Program Schedule

Characteristics of Patients Referred to a Pediatric Infectious Diseases Clinic with Unexplained Fever

Session: Poster Abstract Session: Diagnostic Microbiology: Blood Culture Methodology/Clinical Utilization
Saturday, October 11, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
  • STATLER_POSTER_14.09.24.pdf (1.4 MB)
  • Background: Case series from the 1970s-90s, focusing on children meeting a priori definitions of fever of unknown origin (FUO), established the classic diagnostic categories of infectious, inflammatory, neoplastic, and miscellaneous conditions. These studies also suggested that the proportion of children with no definitive final diagnosis was increasing over time. Few U.S. studies since then have revisited the FUO construct, and none has provided broader insight into children referred with unexplained fever per se.

    Methods: Patients referred to a pediatric infectious diseases clinic for unexplained fever from 1/1/2008-12/31/2012 were identified in a database of outpatient visits. Records were abstracted for demographic, clinical, and laboratory data, and descriptive analyses were performed. 

    Results: Of 4586 visits, 309 were of unique patients with the terms “fever”, “febrile”, or “FUO” in their diagnosis. After exclusions, 221 remained in the study group. By history, ten patients were not truly having fever. Fifty-nine (27%) were referred with prolonged fever. Of these, 11 had diagnoses that were apparent at initial visit. The remaining 48 patients were classified as having FUO; their median age was 5.6 yr (IQR 2.1-11.1), median duration of reported fever was 30 days (21-60), and 71% reported daily fevers. Fifteen (31%) patients with FUO had a definitive diagnosis established—10 infectious, 3 inflammatory, 1 neoplastic, and 1 miscellaneous. Thirty-three (69%) never had a definitive diagnosis established. Of 152 patients with recurrent fevers, 92 (61%) had an intermittent fever pattern; 84 (91%) of these had no specific diagnosis made or were thought to have sequential, self-limited viral illnesses. Of 60 patients with a periodic fever pattern, 20 were thought to have periodic fever, aphthous stomatitis, pharyngitis, and adenitis (PFAPA) syndrome, 1 had familial Mediterranean fever, and 39 had no specific diagnosis made.

    Conclusion: Most children referred with unexplained fever ultimately had either self-limited illnesses or no specific diagnosis established. Serious diagnoses were unusual, suggesting that such diagnoses rarely present with unexplained fevers alone, or that, when they do, the diagnoses are made by primary care providers or other subspecialists.

    Victoria Statler, MD and Gary S. Marshall, MD, Pediatrics, University of Louisville School of Medicine, Louisville, KY


    V. Statler, None

    G. S. Marshall, None

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