We identified diseases that should be considered and useful diagnostic testing in patients with fuo. She has already undergone blood and urine testing, as well as chest radiography, but no source for her fever has been identified. Fever of unknown origin fuo is a relatively uncommon condition in united states children. Fever in infants and children pediatrics merck manuals. Etiology and resource use of fever of unknown origin in.
Etiology and clinical characteristics of fever of unknown. Background fever of unknown origin fuo continues to challenge clinicians to determine an etiology and the need for treatment. Normal body temperature the hypothalamus is the heatregulating center of the body the normal body temperature ranges from 37. Prolonged fever of unknown origin in children jama. Some common causes of fever in children include localized or generalized infection, connective tissue disease, and cancer. Fever and neutropenia in pediatric patients with cancer. Pediatricians often confuse fever without a source and fever of unknown origin. Fever of unknown origin in children world journal of pediatrics. We recently cared for a patient who presented with a 3week history of fever. Neutropenic puo includes patients with fever as above with fuo was defined in 1961 by petersdorf and beeson as the following.
Renal abscess is uncommon in pediatrics and is rarely a cause of fever of unknown origin. Objective fever of unknown origin fuo can be caused by many diseases, and varies depending on region and time period. The issue of fu0 in pediatrics is rather hazy and still represents a challenging diagnostic dilemma. The term fuo is best reserved for children with a fever documented by a health care provider and. Of these, 40 were found to have serious or lethal diseases, 48 had essentially. The primary studies determining the causes of prolonged. A comprehensive evidencebased approach to fever of. Pyrexia of unknown origin history taking geeky medics. It is wellknown that the most common causes of pediatric fuo are infectious diseases. Fever without an identifiable cause fever of unknown origin fuo. Fever of unknown origin pinpointing the culprit fatima ignacio gimenez, md pediatric infectious disease. Definition presence of fever for 8 or more days in a child for whom a careful and thorough history and preliminary laboratory data fail to reveal a probable cause of fever pediatric feigin, et al.
Fever for 2 to 3 weeks, without a known cause after initial investigations. Key questions to ask in the history in children with fever without an apparent source. The primary studies determining the causes of prolonged fever in children were performed 4 decades ago, before major advances in laboratory and diagnostic testing. Fever of unknown origin is more likely to be due to an atypical presentation of a common disease than to a typical presentation of an exotic disease. The most common cause of fuo was infectious disease 37. Pediatrics fever of unknown origin no standard definition in children reasonable definition. In previous studies, infectious disease was the most common cause of pediatric fever of. Fever of unknown origin fuo is a wellknown pediatric presentation. Nosocomial puo in hospital patients with fever of 38. Fever in hospitalized patients receiving acute care and with no infection present or incubating at admission if the diagnosis remains uncertain after 3 days of appropriate evaluation. Pediatric fever of unknown origin american academy of. Knowledge about the etiology of fever of unknown origin fuo has been changed under the influence of new advances in diagnostic techniques in both adulthood and childhood. This disease has been defined as systemic arthritis by the international league of associations for rheumatology ilar classification of juvenile idiopathic arthritis jia, 2 systemic.
An indium scan ultimately led to the diagnosis of a renal abscess. In the prepneumococcal vaccine era, even after a thorough history and physical examination, a source of infection was not identi. This study explored the most common etiologies, characteristics, and average cost of hospitalization for fuo in a pediatric population at an urban, tertiary care hospital in washington, dc. Professor and director, university of florida center for hivaids research, education and service, jacksonville, fl. The term fever of unknown origin fuo in pediatrics has had varying definitions in the literature, with duration of fever ranging, depending on the definition, from 5 to 21 days. Clinical approach to fever of unknown origin in children. After 60 years of the original description of fever of unknown origin fuo by petersdorf and beeson in 1961, fuo remains among the most challenging clinical situations in diagnosis for health care providers to approach and often involves referral to subspecialists. Given that the distribution of diagnosed causes of adult fuo has changed in recent decades, we.
Objective after completing this article, readers should be able to. Aspiration yielded peptostreptococcus asaccharolyticus. Research on fuo in japan has been limited to single medical institution or region, and no nationwide study has been conducted. Etiology and clinical characteristics of fever of unknown origin in. Fever is a common symptom of many clinical conditions, and infection is the most common cause, especially in children. However, the increased availability of rapid diagnostic testing has shortened the period of time before which standard fuo etiologies are seriously considered. Yield of bone marrow examination in diagnosing the source of fever of unknown origin.
Nevertheless, fuo remains a challenging clinical problem for even the most astute clinician. American academy of pediatrics textbook of pediatric care, 2nd edition. Background fever of unknown origin fuo is defined as a temperature higher than 38. Fever of unknown origin american academy of pediatrics. However, the cause is still usually infection, most often viral. Fever of unknown origin in children can signal the presence of a range of disorders, from infectious to oncologic. Further more, the causes of fuo often have an overlapping collection of symptoms and insidious disease courses. Fever is a common presenting complaint in children, accounting for nearly onethird of pediatric outpatient visits in the united states. Pdf clinical approach to fever of unknown origin in children. Methods this article is based on a selective literature search for publications containing the term pediatric fever management, with special attention to metaanalyses and. The value of 18ffdgpetct in identifying the cause of fever of unknown origin fuo and inflammation of unknown origin iuo. Pyrexia of unknown origin puo is defined as fever of 38.
Approach to the child with fever of unknown origin. Department of pediatrics, division of general pediatrics and adolescent medicine, university of north carolina school of medicine, chapel hill, nc. Original article clinical approach to fever of unknown origin in children. These fevers may be caused by more unusual illnesses rheumatologic, oncologic. Fever of unknown origin fuo was defined in 1961 by petersdorf and beeson as the following. Adopt a systematic approach to evaluation and management of fever of unknown origin in patients of various ages. Fever for 3 wk with no identified cause after 3 days of hospital evaluation or. Fever of unknown origin in childhood pediatric clinics of north. Fever is one of the most common symptoms in children.
Research article etiology and resource use of fever of unknown origin in hospitalized children james w. Four days ago, she developed a prominent bump on the left side of her neck. The specific entity of fever of unknown origin fuo, as opposed to a fever without a source fws, has occupied a special place within infectious diseases since the first definition of and series about fuo by petersdorf and beeson in 1961. Clinical policy for wellappearing infants and children. The purpose of collecting these data is to determine. Given that the distribution of diagnosed causes of adult fuo has changed in recent decades, we hypothesized that the etiology of fuo in children has. Fever of unknown origin with polyarthritis imedpub. The specific entity of fever of unknown origin fuo, as opposed to a fever without a source fws, has occupied a special place within infectious diseases since the first definition of and series about fuo by petersdorf and beeson. Evaluation of fever of unknown origin fuo in children requires documentation of fever in the medical setting and repetitive reassessment of history and physical. Fever of unknown origin fuo can be caused by many clinical conditions and remains a diagnostic challenge in clinical. Fever without a source, or fever without a focus, has the following criteria. Pediatric fever without a source emergency medicine. Fever of unknown origin introduction with polyarthritis.