Fever of unknown origin in children: Evaluation
- Debra L Palazzi, MD, MEd
Debra L Palazzi, MD, MEd
- Associate Professor of Pediatrics, Infectious Diseases Section
- Baylor College of Medicine
- Section Editors
- Sheldon L Kaplan, MD
Sheldon L Kaplan, MD
- Editor-in-Chief — Pediatrics
- Section Editor — Pediatric Infectious Diseases
- Professor and Vice Chairman for Clinical Affairs
- 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 "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.
An approach to FUO in children will be reviewed here. Etiologies of pediatric FUO, FWS, and fever in unique host groups (eg, newborns, neutropenic children, or those with human immunodeficiency virus [HIV] infection) are discussed separately. (See "Etiologies of fever of unknown origin in children" and "Fever without a source in children 3 to 36 months of age".)
The term fever of unknown origin (FUO) initially was reserved for adults with fever >38.4ºC (101.2ºF) on at least several measurements over three or more weeks without an established cause after at least one week of investigation in the hospital. This exacting definition probably was never rigorously applied in pediatrics.
We apply the following definitions for FUO and fever without a source (FWS):
●FUO – 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.
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- DIAGNOSTIC APPROACH
- - Fever pattern
- Associated complaints
- Ethnic or genetic background
- General assessment
- Skin and scalp
- Lymph nodes
- DIAGNOSTIC TESTING
- Initial tests
- Additional tests
- - Laboratory tests
- - Imaging
- Other evaluations
- EMPIRICAL TREATMENT
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS