Profile of Fever of Unknown Origin in Children and the Role of Investigation: An Observational Study

Authors : P Aparna REDDY, M Shravani REDDY

Pages : 137-143

Doi:10.5799/jmid.657846

View : 8 | Download : 3

Publication Date : 2019-12-15

Article Type : Research Paper

Abstract :ABSTRACT Objectives: Fever of Unknown Origin insert ignore into journalissuearticles values(FUO); in children remains difficult to diagnose. This prospective, observational study aimed to determine the clinico-etiological profile and the role of clinical procedures in establishing the diagnosis. Methods: Children insert ignore into journalissuearticles values(1 month-16 years); with prolonged fever meeting the criteria of FUO were included. A detailed medical history, physical examination and laboratory tests were conducted according to an algorithm insert ignore into journalissuearticles values(phase I-III);. Clinical procedures that were useful in obtaining final etiology were evaluated. Results: In total, 69 children were enrolled, categorized into five groups based on etiology of FUO. Infections insert ignore into journalissuearticles values(31.8%); were the leading cause followed by malignancy insert ignore into journalissuearticles values(20.2%);, connective tissue disorder and miscellaneous conditions insert ignore into journalissuearticles values(14.5%);; undiagnosed patients insert ignore into journalissuearticles values(18.8%); had either a spontaneous resolution or incomplete workup. Duration of fever was 20-60 days, longer in malignancies, least in infections and mean ± SD duration between admission and a definitive diagnosis was 5.65 ± 1.06 days. Tuberculosis was the most common among the infections, systemic onset juvenile idiopathic arthritis and Common acute lymphoblastic leukemia antigen positive B cell acute lymphoblastic leukemia were common causes of connective tissue disorder and malignancy, respectively. The diagnosis was established by Phase II insert ignore into journalissuearticles values(33.3%); and Phase III insert ignore into journalissuearticles values(34.8%); investigations. Non-invasive and invasive investigations were useful in 56.3%, and 43.7 %, respectively. Conclusions: Infections are the most common cause of FUO in children followed by malignancy. A stepwise approach is useful in diagnosis. Infections and connective tissue disorders are diagnosed by non-invasive investigations while malignancy and miscellaneous conditions by invasive investigations. Focused clinical and diagnostic approach is mandated. J Microbiol Infect Dis 2019; 9insert ignore into journalissuearticles values(3);:137-143.
Keywords : Acute lymphoblastic leukemia, algorithm, fever of unknown origin, children