Broad laboratory testing is often more harmful than helpful. Adopt a systematic approach to evaluation and management of fever of unknown origin in patients of various ages. The history needs to include details of immunisations. The history and physical are the foundation for your ddx development and subsequent testing strategy. Fever of unknown origin american academy of pediatrics. Fever of unknown origin is an important diagnostic challenge in pediatrics that requires a thoughtful approach. 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. Normal body temperature the hypothalamus is the heatregulating center of the body the normal body temperature ranges from 37. Pyrexia of unknown origin pyrexia of unknown origin britton, philip n 201201 00. Objective fever of unknown origin fuo can be caused by many diseases, and varies depending on region and time period. Research on fuo in japan has been limited to single medical institution or region, and no nationwide study has been conducted. Fever of unknown origin fuo is a wellknown pediatric presentation.
The definition of pyrexia of unknown origin puo dates back to 1961. 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 fuo was defined in 1961 by petersdorf and beeson as the following. Few clinical problems generate such a wide differential diagnosis as pyrexia fever of unknown origin. Program of microbiology, virology, and infection control, department of pathology and laboratory medicine, british columbias childrens hospital, vancouver, british columbia, canada v6h 3v4. A free powerpoint ppt presentation displayed as a flash slide show on. The differential for fever of unknown origin is vast, but resist the urge to order every test available in your hospital. Pyrexia of unknown origin guideline introduction in the paediatric population, pyrexia of unknown origin puo is described as fever of. Lyme disease presenting as prolonged pyrexia of unknown origin. It has been historically used to describe a subacute presentation of a single illness of at least 3 weeks duration during which a fever 38. 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. It is important to distinguish children with fever without source from children with pyrexia of unknown origin. Clinical approach to fever of unknown origin in children.
Current clinical topics in infectious diseases, remington js, swartz mn eds, blackwell science, boston 1991. The primary studies determining the causes of prolonged fever in children were performed 4 decades ago, before major advances in laboratory and diagnostic testing. The initial definition proposed by petersdorf and beeson in 1961, 1 later revised, is a fever of 38. T here is paucity of recent data on the etiology of fever of unknown origin fuo in indian children. Pyrexia of unknown origin stephen hughes mrcpch phd consultant paediatric immunologist pretest the commonest cause of puo is. Department of pediatrics, the university of british columbia, vancouver. In 1961, petersdorf and beeson described for the first time fever of unknown origin fuo as fever lasting 3 weeks, with temperature higher than 38.
Results for pyrexia in children of unknown origin 1 10 of 71 sorted by relevance date click export csv or ris to download the entire page or use the checkboxes to select a subset of records to download. After completing this article, readers should be able to. Etiology and resource use of fever of unknown origin in. A positron emission tomography scan was performed fig. Of these, 40 were found to have serious or lethal diseases, 48 had essentially. Pediatric fever of unknown origin american academy of. The issue of fu0 in pediatrics is rather hazy and still represents a challenging diagnostic dilemma. Pyrexia of unknown origin, journal of paediatrics and. Puerperal pyrexia is defined as the presence of a fever in a woman, within six weeks of giving birth. The term fuo is best reserved for children with a fever documented by a health care provider and. Fever is a common symptom of many clinical conditions, and infection is the most common cause, especially in children. Fever in infants and children pediatrics merck manuals. This approach is more difficult when the clinical features are few, subtle, or insufficient to characterise a disease or group of diseases.
A case of fever of unknown origin american academy of. Pyrexia of unknown origin puo is defined as fever of 38. Department of pediatrics, division of general pediatrics and adolescent medicine, university of north carolina school of medicine, chapel hill, nc. A comprehensive evidencebased approach to fever of. We identified diseases that should be considered and useful diagnostic testing in patients with fuo.
Etiology of fever of unknown origin in children from. However, the increased availability of rapid diagnostic testing has shortened the period of time before which standard fuo etiologies are seriously considered. American academy of pediatrics textbook of pediatric care, 2nd edition. 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. Pediatricians often confuse fever without a source and fever of unknown origin. A subscription is required to access all the content in best practice. Some common causes of fever in children include localized or generalized infection, connective tissue disease, and cancer.
Enteric fever, pyrexia of unknown origin, tuberculosis. Assessment of fever in children differential diagnosis. Although no precise definition of fever of unknown origin fuo in children is uniformly accepted, the following criteria have been proposed. Fever is a common presenting complaint in children, accounting for nearly onethird of pediatric outpatient visits in the united states. This descriptive study prospectively enrolledconsecutive children aged 3 months to 18 years with fuo presenting to the outpatient department of a tertiary care private hospital. Prolonged fever of unknown origin in children jama. Raghuram takes a look at traditional and new definitions of fuos as well as a practical algorithm for their workup. The term fuo is best reserved for children with a fever documented by a health care provider and for which the. Ppt pyrexia of unknown origin powerpoint presentation. Investigating and managing pyrexia of unknown origin in. Fever for 3 wk with no identified cause after 3 days of hospital evaluation or. Etiological study of fever of unknown origin in patients admitted to medicine ward of a teaching hospital of eastern india.
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. Choose one of the access methods below or take a look at our subscribe or free trial options. Diagnosis often involves pattern recognitionfor example, thyrotoxicosis or rheumatoid arthritis commonly have a constellation of distinctive clinical features and laboratory tests are then done for confirmation. Pyrexia of unknown origin history taking geeky medics.
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