Pediatric Fever of Unknown Origin

Prevalence of meningitis in newborns with fever in a third-level hospital center: Meningitis in febrile newborns

“…Female: 18 (48.6%) versus 14 (50%), male: 19 (51.4%) versus 14 (50%) (p = 0.914), gestational age at birth: 39 (35.1-40.6) weeks versus 38 (35-40.6) weeks (p = 0.435), weight at birth: 3070 (1770-4280) grams versus 2890 (1820-3910) grams (p = 0.330), low weight for gestational age: 8 (21.6%) versus 6 (21.4%) (p = 0.985), and age at diagnosis: 5 (1-80) days versus 6.5 days (p = 0.689). Regarding the length of hospital stay, this was greater for Group A: 14 (3-39) days versus 6 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14) days for Group B (p < 0.001) due to the number of days that IV antibiotic therapy was administered: 14 (3-21) days for Group A versus 5.5 (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14) days for Group B (p < 0.001) (Table 2).…”

“…To perform a meningitis diagnosis in newborns, it is important to analyze, in addition to clinical data, the complete hematic biometry in search of leukocytosis or neutrophilia, in addition to conducting C-reactive protein and procalcitonin as acute-phase reactants, as well as a complete approach in search of a source of infection, since in newborns, sepsis and meningitis are clinically indistinguishable 11,12 . The following tests may be conducted: A general urine test and culture, a blood culture, and a full biochemical profile, in addition to a lumbar puncture for cytochemical analysis and a cerebrospinal fluid culture 13 .…”

Update on Fever of Unknown Origin in Children: Focus on Etiologies and Clinical Approach

“…Normally, most feverish diseases resolve before the origin or cause can be clarified, but sometimes fever prolongs without reaching a diagnosis [2]. As known, fever can have several patterns [3]: continuous, if the temperature remains high all day with fluctuation below 1 degree; remittent, if the temperature undergoes wide daily fluctuations (2-3 degrees), without falling <37 • C; intermittent, if hours of fever alternate with others of apyrexia on the same day; periodic, if it appears every 3-4 days; and recurrent, if the feverish episodes last a few days, interrupted by days or weeks of apyrexia [4].…”

“…If the patient is hospitalized, observing the temperature curve helps to visualize the fever pattern. Furthermore, in suspicion of fictitious fever, it is useful to ask parents to keep a "fever diary" [3,4].…”

“…For years, the few studies that have focused on the specific definition of FUO in pediatrics have provided slightly different parameters for the value, frequency, and duration of fever [6]. The most appropriate current definition provides for a temperature above 38.3 • C, at least once a day, for more than 8 days in a child evaluated on an outpatient basis by the pediatrician (with inconclusive history, physical examination, and first-level investigations) [3]. In this respect, it is also useful to distinguish FUO from fever without source (FWS), based on the fever duration, which, in the latter case, is less than a week [7].…”