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Prolonged fever in children
C H Chien1, C Y Lee, L M Huang
1Department of Pediatrics, Provincial Hsin-Chu Hospital, Hsin-Chu City, Taiwan, R.O.C.
Insights
Diagnosing prolonged fevers in children is challenging. This study found infections, autoimmune diseases, and neoplasms were common causes, with a high diagnostic rate achieved through thorough clinical evaluation.
Area of Science:
- Pediatrics
- Infectious Diseases
- Rheumatology
Background:
- Prolonged fever in children without an initial diagnosis poses a clinical challenge.
- Identifying the underlying cause is crucial for appropriate management and prognosis.
Purpose of the Study:
- To retrospectively analyze the causes and outcomes of prolonged fever in children.
- To evaluate the diagnostic rate and methods used in a cohort of pediatric patients.
Main Methods:
- Retrospective analysis of 86 children with fever lasting at least 6 days.
- Inclusion criteria: absence of diagnosis after initial examination and preliminary tests.
- Data collected on patient demographics, diagnoses, diagnostic methods, and outcomes.
Main Results:
- Infections (bacterial, viral, mycoplasmal, malaria) accounted for 43% of cases.
- Collagen vascular diseases (15%) and neoplastic/hematological diseases (15%) were significant contributors.
- Central fever was diagnosed in 16% of patients.
- Overall diagnostic rate was 98%.
- Poor outcomes were observed in 22% of children, particularly those with collagen vascular diseases or neoplasms.
Conclusions:
- Prolonged fever in children has diverse etiologies, including infections, autoimmune conditions, and malignancies.
- A comprehensive approach combining medical history, physical examination, laboratory tests, and clinical course observation is key to diagnosis.
- Invasive studies should be reserved for specific indications.
Abstract:
During a four-year period, 86 children with fever lasting for at least 6 days without diagnosis at admission after initial physical examination and preliminary laboratory tests were included in a retrospective analysis. Their ages ranged from 2 months to 16 years, and there were 55 males and 31 females. Bacterial infections occurred in 19 patients (22%), viral infections in 17 (20%), mycoplasmal infections in 3 and malaria in 1. Collagen vascular diseases were diagnosed in 13 children (15%), including 7 juvenile rheumatoid arthritis and 5 systemic lupus erythematosus. Thirteen children (15%) had neoplastic or hematological diseases, including leukemia, lymphoma, myelodysplastic syndrome, and neuroblastoma. The fevers of the other 14 patients (16%) were attributed to central fever. The overall diagnostic rate was 98%. Twenty-two children had a poor outcome, including 6 children with collagen vascular diseases and 12 with neoplasms. Diagnoses were made mainly through a complete medical history, meticulous physical examination, regular laboratory tests, and an observation of clinical course. Invasive tissue studies can be fruitful when used appropriately and should be considered for specific indication only.