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[Management of prolonged fever in infants]
1Hôpital Robert-Debré, Paris, France.
Insights
Prolonged fever, lasting over 5 days, is usually infectious in young children, often viral. A structured approach with clinical evaluation and targeted tests aids diagnosis, identifying causes like Mycoplasma or Kawasaki disease.
Area of Science:
- Pediatric Infectious Diseases
- Clinical Diagnosis
- Rheumatology
Background:
- Prolonged fever, defined as unexplained fever exceeding 5 days, is a common clinical challenge in infants and early childhood.
- Infectious etiologies, particularly viral infections, represent the most frequent cause of prolonged fever in this age group.
- Other significant infectious causes include Mycoplasma pneumoniae, urinary tract infections, and otitis media.
Observation:
- Inflammatory conditions are less common but critical considerations, with Kawasaki disease being the primary inflammatory etiology.
- Systemic juvenile idiopathic arthritis (Still's disease) is a rarer, yet important, differential diagnosis for prolonged fever.
- A systematic clinical evaluation and chronological approach are essential for guiding diagnostic investigations.
Findings:
- The majority of prolonged fever cases in children are attributable to common infections.
- Diagnostic yield is maximized through a combination of careful clinical assessment and targeted laboratory and imaging studies.
- An oriented strategy significantly reduces the need for extensive and potentially unnecessary investigations.
Implications:
- Effective etiological diagnosis of prolonged fever can be achieved with a focused diagnostic workup.
- This approach aids in timely management and reduces healthcare costs associated with broad, non-specific testing.
- Highlights the importance of clinical acumen in differentiating infectious from inflammatory causes of fever in pediatrics.
Abstract:
Prolonged fever is defined as an unexplained fever of more than 5 days duration. In infancy and early childhood, it is most often of infectious origin, viral infections being the most frequent. Mycoplasma pneumoniae infections, urinary tract infection and otitis media are also commonly involved. Kawasaki disease is the main inflammatory etiology, juvenile rhumatoïd arthritis in its systemic form (Still's disease) being much rarer. In most cases the etiological diagnosis can be made with a limited number of laboratory and/or imaging investigations based upon a careful clinical evaluation and an oriented chronological strategy.