Fever of unknown origin (peds): Difference between revisions

Latest revision as of 23:08, 28 November 2019

This page is for pediatric patients. For adult patients, see: fever of unknown origin

Background

Prolonged fever of unknown origin without identified cause generally has favorable prognosis.

Clinical Features

Original definition^[1]
- Fever >38.3 C on several occasions
- Lasting for at least 3 weeks
- No clear diagnosis after 1 week inpatient workup
Newer definition^[2] - "Prolonged fever" with:
- 3 outpatient visits without identifying a cause or
- 3 inpatient days without identifying a cause or
- 1 week of “intelligent and invasive” ambulatory investigation

Differential Diagnosis

Infection
- Bacterial
  - Adenitis
  - Endocarditis
  - Mastoiditis
  - Occult abscess
  - Pyelonephritis
  - Sinusitis
  - Tb
  - Mycoplasmal
  - Chlamydial
    - Lymphogranuloma venereum
    - Psittacosis
  - Rickettsial
    - Q fever
    - Rocky mountain spotted fever
- Viral
- Fungal
  - Blastomycosis
  - Histoplasmosis
- Parasitic
Non-infectious Inflammatory
- Juvenile idiopathic arthritis
- SLE
- Regional enteritis
- Rheumatic fever
- Ulcerative colitis
- Vasculitis
Malignancy
Drug Induced
- Antibiotics
- Anticonvulsants
- Anti TB
- Procainamide
- Quinidine
- Serum sickness
Misc
- AIDS
- CNS dysfunction
- Environmental hyperthermia
- Factitious
- Familial dysautonomia
- Kawasaki
- PE
- Serial infections
- Thyrotoxicosis

Evaluation

Clinical (preliminary) diagnosis

Management

Treat underlying cause (once identified)
Empiric treatment generally not recommended

Disposition

Frequently admitted for workup

References

↑ Kaya A, Ergul N, Kaya SY, et al. The management and the diagnosis of fever of unknown origin. Expert Rev Anti Infect Ther. 2013 Aug;11(8):805-15.
↑ Durack DT, Street AC. Fever of unknown origin--reexamined and redefined. Curr Clin Top Infect Dis. 1991;11:35-51.

Authors:

[Kaya-1] Kaya A, Ergul N, Kaya SY, et al. The management and the diagnosis of fever of unknown origin. Expert Rev Anti Infect Ther. 2013 Aug;11(8):805-15.

[2] Durack DT, Street AC. Fever of unknown origin--reexamined and redefined. Curr Clin Top Infect Dis. 1991;11:35-51.

[1]

[2]

@@ Line 1: / Line 1: @@
-==Diagnosis==
+{{Peds top}} [[fever of unknown origin]]
-Febrile >14dys (without clear source)
+==Background==
+*Prolonged fever of unknown origin without identified cause generally has favorable prognosis.
-==DDx==
+==Clinical Features==
-# INFECTION
+*Original definition<ref name="Kaya">Kaya A, Ergul N, Kaya SY, et al. The management and the diagnosis of fever of unknown origin. Expert Rev Anti Infect Ther. 2013 Aug;11(8):805-15.</ref>
-## Bacterial
+**Fever >38.3 C on several occasions
-###Adenitis
+**Lasting for at least 3 weeks
-### [[Endocarditis]]
+**No clear diagnosis after 1 week inpatient workup
-### [[Mastoiditis]]
+*Newer definition<ref>Durack DT, Street AC. Fever of unknown origin--reexamined and redefined. Curr Clin Top Infect Dis. 1991;11:35-51.</ref> - "Prolonged fever" with:
-### Occult [[abscess]]
+**3 outpatient visits without identifying a cause '''or'''
-### [[Pyelonephritis]]
+**3 inpatient days without identifying a cause '''or'''
-### [[Sinusitis]]
+**1 week of “intelligent and invasive” ambulatory investigation
-### [[Tb]]
-## Viral
+==Differential Diagnosis==
-### CMV
+*'''Infection'''
-### Hep A,B, C
+**Bacterial
-### Mono
+***Adenitis
-## Chlamydial
+***[[Endocarditis]]
-### Lymphogranuloma venereum
+***[[Mastoiditis]]
-### Psittacosis
+***Occult [[abscess]]
-## Mycoplasmal
+***[[Pyelonephritis]]
-## Fungal
+***[[Sinusitis]]
-### Blastomycosis
+***[[Tb]]
-### Cysticercosis
+***[[Mycoplasma|Mycoplasmal]]
-### Histoplasmosis
+***Chlamydial
-### Rickettsial
+****[[Lymphogranuloma venereum]]
-#### [[Q fever]]
+****[[Psittacosis]]
-#### Rocky Mt
+***[[Rickettsia]]l
-###Parasitic
+****[[Q fever]]
-#### Malaria
+****[[Rocky mountain spotted fever]]
-#### Toxo
+**Viral
-# COLLAGEN VASCULAR
+***[[CMV]]
-## JRA
+***[[Viral hepatitis]]
-## LSE
+***[[Mononucleosis]]
-## Regional enteritis
+**[[Fungal infections|Fungal]]
-## Rheumatic fever
+***[[Blastomycosis]]
-## [[Ulcerative colitis]]
+***[[Histoplasmosis]]
-## Vasculitis
+**[[Parasitic infection|Parasitic]]
-# MALIGNANCY
+***[[Malaria]]
-##Leukemia
+***[[Toxoplasmosis]]
-## Lymphoma
+***[[Cysticercosis]]
-## Neuroblastoma
+*'''Non-infectious Inflammatory'''
-## Wilm's tumor
+**[[Juvenile idiopathic arthritis]]
-# DRUG INDUCED
+**[[SLE]]
-## [[Antibiotics]]
+**Regional enteritis
-## Anticonvulsants
+**[[Rheumatic fever]]
-## Anti TB
+**[[Ulcerative colitis]]
-## Procainamide
+**[[Vasculitis]]
-##Quinidine
+*'''Malignancy'''
-## Serum sickness
+**[[Leukemia]]
-# MISC
+**[[Lymphoma]]
-## [[AIDS]]
+**[[Neuroblastoma (peds)|Neuroblastoma]]
-## CNS
+**[[Wilms' tumor]]
-## Environmental
+*'''Drug Induced'''
-##Factitious
+**[[Antibiotics]]
-##Familial dysautonomia
+**[[Anticonvulsants]]
-## [[Kawasaki]]
+**Anti [[TB]]
-## [[PE]]
+**[[Procainamide]]
-##Serial infections
+**[[Quinidine]]
-##[[Thyrotoxicosis]]
+**[[Serum sickness]]
+*'''Misc'''
+**[[AIDS]]
+**CNS dysfunction
+**Environmental [[hyperthermia]]
+**Factitious
+**Familial dysautonomia
+**[[Kawasaki]]
+**[[PE]]
+**Serial infections
+**[[Thyrotoxicosis]]
+==Evaluation==
+*Clinical (preliminary) diagnosis
+==Management==
+*Treat underlying cause (once identified)
+*Empiric treatment generally not recommended
+==Disposition==
+*Frequently admitted for workup
 ==See Also==
-*[[Pediatric Fever]]
+*[[Pediatric fever of uncertain source]]
-==Source==
+==References==
-*Rosen
+<References/>
-[[Category:Peds]]
+[[Category:Pediatrics]]