Clinical significance of historical findings* in children with fever of unknown origin^¶

Fever history	Potential significance
What is the fever pattern?	Refer to UpToDate topic on FUO in children for details
Is the fever associated with ill-appearance or symptoms (eg, malaise)?	Absence of malaise or other generalized symptoms with high fever may suggest factitious fever
Persistence of constitutional symptoms after fever abates?	Persistence is worrisome for systemic disease
Is there associated sweating with fever?	Yes: Hyperthyroidism No: Ectodermal dysplasia
Is there associated sweating with defervescence?	No: Factitious fever
Associated complaints	Possible cause(s)
Red eyes	Kawasaki disease Leptospirosis Tuberculosis Infectious mononucleosis Tularemia
Nasal discharge	Rhinosinusitis
Recurrent pharyngitis with ulcerations	PFAPA syndrome
Gastrointestinal complaints	Salmonellosis Intra-abdominal abscess Hepatic cat scratch disease Inflammatory bowel disease Leptospirosis
Limb or bone pain	Brucellosis Leukemia Lymphoma Osteomyelitis Infantile cortical hyperostosis Kikuchi-Fujimoto disease
Exposures	Possible cause(s)/potential significance
Medications (prescription or nonprescription, including topical agents)	Drug fever
Surgery	Abdominal surgery: Intra-abdominal abscess Tracheotomy or gastric tube, cochlear implant or other implantable devices: Expanded list of potential pathogens
Ill-contacts	FUO is usually caused by unusual presentations of common illnesses
Travel history, extending back to birth (including tick and insect exposure)	Endemic pathogens, for example: Histoplasmosis Coccidioidomycosis Blastomycosis Leishmaniasis Malaria Tuberculosis Typhoid fever
Animals (household pets, domestic animals, or wild animals)	Refer to UpToDate topics on zoonoses for details
Ticks	Rocky Mountain spotted fever Human ehrlichiosis or anaplasmosis Tularemia Tick-borne relapsing fever Lyme disease
Mosquitos	Arboviruses (eg, West Nile virus)
Sand flies	Leishmaniasis
Diet	Game meat: Toxoplasmosis, tularemia Raw/undercooked meat: Tularemia, brucellosis Raw shellfish: Hepatitis
Pica (specifically eating dirt)	Visceral larva migrans Toxoplasmosis
Ethnic or genetic background	Possible cause
Ulster Scot individuals	Nephrogenic diabetes insipidus
Turkish, Armenian, North African Jewish, Arabian individuals	Familial Mediterranean fever^Δ
Ashkenazi Jewish individuals	Familial dysautonomia

FUO: fever of unknown origin; PFAPA: periodic fever, aphthous stomatitis, pharyngitis, and adenitis.

* Repeating the history on multiple occasions and rephrasing questions may be necessary to elicit important information. Repeating the history may help the patient or parent remember information that was omitted, forgotten, or deemed unimportant in the initial history.

¶ We define FUO as fever >38.3°C (101°F) for ≥8 days.

Δ Familial Mediterranean fever is not restricted to these ethnic/racial groups.

Graphic 111286 Version 4.0

خرید پکیج

Clinical significance of historical findings* in children with fever of unknown origin¶

Clinical significance of historical findings* in children with fever of unknown origin^¶