Fever of unknown origin (peds): Difference between revisions

Latest revision as of 23:08, 28 November 2019

This page is for pediatric patients. For adult patients, see: fever of unknown origin

Background

Prolonged fever of unknown origin without identified cause generally has favorable prognosis.

Clinical Features

Original definition^[1]
- Fever >38.3 C on several occasions
- Lasting for at least 3 weeks
- No clear diagnosis after 1 week inpatient workup
Newer definition^[2] - "Prolonged fever" with:
- 3 outpatient visits without identifying a cause or
- 3 inpatient days without identifying a cause or
- 1 week of “intelligent and invasive” ambulatory investigation

Differential Diagnosis

Infection
- Bacterial
  - Adenitis
  - Endocarditis
  - Mastoiditis
  - Occult abscess
  - Pyelonephritis
  - Sinusitis
  - Tb
  - Mycoplasmal
  - Chlamydial
    - Lymphogranuloma venereum
    - Psittacosis
  - Rickettsial
    - Q fever
    - Rocky mountain spotted fever
- Viral
- Fungal
  - Blastomycosis
  - Histoplasmosis
- Parasitic
Non-infectious Inflammatory
- Juvenile idiopathic arthritis
- SLE
- Regional enteritis
- Rheumatic fever
- Ulcerative colitis
- Vasculitis
Malignancy
Drug Induced
- Antibiotics
- Anticonvulsants
- Anti TB
- Procainamide
- Quinidine
- Serum sickness
Misc
- AIDS
- CNS dysfunction
- Environmental hyperthermia
- Factitious
- Familial dysautonomia
- Kawasaki
- PE
- Serial infections
- Thyrotoxicosis

Evaluation

Clinical (preliminary) diagnosis

Management

Treat underlying cause (once identified)
Empiric treatment generally not recommended

Disposition

Frequently admitted for workup

References

↑ Kaya A, Ergul N, Kaya SY, et al. The management and the diagnosis of fever of unknown origin. Expert Rev Anti Infect Ther. 2013 Aug;11(8):805-15.
↑ Durack DT, Street AC. Fever of unknown origin--reexamined and redefined. Curr Clin Top Infect Dis. 1991;11:35-51.

Authors:

[Kaya-1] Kaya A, Ergul N, Kaya SY, et al. The management and the diagnosis of fever of unknown origin. Expert Rev Anti Infect Ther. 2013 Aug;11(8):805-15.

[2] Durack DT, Street AC. Fever of unknown origin--reexamined and redefined. Curr Clin Top Infect Dis. 1991;11:35-51.

[1]

[2]

@@ Line 1: / Line 1: @@
-==Diagnosis==
+{{Peds top}} [[fever of unknown origin]]
-Febrile >14dys (without clear source)
+==Background==
+*Prolonged fever of unknown origin without identified cause generally has favorable prognosis.
-==DDx==
+==Clinical Features==
-# INFECTION
+*Original definition<ref name="Kaya">Kaya A, Ergul N, Kaya SY, et al. The management and the diagnosis of fever of unknown origin. Expert Rev Anti Infect Ther. 2013 Aug;11(8):805-15.</ref>
-## Bacterial
+**Fever >38.3 C on several occasions
-###Adenitis
+**Lasting for at least 3 weeks
-### Endocarditis
+**No clear diagnosis after 1 week inpatient workup
-### Mastoiditis
+*Newer definition<ref>Durack DT, Street AC. Fever of unknown origin--reexamined and redefined. Curr Clin Top Infect Dis. 1991;11:35-51.</ref> - "Prolonged fever" with:
-### Occult abcess
+**3 outpatient visits without identifying a cause '''or'''
-### Pyelonephritis
+**3 inpatient days without identifying a cause '''or'''
-### Sinusitis
+**1 week of “intelligent and invasive” ambulatory investigation
-### Tb
-## Viral
-### CMV
-### Hep A,B, C
-### Mono
-## Chlamydial
-### Lymphogranuloma venereum
-### Psittacosis
-## Mycoplasmal
-## Fungal
-### Blastomycosis
-### Cysticercosis
-### Histoplasmosis
-### Rickettsial
-#### Q fever
-#### Rocky Mt
-###Parasitic
-#### Malaria
-#### Toxo
-# COLLAGEN VASCULAR
-## JRA
-## LSE
-## Regional enteritis
-## Rheumatic fever
-## Ulcerative colitis
-## Vasculitis
-# MALIGNANCY
-##Leukemia
-## Lymphoma
-## Neuroblastoma
-## Wilm's tumor
-# DRUG INDUCED
-## Abx
-## Anticonvulsants
-## Anti TB
-## Procainamide
-##Quinidine
-## Serum sickness
-# MISC
-## AIDS
-## CNS
-## Environmental
-##Factitious
-##Familial dysautonomia
-## Kawasaki
-## PE
-##Serial infections
-##Thyrotoxicosis
-==Source==
+==Differential Diagnosis==
-/13/06 DONALDSON (adapted from Rosen)
+*'''Infection'''
+**Bacterial
+***Adenitis
+***[[Endocarditis]]
+***[[Mastoiditis]]
+***Occult [[abscess]]
+***[[Pyelonephritis]]
+***[[Sinusitis]]
+***[[Tb]]
+***[[Mycoplasma|Mycoplasmal]]
+***Chlamydial
+****[[Lymphogranuloma venereum]]
+****[[Psittacosis]]
+***[[Rickettsia]]l
+****[[Q fever]]
+****[[Rocky mountain spotted fever]]
+**Viral
+***[[CMV]]
+***[[Viral hepatitis]]
+***[[Mononucleosis]]
+**[[Fungal infections|Fungal]]
+***[[Blastomycosis]]
+***[[Histoplasmosis]]
+**[[Parasitic infection|Parasitic]]
+***[[Malaria]]
+***[[Toxoplasmosis]]
+***[[Cysticercosis]]
+*'''Non-infectious Inflammatory'''
+**[[Juvenile idiopathic arthritis]]
+**[[SLE]]
+**Regional enteritis
+**[[Rheumatic fever]]
+**[[Ulcerative colitis]]
+**[[Vasculitis]]
+*'''Malignancy'''
+**[[Leukemia]]
+**[[Lymphoma]]
+**[[Neuroblastoma (peds)|Neuroblastoma]]
+**[[Wilms' tumor]]
+*'''Drug Induced'''
+**[[Antibiotics]]
+**[[Anticonvulsants]]
+**Anti [[TB]]
+**[[Procainamide]]
+**[[Quinidine]]
+**[[Serum sickness]]
+*'''Misc'''
+**[[AIDS]]
+**CNS dysfunction
+**Environmental [[hyperthermia]]
+**Factitious
+**Familial dysautonomia
+**[[Kawasaki]]
+**[[PE]]
+**Serial infections
+**[[Thyrotoxicosis]]
-[[Category:Peds]]
+==Evaluation==
+*Clinical (preliminary) diagnosis
+==Management==
+*Treat underlying cause (once identified)
+*Empiric treatment generally not recommended
+==Disposition==
+*Frequently admitted for workup
+==See Also==
+*[[Pediatric fever of uncertain source]]
+==References==
+<References/>
+[[Category:Pediatrics]]