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Prolonged unexplained pyrexia: a review of 221 paediatric cases from Kuwait
A E Mouaket1, M M el-Ghanim, Y K Abd-el-Al
1Department of Paediatrics, Mubarak El-Kabeer Hospital, Hawalli, Kuwait.
Insights
In Kuwait, infections are the primary cause of prolonged fever in children, with Brucella being the most common. Prompt diagnosis and treatment are crucial, especially for suspected bacterial infections like brucellosis.
Area of Science:
- Pediatrics
- Infectious Diseases
- Clinical Medicine
Background:
- Prolonged pyrexia (fever) in children presents a diagnostic challenge.
- Identifying the etiology of persistent fever is critical for timely and appropriate management.
Purpose of the Study:
- To investigate the causes of prolonged pyrexia in pediatric patients in Kuwait.
- To determine the most frequent etiologies and assess diagnostic indicators.
Main Methods:
- Retrospective analysis of 221 pediatric admissions with prolonged pyrexia over three years (1985-1987).
- Evaluation of clinical data, laboratory results, and diagnostic procedures.
Main Results:
- Infections accounted for 78% of cases, with Brucella (38%) and typhoid fever (9%) being the most common. 15% of cases remained undiagnosed.
- Fever duration was a more reliable diagnostic clue than fever height or pattern.
- Erythrocyte sedimentation rate and white blood count had limited diagnostic value; C-reactive protein was elevated in bacterial infections, malignancies, and connective tissue diseases.
Conclusions:
- Bacterial infections, particularly brucellosis, are highly prevalent in children with prolonged pyrexia in Kuwait.
- Diagnostic and therapeutic interventions should be expedited, prioritizing the exclusion of bacterial infections.
Abstract:
Over a three year period (January 1985 through December 1987), 221 children with prolonged pyrexia were admitted to the paediatric departments in two regional hospitals in Kuwait. Infections, connective tissue diseases and malignancies constituted 78%, 5% and 2%, respectively, and 15% of the cases remained undiagnosed. Brucella was the most common infectious agent encountered (38% of all cases), followed by typhoid fever (9%). The duration of fever was more helpful in the differential diagnosis than its height or pattern. The erythrocyte sedimentation rate and the white blood count were of limited value, and the C-reactive protein was positive in bacterial infections, malignancies and connective tissue diseases. Since a child presenting with prolonged pyrexia in this country has over a 70% chance of having a bacterial infection, both diagnostic and therapeutic procedures should be performed as an emergency measure. Particular emphasis should be put on the exclusion of brucellosis.