Etiology and Resource Use of Fever of Unknown Origin in Hospitalized Children

Antoon, James W.; Peritz, David C.; Parsons, Michael R.; Skinner, Asheley Cockrell; Lohr, Jacob A.

doi:10.1542/hpeds.2017-0098

Cited by 29 publications

(27 citation statements)

References 17 publications

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“…The differential diagnosis of fever is broad. The most common cause is infection, with autoimmune disease and malignancy as second and third causes, respectively (6,7). In approximately 50% of infants up to 3 years old with fever, no cause is found (8).…”

Section: Introductionmentioning

confidence: 99%

Role of FDG-PET/CT in children with fever of unknown origin

Pijl

Kwee

Legger

et al. 2020

Eur J Nucl Med Mol Imaging

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Purpose To determine the role of 18F-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET)/computed tomography (CT) in children with fever of unknown origin (FUO). Methods This retrospective single-center study included 110 children (0–18 years) with FUO who underwent FDG-PET/CT between 2010 and 2019. The diagnostic value of FDG-PET/CT for identifying cause of fever was calculated, treatment modifications after FDG-PET/CT were assessed, and logistic regression analyses were performed to identify clinical and biochemical factors associated with FDG-PET/CT outcome. Results In 53 out of 110 patients (48%), FDG-PET/CT identified a (true positive) cause of fever. Endocarditis (11%), systemic juvenile idiopathic arthritis (5%), and inflammatory bowel disorder (5%) were the most common causes of FUO. In 42 patients (38%), no cause of fever was found on FDG-PET/CT. In 58 out of 110 patients (53%), treatment modifications were made after FDG-PET/CT. FDG-PET/CT achieved a sensitivity of 85.5%, specificity of 79.2%, positive predictive value of 84.1%, and negative predictive value of 80.9%. On multivariate logistic regression, C-reactive protein was positively associated with finding a true positive focus of fever on FDG-PET/CT (OR = 1.01 (95% CI 1.00–1.02) per mg/L increase in CRP), while leukocyte count was negatively associated with finding a true positive focus of fever (OR = 0.91 (95% CI 0.85–0.97) per 109 leukocytes/L increase). Conclusion FDG-PET/CT is a valuable diagnostic tool in the evaluation of children with FUO, since it may detect a true underlying cause in almost half (48%) of all cases where none was found otherwise. It allows full-body evaluation in patients without disease-specific symptoms on one examination. CRP and leukocyte count were significantly associated with FDG-PET/CT results, which may contribute to a priori assessment on the outcome of FDG-PET/CT. Future research could be aimed at evaluating more patient-specific factors to prospectively estimate the added value of FDG-PET/CT in children with FUO.

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Section: Introductionmentioning

confidence: 99%

Role of FDG-PET/CT in children with fever of unknown origin

Pijl

Kwee

Legger

et al. 2020

Eur J Nucl Med Mol Imaging

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“…Infections are the main causes of FUO in children, [8,25,26,40] including the children in Taiwan. [41,42] Notably, a significant proportion of pediatric patients, accounting approximately 25%–30%, remain undiagnosed.…”

Section: Discussionmentioning

confidence: 99%

“…[41,42] Notably, a significant proportion of pediatric patients, accounting approximately 25%–30%, remain undiagnosed. [8,25,26,40] However, in adults, the number of undiagnosed cases has been demonstrated to be more common than that of the infectious etiology cases. [15,43]…”

Section: Discussionmentioning

confidence: 99%

The impact of global budgeting in Taiwan on inpatients with unexplained fever

Liu

et al. 2019

Medicine

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“…Infections, mainly bacterial, are the main cause of fever of unknown origin (FUO) in children. These are followed by autoimmune diseases and cancer (7)(8)(9) . According to Chow and Robinson, abscesses account for about 5% of FUO cases, which means that patients with this condition are only a small fraction among all paediatric patients with FUO (8) .…”

Section: Discussionmentioning

confidence: 99%

Splenic abscess in a child as a cause of fever of unknown origin

Będzichowska¹,

Wawrzyniak²,

Bil³

et al. 2019

Pediatr Med Rodz

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Splenic abscess is a rare condition, with peak incidence in the third and sixth decade of life. It is significantly less common in children than in adults. The main causes of abscess include multiorgan infections, immune deficiency, and trauma. Coexisting diabetes, infective endocarditis and immune deficiency are adverse prognostic factors. Aetiological factors of splenic abscess include aerobic and anaerobic bacteria and fungi. The symptoms of splenic abscess are non-specific and include abdominal pain in the upper-left-quadrant, fever, splenomegaly, and increased inflammatory markers. The diagnosis is confirmed by abdominal sonographic and computed tomography findings. Conservative (antibiotic therapy) and surgical (drainage and splenectomy) treatment is used. Splenic abscess is an exceptionally dangerous condition in which early, correct diagnosis and treatment can reduce mortality from several dozen to less than 10%. The presented case illustrates the course of disease in a 6-year-old boy, emphasising the need to include splenic abscess in the differential diagnosis of fever of unknown origin.

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Etiology and Resource Use of Fever of Unknown Origin in Hospitalized Children

Cited by 29 publications

References 17 publications

Role of FDG-PET/CT in children with fever of unknown origin

Role of FDG-PET/CT in children with fever of unknown origin

The impact of global budgeting in Taiwan on inpatients with unexplained fever

Splenic abscess in a child as a cause of fever of unknown origin

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