Fever of unknown origin (peds)
Background
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
- COLLAGEN VASCULAR
- 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
Disposition
- Frequently admitted for workup