Select 5-Minute Pediatrics Topics
Fever of Unknown Origin
Basics
DESCRIPTION
Fever of unknown origin (FUO) implies
- A febrile illness (38.3°C on multiple occasions)
- Present for >14 days
- No apparent source despite careful history taking, physical exam, and preliminary lab studies
ETIOLOGY
- Etiology has changed as the use of more sensitive tests (e.g., MRI, polymerase chain reaction [PCR] tests) permits earlier detection of many conditions that caused FUO in the past.
- Fever resolves in 40–60% of children without identification of a specific cause.
- FUO in the pediatric population is more often an unusual presentation of a common disease than a common presentation of an unusual disease.
- Common infectious causes
- Respiratory infections (otitis media, mastoiditis, sinusitis, pneumonia, pharyngitis, peritonsillar/retropharyngeal abscess)
- Systemic viral syndrome
- Infectious mononucleosis (Epstein-Barr virus [EBV], cytomegalovirus [CMV])
- Urinary tract infection (UTI)
- Bone or joint infection
- Enteric infection (Salmonella, Yersinia enterocolitica, Yersinia pseudotuberculosis, Campylobacter jejuni)
- Cat-scratch disease
- Less common infectious causes
- Tuberculosis (TB)
- Lyme disease
- Rickettsial disease (Rocky Mountain spotted fever, ehrlichiosis, anaplasmosis)
- Malaria
- CNS infection (bacterial or viral meningoencephalitis, intracranial abscess)
- Dental or periodontal abscess
- Subacute bacterial endocarditis (SBE)
- HIV infection
- Human herpes viruses
- Acute rheumatic fever
- Other infectious causes
- Q fever
- Brucellosis
- Toxoplasmosis
- Syphilis
- Parvovirus B19
- Endemic fungi (histoplasmosis, blastomycosis, coccidioidomycosis)
- Psittacosis
- Typhoid (Salmonella spp.)
- Chronic meningococcemia
- Possible noninfectious causes
- Collagen vascular disease (systemic juvenile idiopathic arthritis [JIA], systemic lupus erythematosus, dermatomyositis, sarcoidosis, vasculitis syndrome)
- Malignancy
- Kawasaki syndrome
- Inflammatory bowel disease (IBD)
- Drug fever
- Hyperthyroidism
- Factitious fever or Munchausen syndrome by proxy
- Centrally mediated fever
- Periodic fever syndromes
- Kikuchi-Fujimoto disease (histiocytic necrotizing lymphadenitis)
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Citation
Cabana, Michael D., editor. "Fever of Unknown Origin." Select 5-Minute Pediatrics Topics, 7th ed., Wolters Kluwer Health, 2015. Medicine Central, im.unboundmedicine.com/medicine/view/Select-5-Minute-Pediatric-Consult/14110/1.4/Fever_of_Unknown_Origin.
Fever of Unknown Origin. In: Cabana MDM, ed. Select 5-Minute Pediatrics Topics. Wolters Kluwer Health; 2015. https://im.unboundmedicine.com/medicine/view/Select-5-Minute-Pediatric-Consult/14110/1.4/Fever_of_Unknown_Origin. Accessed October 7, 2024.
Fever of Unknown Origin. (2015). In Cabana, M. D. (Ed.), Select 5-Minute Pediatrics Topics (7th ed.). Wolters Kluwer Health. https://im.unboundmedicine.com/medicine/view/Select-5-Minute-Pediatric-Consult/14110/1.4/Fever_of_Unknown_Origin
Fever of Unknown Origin [Internet]. In: Cabana MDM, editors. Select 5-Minute Pediatrics Topics. Wolters Kluwer Health; 2015. [cited 2024 October 07]. Available from: https://im.unboundmedicine.com/medicine/view/Select-5-Minute-Pediatric-Consult/14110/1.4/Fever_of_Unknown_Origin.
* Article titles in AMA citation format should be in sentence-case
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