Fever of Unknown Origin in Children: Approach and Management

Abstract

Fever of Unknown Origin in Children:  Approach and Management

Taweewong         Tantracheewathorn        MD

*Department of Medicine, BMA Medical College and Vajira Hospital

Fever of unknown origin (FUO) is a troublesome medical problem and occurs frequently in pediatric patients.  Although there are various definitions of FUO in children, the definition recently used by many experts is "fever for more than 7 days which the initial history, physical examination and laboratory evaluation fail to reveal a cause".  The causes of FUO are common diseases with unusual or incomplete manifestations rather than rare diseases.  The three most common causes are infectious diseases, collagen vascular diseases and malignancy respectively.  The principles for management are thorough history taking and physical examination.  The initial laboratory tests in all patients should include CBC with peripheral blood smear, urine examination, chest x-ray, hemoculture, erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) and tuberculin test. If the diagnosis can't be done by the preliminary data, periodic reassessments are helpful for the correct diagnosis.  The extent of laboratory investigation depends on history and physical examination, and should be directed toward the most likely diagnostic possibilities.  The importance in evaluating FUO is to identify patients with serious or life-threatening causes which delayed in diagnosis and treatment could increase morbidity and mortality. However, the prognosis of pediatric FUO is better than adult and the mortality rate is about 2.5-17.0%.

Key word: fever, fever of unknown origin, children

Vajira Med J 2006 ; 50 : 203 - 213