Further more, the causes of fuo often have an overlapping collection of symptoms and insidious disease courses. After completing this article, readers should be able to. 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. Methods this article is based on a selective literature search for publications containing the term pediatric fever management, with special attention to metaanalyses and. Objective fever of unknown origin fuo can be caused by many diseases, and varies depending on region and time period. In previous studies, infectious disease was the most common cause of pediatric fever of.
A 15monthold girl presents to the ed with 8 days of fever. The purpose of collecting these data is to determine. Original article clinical approach to fever of unknown origin in children. 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.
The term fuo is best reserved for children with a fever documented by a health care provider and for which the. Pyrexia of unknown origin puo is defined as fever of 38. Pediatricians often confuse fever without a source and fever of unknown origin. Fever of unknown origin fuo can be caused by many clinical conditions and remains a diagnostic challenge in clinical. Department of pediatrics, division of general pediatrics and adolescent medicine, university of north carolina school of medicine, chapel hill, nc. Yield of bone marrow examination in diagnosing the source of fever of unknown origin. 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. Fever without an identifiable cause fever of unknown origin fuo. Fever of unknown origin in children world journal of pediatrics. The primary studies determining the causes of prolonged fever in children were performed 4 decades ago, before major advances in laboratory and diagnostic testing. We identified diseases that should be considered and useful diagnostic testing in patients with fuo. Fever of unknown origin in children can signal the presence of a range of disorders, from infectious to oncologic.
These fevers may be caused by more unusual illnesses rheumatologic, oncologic. However, the cause is still usually infection, most often viral. A comprehensive evidencebased approach to fever of. 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. American academy of pediatrics textbook of pediatric care, 2nd edition. Fever for 3 wk with no identified cause after 3 days of hospital evaluation or. Prolonged fever of unknown origin in children jama. Educational gap pediatricians often confuse fever without a source and fever of unknown origin. Pyrexia of unknown origin history taking geeky medics. The issue of fu0 in pediatrics is rather hazy and still represents a challenging diagnostic dilemma. Etiology and clinical characteristics of fever of unknown. The primary studies determining the causes of prolonged. We recently cared for a patient who presented with a 3week history of fever. The value of 18ffdgpetct in identifying the cause of fever of unknown origin fuo and inflammation of unknown origin iuo.
Professor and director, university of florida center for hivaids research, education and service, jacksonville, fl. Fever is a common symptom of many clinical conditions, and infection is the most common cause, especially 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. However, the increased availability of rapid diagnostic testing has shortened the period of time before which standard fuo etiologies are seriously considered. Four days ago, she developed a prominent bump on the left side of her neck. Evaluation of fever of unknown origin fuo in children requires documentation of fever in the medical setting and repetitive reassessment of history and physical. It is wellknown that the most common causes of pediatric fuo are infectious diseases. Fever of unknown origin introduction with polyarthritis. Fever of unknown origin fuo is a wellknown pediatric presentation. 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. Fever for 2 to 3 weeks, without a known cause after initial investigations.
The term fuo is best reserved for children with a fever documented by a health care provider and. 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. Fever of unknown origin with polyarthritis imedpub. Fever and neutropenia in pediatric patients with cancer.
Fever in infants and children pediatrics merck manuals. Of these, 40 were found to have serious or lethal diseases, 48 had essentially. Background fever of unknown origin fuo is defined as a temperature higher than 38. Clinical approach to fever of unknown origin in children.
Fever of unknown origin american academy of pediatrics. Some common causes of fever in children include localized or generalized infection, connective tissue disease, and cancer. Pdf clinical approach to fever of unknown origin in children. Pediatric fever without a source emergency medicine. Pediatric fever of unknown origin american academy of. Etiology and clinical characteristics of fever of unknown origin in. She has already undergone blood and urine testing, as well as chest radiography, but no source for her fever has been identified. Pediatrics fever of unknown origin no standard definition in children reasonable definition. Fever is a common presenting complaint in children, accounting for nearly onethird of pediatric outpatient visits in the united states. Normal body temperature the hypothalamus is the heatregulating center of the body the normal body temperature ranges from 37.
In the prepneumococcal vaccine era, even after a thorough history and physical examination, a source of infection was not identi. Research article etiology and resource use of fever of unknown origin in hospitalized children james w. Nosocomial puo in hospital patients with fever of 38. 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. 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. Fever is one of the most common symptoms in children. Aspiration yielded peptostreptococcus asaccharolyticus.
Key questions to ask in the history in children with fever without an apparent source. Renal abscess is uncommon in pediatrics and is rarely a cause of fever of unknown origin. Research on fuo in japan has been limited to single medical institution or region, and no nationwide study has been conducted. Etiology and resource use of fever of unknown origin in.
Clinical policy for wellappearing infants and children. Objective after completing this article, readers should be able to. Background fever of unknown origin fuo continues to challenge clinicians to determine an etiology and the need for treatment. Nevertheless, fuo remains a challenging clinical problem for even the most astute clinician. Fever of unknown origin fuo was defined in 1961 by petersdorf and beeson as the following. Fever of unknown origin pinpointing the culprit fatima ignacio gimenez, md pediatric infectious disease. Fever without a source, or fever without a focus, has the following criteria. An indium scan ultimately led to the diagnosis of a renal abscess. 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. Fever of unknown origin fuo is a relatively uncommon condition in united states children. Fever of unknown origin in childhood pediatric clinics of north.
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