scholarly journals Long-term fever in a child: what is the reason, how to examine, treat or not treat?

2020 ◽  
pp. 151-162
Author(s):  
I. N. Zakharova ◽  
I. M. Osmanov ◽  
T. M. Tvorogova ◽  
A. N. Goryainova ◽  
Yu. A. Dmitrieva ◽  
...  
Keyword(s):  
Fever Of Unknown Origin ◽  
Stable Condition ◽  
Unknown Origin ◽  
Deficiency Syndrome ◽  
Kawasaki Syndrome ◽  
Mevalonate Kinase Deficiency ◽  
Clinical Observations ◽  
The Status ◽  
Febrile Condition ◽  
Paediatric Practice

Long unclear fever in children of different ages remains one of the difficult and topical issues in the paediatric practice. Despite up-to-date techniques of laboratory and instrumental examination, verification of prolonged fever causes remains difficult; it cannot be deciphered in 10% of cases. It is especially important to differentiate fever from hyperthermia in paediatric practice. The article provides an overview of the status update on the issue. The mechanisms of fever and hyperthermia are described, criteria for fever of unknown origin are given. It is stated that infectious diseases under the guise of fever of unknown origin develop in 60–70% of children. Systemic connective tissue disease and vasculitis are detected in 20% of cases, hemato-oncological – in 5%, auto-inflammatory – in 5%, the cause of fever remains unknown in 10% of cases. The article provides clinical observations of children with diseases debuting as fever of unknown origin with the following diagnoses: juvenile rheumatoid arthritis (JRA), a systemic variant with high activity (DAS index 28 = 5.1 at the rate of < 2.6); mucocutaneous lymphonodular syndrome (Kawasaki syndrome), damages of cardiovascular system (small coronary artery aneurysms), bacterial-viral infection; auto-inflammatory syndrome – mevalonate kinase deficiency syndrome (hyper-IgD syndrome). Diagnostic approaches to the verification of febrile condition are outlined. It is noted that treatment should not be started in a stable condition of the patient without establishing the cause of the fever, and it is advisable to use only an antipyretic agent with central and peripheral effects, pronounced antipyretic effect, analgesic and anti-inflammatory effects.

scholarly journals A Case Report on Fever of Unknown Origin in a School Going Child– An Uncommon Answer in a Common Question

2018 ◽  
Vol 17 (2) ◽  
pp. 58-63
Author(s):  
Dhan Bahadur Shrestha ◽  
Suju Mool ◽  
Sijan Karki
Keyword(s):  
Escherichia Coli ◽  
Bone Marrow ◽  
Case Report ◽  
Patient Care ◽  
Enteric Fever ◽  
Fever Of Unknown Origin ◽  
Unknown Origin ◽  
Bone Marrow Culture ◽  
Febrile Condition ◽  
Inpatient Department

Fever is one of the commonest complaints in paediatrics outpatient as well as inpatient department. Fever of unknown origin (FUO) is a diagnosis of exclusion given to the febrile condition lasting more than three weeks with temperature 38.30C or more with unknown cause despite of one week in patient care. Here we present a case of FUO in a child which was investigated thoroughly and managed on the line of enteric fever. However, the patient remained febrile. Hence, further investigations were undertaken and finally, bone marrow culture grew a very uncommon organism- Escherichia coli. The child was treated as per the sensitivity and responded well to treatment and was discharged after improvement. Here, we would like to present this case of FUO to highlight the possibility of bone marrow invasion by an uncommon organism as a source of fever in children.

scholarly journals TNFRSF1A gene variant identified in a boy with recurrent episodes of fever

2018 ◽  
Vol 146 (9-10) ◽  
pp. 577-580
Author(s):  
Srdja Jankovic ◽  
Goran Djuricic ◽  
Aleksandra Radosavljevic ◽  
Dragana Janic
Keyword(s):  
Fever Of Unknown Origin ◽  
Periodic Fever ◽  
Tumor Necrosis Factor Receptor ◽  
Unknown Origin ◽  
Recurrent Fever ◽  
Diagnostic Challenge ◽  
Periodic Fever Syndromes ◽  
Tnfrsf1a Gene ◽  
Febrile Condition ◽  
Fever Syndromes

Introduction. Fever of unknown origin is an important diagnostic challenge. Although rare, periodic fever syndromes may often present with a chronic or recurrent febrile condition with a variable temporal pattern of occurrence. Although clinical characteristics often indicate the syndrome in question, there are many atypical forms, and the genotype?phenotype relationship is highly complex, warranting in many cases the designation of a ?syndrome spectrum? rather than a syndrome per se. The aim of this paper was to present a boy with recurrent fever of unknown origin. Case outline. We hereby present a boy with recurrent fever of unknown origin who was by clinically guided partial exome sequencing found to have a heterozygous variant 434A>G in the TNFRSF1A gene, otherwise connected with tumor necrosis factor receptor-associated periodic fever syndrome. The patient responded well to short courses of glucocorticoids and is no longer subjected to unnecessary antibiotic treatment he had frequently received in the past. Conclusion. Periodic fever syndromes should be kept in mind as a differential diagnostic possibility in children with fever of unknown origin.

