Fever of unknown origin (peds): Difference between revisions
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{{Peds top}} [[fever of unknown origin]] | |||
==Background== | ==Background== | ||
*Prolonged fever of unknown origin without identified cause generally has favorable prognosis. | |||
==Clinical Features== | ==Clinical Features== | ||
* | *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> | ||
**Fever >38.3 C on several occasions | |||
**Lasting for at least 3 weeks | |||
**No clear diagnosis after 1 week inpatient workup | |||
*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: | |||
**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== | ==Differential Diagnosis== | ||
* | *'''Infection''' | ||
** Bacterial | **Bacterial | ||
***Adenitis | ***Adenitis | ||
*** [[Endocarditis]] | ***[[Endocarditis]] | ||
*** [[Mastoiditis]] | ***[[Mastoiditis]] | ||
*** Occult [[abscess]] | ***Occult [[abscess]] | ||
*** [[Pyelonephritis]] | ***[[Pyelonephritis]] | ||
*** [[Sinusitis]] | ***[[Sinusitis]] | ||
*** [[Tb]] | ***[[Tb]] | ||
** | ***[[Mycoplasma|Mycoplasmal]] | ||
*** | ***Chlamydial | ||
*** | ****[[Lymphogranuloma venereum]] | ||
*** | ****[[Psittacosis]] | ||
** | ***[[Rickettsia]]l | ||
*** | ****[[Q fever]] | ||
*** | ****[[Rocky mountain spotted fever]] | ||
* | **Viral | ||
** | ***[[CMV]] | ||
*** | ***[[Viral hepatitis]] | ||
*** | ***[[Mononucleosis]] | ||
*** | **[[Fungal infections|Fungal]] | ||
** | ***[[Blastomycosis]] | ||
***[[Histoplasmosis]] | |||
*** | **[[Parasitic infection|Parasitic]] | ||
** | ***[[Malaria]] | ||
*** | ***[[Toxoplasmosis]] | ||
**** | ***[[Cysticercosis]] | ||
* | *'''Non-infectious Inflammatory''' | ||
** | **[[Juvenile idiopathic arthritis]] | ||
** | **[[SLE]] | ||
** Regional enteritis | **Regional enteritis | ||
** Rheumatic fever | **[[Rheumatic fever]] | ||
** [[Ulcerative colitis]] | **[[Ulcerative colitis]] | ||
** Vasculitis | **[[Vasculitis]] | ||
* | *'''Malignancy''' | ||
**Leukemia | **[[Leukemia]] | ||
** Lymphoma | **[[Lymphoma]] | ||
** Neuroblastoma | **[[Neuroblastoma (peds)|Neuroblastoma]] | ||
** | **[[Wilms' tumor]] | ||
* | *'''Drug Induced''' | ||
** [[Antibiotics]] | **[[Antibiotics]] | ||
** Anticonvulsants | **[[Anticonvulsants]] | ||
** Anti TB | **Anti [[TB]] | ||
** Procainamide | **[[Procainamide]] | ||
**Quinidine | **[[Quinidine]] | ||
** Serum sickness | **[[Serum sickness]] | ||
* | *'''Misc''' | ||
** [[AIDS]] | **[[AIDS]] | ||
** CNS | **CNS dysfunction | ||
** Environmental | **Environmental [[hyperthermia]] | ||
**Factitious | **Factitious | ||
**Familial dysautonomia | **Familial dysautonomia | ||
** [[Kawasaki]] | **[[Kawasaki]] | ||
** [[PE]] | **[[PE]] | ||
**Serial infections | **Serial infections | ||
**[[Thyrotoxicosis]] | **[[Thyrotoxicosis]] | ||
== | ==Evaluation== | ||
*Clinical (preliminary) diagnosis | *Clinical (preliminary) diagnosis | ||
==Management== | ==Management== | ||
*Treat underlying cause (once identified) | |||
*Empiric treatment generally not recommended | |||
==Disposition== | ==Disposition== | ||
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==See Also== | ==See Also== | ||
*[[Pediatric | *[[Pediatric fever of uncertain source]] | ||
==References== | ==References== | ||
<References/> | |||
[[Category: | [[Category:Pediatrics]] | ||
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
- Rickettsial
- Viral
- Fungal
- Parasitic
- Bacterial
- Non-infectious Inflammatory
- Juvenile idiopathic arthritis
- SLE
- Regional enteritis
- Rheumatic fever
- Ulcerative colitis
- Vasculitis
- Malignancy
- Drug Induced
- 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