Fever of unknown origin in children: Etiology
- Debra L Palazzi, MD, MEd
Debra L Palazzi, MD, MEd
- Associate Professor of Pediatrics, Infectious Diseases Section
- Baylor College of Medicine
- Section Editors
- Morven S Edwards, MD
Morven S Edwards, MD
- Section Editor — Pediatric Infectious Diseases
- Professor of Pediatrics
- Baylor College of Medicine
- Robert Sundel, MD
Robert Sundel, MD
- Section Editor — Pediatric Rheumatology
- Associate Professor of Pediatrics
- Harvard Medical School
- Jan E Drutz, MD
Jan E Drutz, MD
- Section Editor — General Pediatrics
- Professor of Pediatrics
- Baylor College of Medicine
Fever is a common presenting complaint in children, accounting for nearly one-third of pediatric outpatient visits in the United States . 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 . Although the original definition has been modified, the assessment of broad categories of illness (including infections, connective tissue disease, and malignancy) as a cause of FUO remains useful.
Common etiologies of FUO in children will be discussed below. The approach to the child with FUO, FWS, and fever in unique host groups (eg, newborns, neutropenic children, or those with human immunodeficiency virus [HIV] infection) are discussed separately. (See "Fever of unknown origin in children: Evaluation" and "Fever without a source in children 3 to 36 months of age".)
We apply the term fever of unknown origin (FUO) to children with fever >38.3ºC (101ºF) of at least eight days' duration, in whom no diagnosis is apparent after initial outpatient or hospital evaluation that includes a careful history and physical examination and initial laboratory assessment. (See "Fever of unknown origin in children: Evaluation", section on 'Definitions'.)
The number of infectious and noninfectious etiologies of fever of unknown origin (FUO) in children is extensive (table 1). FUO is usually caused by common disorders, often with an unusual presentation [3-13].
The three most common etiologic categories of FUO in children in order of frequency are infectious diseases, connective tissue diseases, and neoplasms [3-14]. In addition, there are causes of FUO, such as drug fever, factitious fever, central nervous system dysfunction, and others, that do not fit into the above categories. In many cases, a definitive diagnosis is never established and fever resolves.
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- GENERALIZED INFECTIONS
- Cat scratch disease
- Viral infections
- LOCALIZED INFECTIONS
- Bone and joint
- Infective endocarditis
- Intraabdominal abscess
- Hepatic infection
- Upper respiratory tract infection
- Urinary tract infection
- RHEUMATOLOGIC DISEASES
- Juvenile idiopathic arthritis
- OTHER CAUSES
- Central nervous system dysfunction
- Diabetes insipidus
- Drug fever
- Factitious fever
- Familial dysautonomia
- Hemophagocytic lymphohistiocytosis
- Infantile cortical hyperostosis
- Inflammatory bowel disease
- Kawasaki disease
- Kikuchi disease
- Periodic fevers
- INFORMATION FOR PATIENTS