scholarly journals Clinical course of coxsackievirus B (1-6) infection

2020 ◽  
Vol 17 (1) ◽  
pp. 3-7
Author(s):  
Slađana Pavić ◽  
Marija Antić ◽  
Radmila Sparić ◽  
Aleksandra Pavić
Keyword(s):  
Aseptic Meningitis ◽  
Fever Of Unknown Origin ◽  
Antinuclear Antibodies ◽  
Clinical Course ◽  
Acute Myocarditis ◽  
Clinical Manifestations ◽  
Unknown Origin ◽  
Coxsackievirus B ◽  
Virus Serotype ◽  
Febrile Condition

Objective. Coxsackievirus B (1-6) infections are the common infections of children and adults. Clinical manifestations include fever, aseptic meningitis, pleurodinia, myocarditis, gastroenterocolitis, maculous exanthem. The clinical course of the infection is influenced by the characteristics of the host, as well as the virus serotype. The pathogenesis of the diseases is explained by the immune mediated mechanism and the direct cytotoxic effect of the virus. Methods. Retrospectively analyzed virus serotype, clinical and biochemical data in patients with coxsackievirus B (1-6) infection. Patients who had an unclear febrile condition for more than six months were tested for autoantibodies. Results. We examined a total of 378 patients with coxsackievirus B (1-6) infection (302 women, 76 men), age 19 to 79 years. The dominant symptoms were weakness, elevated body temperature, fatigue and muscle aches. In 55% the clinical course was fever of unknown origin, in 13% myalgia/pleurodinia, 9% acute gastroenterocolitis and acute myocarditis/ pericarditis, 2% aseptic meningitis, 2.4% respiratory disease, 3% acute pancreatitis and 1% diabetes mellitus. Autoantibodies were detected in 69% of patients with fever of unknown origin. Antinuclear antibodies were most common, in 67%. Serotype B2 had 36% of these patients. Serotype B2 had 36% of these patients and serotype B4 had 14%. Conclusion. The most common clinical form of coxsackievirus B (1-6) infection is an fever of unknown origin caused by a B2 serotype of the virus. In most of these patients, an elevated titre of antinuclear antibodies can be detected.

Recommendations for the inclusion of Fabry disease as a rare febrile condition in existing algorithms for fever of unknown origin

2017 ◽  
Vol 12 (7) ◽  
pp. 1059-1067 ◽  
Author(s):  
Raffaele Manna ◽  
◽  
Roberto Cauda ◽  
Sandro Feriozzi ◽  
Giovanni Gambaro ◽  
...  
Keyword(s):  
Fabry Disease ◽  
Fever Of Unknown Origin ◽  
Unknown Origin ◽  
Febrile Condition

Patients with fever of unknown origin (FUO): diagnosis by nuclear medicine imaging

2001 ◽  
Vol 40 (03) ◽  
pp. 59-70 ◽  
Author(s):  
W. Becker ◽  
J. Meiler
Keyword(s):  
Nuclear Medicine ◽  
Fever Of Unknown Origin ◽  
Tumor Imaging ◽  
White Blood Cells ◽  
Unknown Origin ◽  
Final Diagnosis ◽  
Recurrent Fever ◽  
Nuclear Medicine Imaging

SummaryFever of unknown origin (FUO) in immunocompetent and non neutropenic patients is defined as recurrent fever of 38,3° C or greater, lasting 2-3 weeks or longer, and undiagnosed after 1 week of appropriate evaluation. The underlying diseases of FUO are numerous and infection accounts for only 20-40% of them. The majority of FUO-patients have autoimmunity and collagen vascular disease and neoplasm, which are responsible for about 50-60% of all cases. In this respect FOU in its classical definition is clearly separated from postoperative and neutropenic fever where inflammation and infection are more common. Although methods that use in-vitro or in-vivo labeled white blood cells (WBCs) have a high diagnostic accuracy in the detection and exclusion of granulocytic pathology, they are only of limited value in FUO-patients in establishing the final diagnosis due to the low prevalence of purulent processes in this collective. WBCs are more suited in evaluation of the focus in occult sepsis. Ga-67 citrate is the only commercially available gamma emitter which images acute, chronic, granulomatous and autoimmune inflammation and also various malignant diseases. Therefore Ga-67 citrate is currently considered to be the tracer of choice in the diagnostic work-up of FUO. The number of Ga-67-scans contributing to the final diagnosis was found to be higher outside Germany than it has been reported for labeled WBCs. F-l 8-2’-deoxy-2-fluoro-D-glucose (FDG) has been used extensively for tumor imaging with PET. Inflammatory processes accumulate the tracer by similar mechanisms. First results of FDG imaging demonstrated, that FDG may be superior to other nuclear medicine imaging modalities which may be explained by the preferable tracer kinetics of the small F-l 8-FDG molecule and by a better spatial resolution of coincidence imaging in comparison to a conventional gamma camera.

The Changing Etiology of Fever of Unknown Origin in Children

PEDIATRICS ◽  
2016 ◽  
Vol 137 (Supplement 3) ◽  
pp. 355A-355A
Author(s):  
James W. Antoon ◽  
David Peritz ◽  
Michael Parsons ◽  
Jacob Lohr
Keyword(s):  
Fever Of Unknown Origin ◽  
Unknown Origin
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