Clinical profile and etiological spectrum of fever of unknown origin in children aged 2 months to 12 years

Abstract

Background: Fever of unknown origin is one of the leading etiologies for morbidity and mortality among children worldwide and their spectrum keeps changing constantly from time to time. The objective of this study was to study the clinical profile and etiological spectrum of fever beyond 2 weeks duration in children aged 2 months to 12 years admitted in a tertiary care hospital. Methods: A prospective observational study, done in tertiary care centre over six month period (May 2016 to October 2016). Children aged 2 months to 12 years presenting with fever beyond 2 weeks duration fulfilling the inclusion criteria were included in the study and evaluated further. Initial investigations include complete blood count including peripheral smear for MP/malignancy, urine routine, chest X-ray, mantoux, CRP, blood and urine cultures were done followed by specific serology tests and further relevant investigations. The etiological outcomes were mainly analysed. Results: The etiological outcomes of the study were classified into 5 groups as infections, malignancies, connective tissue disorder, miscellaneous and undiagnosed. Among the study population, infection emerged as the major etiological outcome constituting 69.1% followed by malignancies (16.7%), connective tissue disorder (5%), miscellaneous (5.8%) and undiagnosed (3.4%). Conclusions: Infections, especially enteric fever still remains the leading etiology of fever beyond 2 weeks duration or FUO in children aged 2months to 12 years. Irrational usage of antibiotics has been highlighted in general practice which needs to be amended by periodic discussions and epidemiological surveys to prevent the emergence of drug resistance.

Clinico-aetiological profile of fever of unknown origin (FUO) in children in a single centre

“…Infections are the main cause for FUO constituting 60-70% 8 . In our study they accounted for 70.8% similar to studies by Landge A A et al (79%), Santosh G et al (69.1%) and Joshi N (69%) 9,10,11 . Table 2 shows the percentages of various causes in different studies.…”

Clinicoetiological profile of pyrexia of unknown origin in children 1-12 years of age in a tertiary care centre

“…For example, in a retrospective study conducted by Sumathisri et al infectious disease was responsible for 90.6%, similarly Nalli et al 1 got an incidence of 38% as infectious cause of PUO, Govindarajulu et al found incidence of 69.1%. 1,11,14 Among infectious causes, the major proportion (17.5%) was respiratory tract infection, followed by scrub typhus (13.5%), urinary tract infections (10%). Typhoid and TB contributed 8% each to PUO in the study population.…”

“…18 Other studies as done by Nalli et al, Govindarajulu et al also had findings similar to our study and in both studies, malignancy was the second most common cause of PUO with a higher proportion than collagen vascular disorders. 1,14 Among participants with malignancy, the most common diagnosis was acute lymphoblastic leukemia (7%) followed by acute myeloid leukemia (2.5%). Nalli et al also in his prospective, observational study discovered the commonest malignancy causing PUO in pediatric patients being acute lymphoblastic leukemia.…”

A Cross-sectional Study of Undiagnosed Fever in a Rural Population at a Tertiary Care Hospital of West Bengal

“…[15] Another study among paediatric population found enteric fever and acute lymphoblastic leukemia as the most frequent causes. [16] As obtained by D.Prabahkumar et al, there has been a fall in the incidence of infections ranging from 16%-57%,in parallel to increase in diagnosis of inflammatory disorders attributed mainly due to increased awareness and advances in diagnostic facilities. [17] It is to be noted that even after the introduction of ongoing Revised National Tuberculosis Control Program (RNTCP) from 1997, the scourge of Tuberculosis still plagues our rural population.…”