Fever of unknown origin (peds): Difference between revisions
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
*'''Infection''' | *'''Infection''' | ||
** Bacterial | **Bacterial | ||
*** Adenitis | ***Adenitis | ||
*** [[Endocarditis]] | ***[[Endocarditis]] | ||
*** [[Mastoiditis]] | ***[[Mastoiditis]] | ||
*** Occult [[abscess]] | ***Occult [[abscess]] | ||
*** [[Pyelonephritis]] | ***[[Pyelonephritis]] | ||
*** [[Sinusitis]] | ***[[Sinusitis]] | ||
*** [[Tb]] | ***[[Tb]] | ||
** Viral | **Viral | ||
*** CMV | ***CMV | ||
*** Hep A,B, C | ***Hep A,B, C | ||
*** Mono | ***Mono | ||
** Chlamydial | **Chlamydial | ||
*** Lymphogranuloma venereum | ***Lymphogranuloma venereum | ||
*** Psittacosis | ***Psittacosis | ||
** Mycoplasmal | **Mycoplasmal | ||
** Fungal | **Fungal | ||
*** Blastomycosis | ***Blastomycosis | ||
*** Cysticercosis | ***Cysticercosis | ||
*** Histoplasmosis | ***Histoplasmosis | ||
*** Rickettsial | ***Rickettsial | ||
**** [[Q fever]] | ****[[Q fever]] | ||
**** Rocky Mt | ****Rocky Mt | ||
***Parasitic | ***Parasitic | ||
**** Malaria | ****Malaria | ||
**** Toxo | ****Toxo | ||
* '''Non-infectious Inflammatory''' | *'''Non-infectious Inflammatory''' | ||
** JRA | **JRA | ||
** LSE | **LSE | ||
** Regional enteritis | **Regional enteritis | ||
** Rheumatic fever | **Rheumatic fever | ||
** [[Ulcerative colitis]] | **[[Ulcerative colitis]] | ||
** Vasculitis | **Vasculitis | ||
* '''Malignancy''' | *'''Malignancy''' | ||
**Leukemia | **Leukemia | ||
** Lymphoma | **Lymphoma | ||
** Neuroblastoma | **Neuroblastoma | ||
** Wilm's tumor | **Wilm's tumor | ||
* '''Drug Induced''' | *'''Drug Induced''' | ||
** [[Antibiotics]] | **[[Antibiotics]] | ||
** Anticonvulsants | **Anticonvulsants | ||
** Anti TB | **Anti TB | ||
** Procainamide | **Procainamide | ||
**Quinidine | **Quinidine | ||
** Serum sickness | **Serum sickness | ||
* '''Misc''' | *'''Misc''' | ||
** [[AIDS]] | **[[AIDS]] | ||
** CNS | **CNS | ||
** Environmental | **Environmental | ||
**Factitious | **Factitious | ||
**Familial dysautonomia | **Familial dysautonomia | ||
** [[Kawasaki]] | **[[Kawasaki]] | ||
** [[PE]] | **[[PE]] | ||
**Serial infections | **Serial infections | ||
**[[Thyrotoxicosis]] | **[[Thyrotoxicosis]] | ||
Revision as of 05:44, 6 July 2016
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
- Viral
- CMV
- Hep A,B, C
- Mono
- Chlamydial
- Lymphogranuloma venereum
- Psittacosis
- Mycoplasmal
- Fungal
- Blastomycosis
- Cysticercosis
- Histoplasmosis
- Rickettsial
- Q fever
- Rocky Mt
- Parasitic
- Malaria
- Toxo
- Bacterial
- Non-infectious Inflammatory
- JRA
- LSE
- Regional enteritis
- Rheumatic fever
- Ulcerative colitis
- Vasculitis
- Malignancy
- Leukemia
- Lymphoma
- Neuroblastoma
- Wilm's tumor
- Drug Induced
- Antibiotics
- Anticonvulsants
- Anti TB
- Procainamide
- Quinidine
- Serum sickness
- Misc
- AIDS
- CNS
- Environmental
- Factitious
- Familial dysautonomia
- Kawasaki
- PE
- Serial infections
- Thyrotoxicosis
Diagnosis
- Clinical (preliminary) diagnosis
Management
- Treat underlying cause (once identified)
- Empiric treatment generally not recommended
Disposition
- Frequently admitted for workup