Fever of unknown origin in 185 paediatric patients: A single‐centre experience

Abstract

Aim: We conducted a prospective study to evaluate the causes and outcome in children with fever of unknown origin (FUO). Methods: From 1990 to 1999, 185 children with FUO were evaluated. Initial evaluation included routine haematological analysis, Epstein‐Barr virus (EBV) serology, urine, stool or blood cultures, chest X‐ray and tuberculin probe. Results: In 131 (70%) patients diagnosis was established, and 70 (37.8%) had infectious disease. EBV infection was the most common infection followed by visceral leishmaniasis (VL), urinary tract infection (UTI) and tuberculosis. Autoimmune disorders were diagnosed in 24 (12.9%), Kawasaki disease in 12 (6.4%), malignant diseases in 12 (6.4%) and miscellaneous conditions in 15 (8.1%) patients. In the remaining 54 (30%) patients, diagnosis was not established and most of them had self‐limited disease. During the investigation, 26 (14%) patients developed serious organ dysfunction and five patients (two with virus‐associated haemophagocytic syndrome, one with VL and two unknown) died. Conclusion: The most important infectious causes of FUO in our study were EBV infection and VL. Kawasaki disease represented a significant cause of FUO at the beginning of our study because it was not recognized by primary‐care physicians. We report myelodysplastic syndrome as another emerging cause of paediatric FUO. Repeated clinical examination and careful use of specific laboratory examinations, invasive diagnostic procedures or imaging are crucial in approaching paediatric FUO.

Clinical approach to fever of unknown origin in children

“…Similar findings have been reported previously. [10][11][12][13] A recent study of children with FUO conducted by Cho et al in northern Taiwan, in which FUO was defined as fever for more than 2 weeks, found that infectious diseases accounted for 27% of FUO in children, followed by malignancies 16.6%, and collagen vascular disease 12.7%. Cho et al found that upper respiratory diseases (URI) were the most common cause of infectious disease, followed by CMV and EBV infection, and very rare caused by leptospirosis or scrub typhus.…”

“…[10][11][12][13] The 4-stage protocol used in this study to investigate the etiology of FUO provides for a reasonably accurate establishment of a diagnosis. Stage 2 of the protocol was sufficient to establish a diagnosis of infectious disease as the cause of FUO in most patients in this study.…”

Fever of unknown origin in children: a systematic review

“…[6] The 18 included studies published from 1968 to 2008 consisted of 8 studies (all more than a decade old) from only 3 developed countries (Germany, USA and Spain) and 10 studies from developing countries ( Table 1). [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] The number of children in each case series varied from 10 to 221 (median 89.5) for a total of 1638 children (770 males; 628 females; 240 unknown). Definitions of FUO varied widely.…”

“…Tunisia 2006 [18] Fever >17 days for kids between 2 and 15 yrs 110 3 (3%) 8 (7%) 9 (8%) 64 (58%) 26 (24%) Serbia 2006 [19] Fever >3 weeks with temperature >38.3°C & no diagnostic signs or symptoms 185 12 (6%) 24 (12%) 25 (14%) 70 (38%) 54 (29%)…”

Fever without apparent source on clinical examination

“…Pasic et al [19] prospectively investigated the causes and outcome of childhood fever of unknown origin (FUO) in 185 patients referred to a single tertiary-care pediatric center in Belgrade, Serbia and Montenegro. Etiological cause was established in 71% and 38% had infectious diseases.…”