Diagnostic Approach to Fever of Unknown Origin

Antoon, James W.; Knudson-Johnson, Melissa; Lister, William M.

doi:10.1177/0009922811431160

Cited by 8 publications

(5 citation statements)

References 7 publications

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“…Leishmaniasis, an infectious diseases commonly observed in our region, was also the most common infectious cause of fever of known origin, in our study. Juvenile rheumatoid arthritis is the leading one among the collagen vascular diseases that cause FUO 2,25,26 . Also in our study, juvenile rheumatoid arthritis was the most commonly diagnosed collagen vascular disorder.…”

Section: Discussionmentioning

confidence: 99%

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Nedeni bilinmeyen ateş: 30 çocuk hastanın değerlendirilmesi

Gündeşli̇oğlu

Kocabaş

Alhan³

et al. 2019

Cukurova Medical Journal

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The aim of this retrospective study is to evaluate the etiology clinical and laboratory features of fever of unknown origin (FUO) diagnosed in 30 pediatric patients. Materials and Methods: The clinical data including the etiology, diagnostic approaches and clinical characteristics were retrospectively analysed in 30 pediatric patients with FUO who presented to our clinic in oneyear period. Results: The median age of the patients was 63 (6-192) months. Among the patients, 12 were male (40%), while 18 were female (60%). The median duration of the fever was 22.5 (3-60) days during hospital admission. The most common physical findings were hepatomegaly and splenomegaly, which were observed in 53. 3 and 40 patients, respectively. The cause of the FUO was detected to be infection in 14 patients (46.6%), connective tissuevascular diseases in 8 patients (26.7%), malignancies in 5 patients (16.7%), and miscellaneous diseases in 1 patient (3.3%). In two patients (6.6%) the etiology could not be identified. Leishmaniasis, tuberculosis and Brucellosis were the most commonly identified infections, whereas juvenile rheumatoid arthritis and acute lymphoblastic leukemia were the most common non-infectious causes. Conclusion: The most common cause of FUO in our study was infection diseases. Connective-vascular tissue diseases and malignancies are also important causes of FUO. In our opinion, detailed patient history, carefully physical examination and close clinical follow-up may reduce the number of the invasive procedures and noninvasive tests.

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Section: Discussionmentioning

confidence: 99%

“…No fever was observed during the follow-up of this patient. In the literature, various algorithms have been proposed for the diagnosis of the fever of unknown origin 26,28,29 . However, subjecting each patient to these algorithms would lead to excessive testing.…”

Section: Discussionmentioning

confidence: 99%

Nedeni bilinmeyen ateş: 30 çocuk hastanın değerlendirilmesi

Gündeşli̇oğlu

Kocabaş

Alhan³

et al. 2019

Cukurova Medical Journal

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“…Though there are several definitions of FUO in the literature, it is generally accepted to be defined as a fever of unknown etiology greater than 100.5°F (38.3°C) for at least 8 days and with no evident source following initial workup by a clinician. 2 The causes of FUO vary widely but can be broadly categorized into those with infectious and those with noninfectious etiologies (Figure 1). Infectious causes include bacterial, viral, and atypical pathogens, whereas noninfectious etiologies encompass oncological, autoimmune, iatrogenic, and familial disorders.…”

Section: Discussionmentioning

confidence: 99%

“…Infectious causes include bacterial, viral, and atypical pathogens, whereas noninfectious etiologies encompass oncological, autoimmune, iatrogenic, and familial disorders. 2,3 Distinguishing between these categories can be difficult because of the overlapping nature of symptoms and insidious course of clinical progression of disease. Narrowing the differential is further complicated by the lack of standard diagnostic workup for FUO, given that initial laboratory tests are often normal.…”

Section: Discussionmentioning

confidence: 99%

Fever of Unknown Origin in a Child

Antoon

Bradford

2012

Clin Pediatr (Phila)

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A 4-year-old Caucasian boy with no significant past medical history was transferred to our facility following 3 admissions to outside hospitals for fever for approximately 1 month. The patient presented to our hospital with intermittent, daily fever ranging from 100.5°F to 104.5°F that was responsive to antipyretics. Associated symptoms included headache, neck ache, abdominal pain, decreased appetite, decreased balance, weight loss, leg pain, and night sweats. He had no history of sick contacts, recent travel, tick bites, or exposure to animals other than dogs. The patient was healthy and had received recommended routine immunizations and was taking no medications prior to the onset of fevers. Subsequent to the onset of fevers, the patient was treated with antipyretics, several different antibiotics, and a short course of prednisone. The major details of his workup at his primary care physician and 3 outside hospitals are described in Table 1.Physical exam at our institution revealed an awake, alert, agitated appearing child in no acute distress. He had a clear oral pharynx, and his tympanic membranes were normal. His neck was supple without thyromegaly. Bilateral posterior auricular and axillary lymphadenopathy was present. Cardiovascular and respiratory exams were unremarkable. His abdomen was soft and nondistended, with tenderness to palpation in the right upper and lower quadrants. Normoactive bowel sounds were noted, and there was no rebound tenderness, palpable masses, or organomegaly. A musculoskeletal exam exposed limited active, but not passive, range of motion of the left leg. Gait was mildly altered secondary to leg pain. Examination of the skin showed no rashes, insect bites, or ulcerations. Neurological exam revealed an alert and appropriate toddler with normal tone, strength, and reflexes. There were no detectable cranial nerve abnormalities. Both Kernig and Babinski signs were negative.Initial laboratory values were as follows: sodium, 132 mmol/L; potassium, 4.5 mmol/L; chloride, 102 mmol/L; bicarbonate, 22 mmol/L; blood urea nitrogen, 8 mg/dL; creatinine, 0.32 mg/dL; glucose, 84 mg/dL; calcium, 8.2 mg/dL; phosphorus, 4.5 mg/dL; magnesium, 1.8; total protein, 6.0 g/dL; albumin, 2.8 g/dL; total bilirubin, 0.4 g/dL; aspartate aminotransferase (AST), 70 m/dL; alanine aminotransferase (ALT), 144 m/dL; γ-glutamyl transpeptidase, 350 U/L; lactate dehydrogenase (LDH), 982 U/L; C reactive protein, 1.1 mg/dL; ferritin 166 ng/mL; erythrocyte sedimentation rate (ESR), 25 mm/h; white blood cells, 18.6/mm 3 (neutrophils, 5.8; lymphocytes, 11.0; monocytes, 1.4; eosinophils, 0.4; basophils, 0.0); hemoglobin, 9.0 gm/ dL; hematocrit, 26.8 gm/dL; platelets, 77; RBC Distribution Width (RDW), 14.3/mm 3 ; Mean Cell Volume (MCV), 85.0; Activated Partial Thromboplastin Time (aPPT), 34.4 s; international normalized ratio, 1.0; and Prothrombin Time (PT), 11.4 s. In addition, initial anterior-posterior and lateral chest X rays indicated that there was a posterior airspace opacity or pleural fluid at the left lung base.The p...

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“…She was admitted to the hospital for further evaluation of pediatric fever of unknown origin (FUO), that is, temperatures higher than 38.0°C (100.4°F) that continue for longer than 8 days without a clear source despite a careful history, physical examination, and initial laboratory evaluation. 1…”

Section: Case Reportmentioning

confidence: 99%