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Prolonged fever in children: review of 100 cases
Insights
Diagnosing prolonged fevers in children often involves unusual presentations of common diseases. While standard tests were disappointing, specific screenings and procedures aided diagnosis in pediatric fever of unknown origin.
Area of Science:
- Pediatrics
- Infectious Diseases
- Rheumatology
Background:
- Prolonged fever of unknown origin (FUO) in children presents a diagnostic challenge.
- Identifying the etiology is crucial for appropriate management and prognosis.
Purpose of the Study:
- To review the diagnostic approaches and etiologies of FUO in hospitalized children.
- To identify factors influencing the likelihood of specific diagnoses based on age.
Main Methods:
- Retrospective review of 100 pediatric patients admitted with FUO over six years.
- Analysis of diagnostic yield from history, physical examination, laboratory tests, and invasive procedures.
Main Results:
- Infectious causes were most common (52%), followed by collagen-inflammatory diseases (20%).
- Age influenced etiology: younger children (<6 years) more often had infections, while older children (>6 years) were more prone to inflammatory diseases.
- Standard laboratory tests (CBC, urinalysis, X-ray) were often unhelpful; sedimentation rate and serum protein electrophoresis showed greater utility.
- Biopsy and laparotomy provided valuable diagnostic information when performed.
Conclusions:
- Unusual presentations of common diseases are frequent in pediatric FUO.
- Age stratification can guide etiological suspicion.
- Reliable diagnostic tools beyond basic labs are essential for managing complex pediatric fevers.
Abstract:
One hundred children admitted to a hospital over a six-year period with temperatures over 38.5 C for longer than two weeks and of undetermined etiology are reviewed. Fifty-two were infectious (21 presumed viral), 20 collagen-inflammatory, 6 malignancy, 10 miscellaneous, and 12 discharged undiagnosed. Children less than 6 years were more likely to have an infectious etiology while 80% of collagen-inflammatory disease occurred in the group older than 6. The overall mortality (9%) was not age-related. Careful history and physical examinations were helpful but the usual laboratory data (CBC, urinalysis, X-ray) were notably disappointing; however, sedimentation rates and serum protein electrophoresis were often reliable screening tests. Biopsy and laparotomy were less frequently done but when performed yielded productive information. Unusual presentations of common diseases comprised the majority of childhood fevers.