investigations. Given that the distribution of diagnosed causes of adult fuo has changed in recent decades, we hypothesized that the etiology of fuo in children has. The term fuo is best reserved for children with a fever documented by a health care provider and. Jul 15, 2014 fever of unknown origin has been described as a febrile illness temperature of 101f 38. Clinical approach to fever of unknown origin in children. Although there is no standard definition of pediatric fuo, fever lasting anywhere from 10 days to 3 weeks is generally accepted as the working definition of fuo. Professor and director, university of florida center for hivaids research, education and service, jacksonville, fl. This study explored the most common etiologies, characteristics, and average cost of hospitalization for fuo in a pediatric population at an urban, tertiary care hospital in washington, dc. In the prepneumococcal vaccine era, even after a thorough history and physical examination, a source of infection was not identi. Fever in infants and children pediatrics merck manuals. Fever of unknown origin is more likely to be due to an atypical presentation of a common disease than to a typical presentation of an exotic disease. After completing this article, readers should be able to.
In wellappearing immunocompetent infants and children aged 2 months to 2 years presenting with fever. Knowledge about the etiology of fever of unknown origin fuo has been changed under the influence of new advances in diagnostic techniques in both adulthood and childhood. The specific entity of fever of unknown origin fuo, as opposed to a fever without a source fws, has occupied a special place within infectious diseases since the first definition of and series about fuo by petersdorf and beeson in 1961. Further more, the causes of fuo often have an overlapping collection of symptoms and insidious disease courses. The differential diagnosis is broad and includes infectious, autoimmune, oncologic. Nosocomial puo in hospital patients with fever of 38. A comprehensive evidencebased approach to fever of. Mar 01, 2018 fever of unknown origin fuo was defined in 1961 by petersdorf and beeson as the following. Objective after completing this article, readers should be able to. Nevertheless, fuo remains a challenging clinical problem for even the most astute clinician. Pyrexia of unknown origin history taking geeky medics.
Pediatric fever without a source emergency medicine. The history and physical are the foundation for your ddx development and subsequent testing strategy. Methods this article is based on a selective literature search for publications containing the term pediatric fever management, with special attention to metaanalyses and. Pediatrics fever of unknown origin no standard definition in children reasonable definition. Research article etiology and resource use of fever of unknown origin in hospitalized children james w.
These fevers may be caused by more unusual illnesses rheumatologic, oncologic. T here is paucity of recent data on the etiology of fever of unknown origin fuo in indian children. Fever without an identifiable cause fever of unknown origin fuo. Department of pediatrics, division of general pediatrics and adolescent medicine, university of north carolina school of medicine, chapel hill, nc. There are well over 200 different reported causes of fuo. However, the increased availability of rapid diagnostic testing has shortened the period of time before which standard fuo etiologies are seriously considered. Fever is a common symptom of many clinical conditions, and infection is the most common cause, especially in children. Case series of fever of unknown etiology in children, divided into developed and developing countries and listed in order of the year of publication. Original article clinical approach to fever of unknown origin in children. Fever of unknown origin introduction with polyarthritis. Then we are in the fever of unknown origin fuo range, which may require a subspecialist evaluation. Fever in hospitalized patients receiving acute care and with no infection present or incubating at admission if the diagnosis remains uncertain after 3 days of appropriate evaluation. Etiology of fever of unknown origin in children from mumbai. Background fever of unknown origin fuo is defined as a temperature higher than 38.
Fever without a source, or fever without a focus, has the following criteria. Pyrexia of unknown origin puo is defined as fever of 38. Some common causes of fever in children include localized or generalized infection, connective tissue disease, and cancer. Prolonged febrile illness and fever of unknown origin in. The issue of fu0 in pediatrics is rather hazy and still represents a challenging diagnostic dilemma.
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