Aetiology and Management of Children With Acute Fever of Unknown Origin

Abstract

This is part I of a 2-part paper on fever of unknown origin (FUO) in children. FUO is best defined as fever without obvious source on initial clinical examination and then classified into acute (illness of < or =1 week's duration) and prolonged (>7 to 10 days' duration). Aetiologically, there is a marked overlap between acute and prolonged FUO, and infections are major players in both. Age, climate, local epidemiology and host factors are the major aetiological factors that should be considered in the choice of definitive tests. Depending on age, serious bacterial infections (including bacteraemia, meningitis and urinary tract infection) occur in 3 to 20% of cases of acute FUO. Prevention of mortality and sequelae from these infections, particularly bacteraemia and meningitis, is of particular concern in acute FUO. An individualised approach, based on clinical evaluation supplemented with screening and definitive laboratory tests to determine the need for empiric antibiotic therapy and hospitalisation, seems to be the best approach to acute FUO (although this may be less applicable to neonates and infants younger than 90 days, particularly those aged 0 to 7 days). The place of laboratory tests, empiric antibiotic therapy and hospitalisation are important issues that are likely to remain so for some time.

Human Herpes Viruses Are Associated with Classic Fever of Unknown Origin (FUO) in Beijing Patients

“…Despite a comprehensive examination and exhaustive workup in hospital, FUO remains a diagnostic and therapeutic challenge to expert physicians [2], [7], [8]. The three most common aetiological categories of FUO in children in order of frequency are infectious diseases, connective tissue diseases, and neoplasms [7].…”

“…The three most common aetiological categories of FUO in children in order of frequency are infectious diseases, connective tissue diseases, and neoplasms [7]. Numerous studies have reported that a diagnosis is never established in 10∼26% of cases of FUO [2], [7], [15]. We applied the term FUO to patients with a fever >101°F (38.3°C) of at least 8-days' duration, in whom no diagnosis is apparent after an initial outpatient or hospital evaluation that includes a careful history and physical examination and initial laboratory assessment.…”

“…Fever of unknown origin (FUO) has occupied a special place within infectious diseases [2] since Petersdorf and Beeson first defined it in 1961 [3]. Although the original definition has been modified, the assessment of broad categories of illness (including infections, connective tissue disease, and malignancy) as causes of FUO remains useful [4].…”

Referral and previous care of children with meningitis in Nigeria: implications for the presentation and outcome of meningitis in developing countries

“…The prevalence was significantly higher in children with previous care; (iii) An unfortunately common tendency of focusing only on prevalent diseases, commonly malaria, in the evaluation of acutely ill children, except where there are obvious signs of other infections. This is accompanied by the equally unfortunate practice of ascribing fever unresponsive to antimalarial drugs to drugresistant malaria or enteric fever in some cases [15,16]; (iv) Coexisting focal infections and malaria acting as red herrings [15,16]. Malaria and focal infections were common initial diagnoses in facility-referred children in this study;…”

Etiologi dan Karakteristik Demam Berkepanjangan pada Anak di RS Dr. Cipto Mangunkusumo Jakarta

“…Dengan berkembangnya ilmu pengetahuan dan teknologi di bidang kedokteran, metode diagnostik dalam mendiagnosis penyakit menjadi semakin baik. 1,9,10 Penyakit yang semula sulit didiagnosis saat ini menjadi lebih mudah didiagnosis. Faktor lain adalah lokasi dan tempat tinggal pasien.…”