Fever of unknown origin (peds): Difference between revisions
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==Background== | ==Background== | ||
*Prolonged fever of unknown origin without identified cause generally has favorable prognosis. | |||
==Clinical Features== | ==Clinical Features== | ||
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
* | *'''Infection''' | ||
** Bacterial | ** Bacterial | ||
***Adenitis | *** Adenitis | ||
*** [[Endocarditis]] | *** [[Endocarditis]] | ||
*** [[Mastoiditis]] | *** [[Mastoiditis]] | ||
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**** Malaria | **** Malaria | ||
**** Toxo | **** Toxo | ||
* | * '''Non-infectious Inflammatory''' | ||
** JRA | ** JRA | ||
** LSE | ** LSE | ||
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** [[Ulcerative colitis]] | ** [[Ulcerative colitis]] | ||
** Vasculitis | ** Vasculitis | ||
* | * '''Malignancy''' | ||
**Leukemia | **Leukemia | ||
** Lymphoma | ** Lymphoma | ||
** Neuroblastoma | ** Neuroblastoma | ||
** Wilm's tumor | ** Wilm's tumor | ||
* | * '''Drug Induced''' | ||
** [[Antibiotics]] | ** [[Antibiotics]] | ||
** Anticonvulsants | ** Anticonvulsants | ||
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**Quinidine | **Quinidine | ||
** Serum sickness | ** Serum sickness | ||
* | * '''Misc''' | ||
** [[AIDS]] | ** [[AIDS]] | ||
** CNS | ** CNS | ||
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==Management== | ==Management== | ||
*Treat underlying cause (once identified) | |||
*Empiric treatment generally not recommended | |||
==Disposition== | ==Disposition== | ||
Revision as of 05:59, 10 August 2015
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
- Viral
- CMV
- Hep A,B, C
- Mono
- Chlamydial
- Lymphogranuloma venereum
- Psittacosis
- Mycoplasmal
- Fungal
- Blastomycosis
- Cysticercosis
- Histoplasmosis
- Rickettsial
- Q fever
- Rocky Mt
- Parasitic
- Malaria
- Toxo
- Bacterial
- Non-infectious Inflammatory
- JRA
- LSE
- Regional enteritis
- Rheumatic fever
- Ulcerative colitis
- Vasculitis
- Malignancy
- Leukemia
- Lymphoma
- Neuroblastoma
- Wilm's tumor
- Drug Induced
- Antibiotics
- Anticonvulsants
- Anti TB
- Procainamide
- Quinidine
- Serum sickness
- Misc
- AIDS
- CNS
- Environmental
- Factitious
- Familial dysautonomia
- Kawasaki
- PE
- Serial infections
- Thyrotoxicosis
Diagnosis
- Clinical (preliminary) diagnosis
Management
- Treat underlying cause (once identified)
- Empiric treatment generally not recommended
Disposition
- Frequently admitted for workup