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خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : -12 مورد

Suggested approach to initial laboratory and imaging evaluation for fever of unknown origin in children*

Suggested approach to initial laboratory and imaging evaluation for fever of unknown origin in children*
Diagnostic test Potential significance of results
Complete blood count, differential and smear
  • Anemia: Malaria, tuberculosis, infective endocarditis, JIA, SLE, IBD
  • Cytopenia in ≥1 cell line and/or bizarre or immature WBCs: Leukemia, hemophagocytic lymphohistiocytosis, SLE, Kikuchi-Fujimoto disease
  • Leukocytosis or bandemia: Increased risk of bacterial infection, infective endocarditis, JIA, drug fever, infantile cortical hyperostosis
  • Neutropenia: Tuberculosis, Dengue fever, EBV, CMV, HIV, SLE, leukemia, human granulocytic anaplasmosis
  • Atypical lymphocytes: Viral infections (eg, EBV, CMV), Kikuchi-Fujimoto disease
  • Lymphocytosis: Cat scratch disease, EBV, toxoplasmosis
  • Lymphocytopenia: Brucellosis, malaria, tuberculosis, typhoid fever, HIV, SLE
  • Eosinophilia: Parasitic or fungal infection; allergic disorder; neoplasm; immunodeficiency
  • Thrombocytosis: JIA, Kawasaki disease
  • Thrombocytopenia: EBV, CMV, HIV, parvovirus, varicella, leptospirosis, tularemia, rickettsial infection, SLE, Kikuchi-Fujimoto disease
ESR and CRP
  • Elevated: Nonspecific indication of inflammation; may warrant more rapid evaluation; factitious fever unlikely
  • Normal: Reassuring; evaluation can proceed at deliberate pace; does not exclude noninflammatory conditions (eg, familial dysautonomia, ectodermal dysplasia, etc)
Aerobic and anaerobic blood culturesΔ
  • Bacteremia; infective endocarditis
Urinalysis and urine culture
  • Pyuria and bacteriuria: Urinary tract infection
  • Sterile pyuria: Intra-abdominal infection, genitourinary tuberculosis, Kawasaki disease◊
  • Hematuria and/or proteinuria: Infective endocarditis, leptospirosis, SLE
  • Low specific gravity or osmolality: Diabetes insipidus
Chest radiograph
  • Infiltrate: Pneumonia
  • Lymphadenopathy: Tuberculosis
  • Mediastinal mass: Leukemia, lymphoma, neurogenic tumor, rhabdomyosarcoma
  • Small nodular densities: Leptospirosis
Serum electrolytes, BUN, and creatinine
  • Hypernatremia: Diabetes insipidus, dehydration
  • Hyponatremia: Leptospirosis, tularemia
  • Elevated BUN/Cr: Renal impairment (SLE), dehydration
Hepatic aminotransferases
  • Elevated: Brucellosis, tularemia, hepatitis, JIA, Kikuchi-Fujimoto disease, adenovirus, EBV

FUO: fever of unknown origin; JIA: juvenile idiopathic arthritis; SLE: systemic lupus erythematosus; IBD: inflammatory bowel disease; WBC: white blood cell; EBV: Epstein-Barr virus; CMV: cytomegalovirus; ESR: erythrocyte sedimentation rate; CRP: C-reactive protein; IGRA: interferon gamma release assay; BUN: blood urea nitrogen; Cr: creatinine ratio.

* Additional tests may be indicated if the history, examination, or initial diagnostic tests suggest a diagnosis or diagnoses.

¶ ESR may be lowered artifactually in conditions involving consumption of fibrinogen; ESR may be artifactually raised in hypergammaglobulinemia.

Δ Special media or environmental conditions, or longer incubation, may be necessary for specific pathogens (eg, Brucella, Leptospira, Spirillum).

◊ The white blood cells in Kawasaki disease are monocytic cells; because they are, not polymorphonuclear neutrophils they are not detected by dipstick tests for leukocyte esterase.
Graphic 111287 Version 4.0