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Fever of Unknown Origin (FUO) in childrens

Gleice Clemente, Clovis A Silva, Silvana B Sacchetti, Virginia P L Ferriani, Sheila K Oliveira, Flavio Sztajnbok, Blanca E R G Bica, André Cavalcanti, Teresa Robazzi, Marcia Bandeira, Maria Teresa Terreri
Juvenile-Takayasu arteritis (j-TA) is a difficult diagnosis and some patients develop uncommon manifestations and associated diseases that may contribute to the delayed diagnosis. Our aim was to identify the misdiagnoses, the associated diseases and the atypical manifestations observed in a j-TA Brazilian multicentre study. 71 children and adolescents who met the classification criteria for j-TA were included. The misdiagnoses, the associated diseases and the atypical manifestations were evaluated. 19 (26.8%) patients had misdiagnoses...
April 23, 2018: Rheumatology International
James W Antoon, David C Peritz, Michael R Parsons, Asheley C Skinner, Jacob A Lohr
BACKGROUND: Fever of unknown origin (FUO) is a well-known pediatric presentation. The primary studies determining the causes of prolonged fever in children were performed 4 decades ago, before major advances in laboratory and diagnostic testing. Given that the distribution of diagnosed causes of adult FUO has changed in recent decades, we hypothesized that the etiology of FUO in children has concordantly changed and also may be impacted by a definition that includes a shorter required duration of fever...
March 2018: Hospital Pediatrics
Christopher J Palestro, Charito Love
Fever of unknown origin, or FUO, is a challenging condition for patients and clinicians. In up to 50% of cases no diagnosis is established. Patient workup begins with comprehensive history, physical examination and laboratory tests. Radionuclide imaging has been a second-line procedure. Gallium-67 citrate, which accumulates in infection, inflammation, and tumor, was for many years, the radionuclide test of choice in the workup of FUO. The 24-72 hours between injection and imaging, relatively high radiation dose to patients, and suboptimal image quality are significant disadvantages; imaging results are variable...
November 29, 2017: Current Pharmaceutical Design
Nathanial Nolan, Umme-Aiman Halai, Hariharan Regunath, LPatrick Smith, Christian Rojas-Moreno, William Salzer
Primary Cytomegalovirus (CMV) infection is often not suspected as a cause of fever of unknown origin (FUO) in immune-competent adults. We present a case-series of symptomatic primary CMV infection in immunocompetent adults presenting as fever of unknown origin (FUO). All patients with CMV serology tested between November 2008 and June 2016 underwent chart review. Cases were defined as those between 18 and 65 years of age with documented fever and elevated serum anti-CMV IgM. Exclusion criteria were organ specific CMV disease, positive serum anti-EBV IgM, or presence of any immunocompromising condition...
2017: IDCases
Yi-Seul Kim, Kyung-Ran Kim, Ji-Man Kang, Jong-Min Kim, Yae-Jean Kim
PURPOSE: Fever is one of the most common symptoms in children. In previous studies, infectious disease was the most common cause of pediatric fever of unknown origin (FUO). The aim of this study is to investigate the etiology, clinical characteristics and prognosis of pediatric FUO in 21 century with more diagnostics available and to analyze the factors for certain disease categories. METHODS: Among the children under 18 years old who were hospitalized at Samsung Medical Center from January 2000 to December 2014, the patients who met the criteria including fever of ≥38...
March 2017: Korean Journal of Pediatrics
Fernando Martín Del Valle, Cristina Calvo, Inés Martinez-Rienda, Amaia Cilla, María P Romero, Ana Isabel Menasalvas, Leticia Reis-Iglesias, Diana Roda, María J Pena, Nuria Rabella, María Del Mar Portugués de la Red, Gregoria Megías, Antonio Moreno-Docón, Almudena Otero, María Cabrerizo
INTRODUCTION: Human parechovirus (HPeV) is one of the recently described picornaviridae viruses that have been associated with fever of unknown origin (FUO), clinical sepsis, gastroenteritis, meningitis, or encephalitis in very young infants. The aim of this study is to describe the epidemiology and clinical features of these viruses. PATIENTS AND METHODS: A prospective multicentre 3-year study was conducted in 12 hospitals in Spain. Out of 850 specimens examined, 47 were positive (5...
March 29, 2017: Anales de Pediatría: Publicación Oficial de la Asociación Española de Pediatría (A.E.P.)
Michael J Chusid
Childhood fever of unknown origin (FUO) is most often related to an underlying infection but can also be associated with a variety of neoplastic, rheumatologic, and inflammatory conditions. Repeated, focused reviews of patient history and physical examination are often helpful in suggesting a likely diagnosis. Diagnostic workup should be staged, usually leaving invasive testing for last. Advances in molecular genetic techniques have increased the importance of these assays in the diagnosis of FUO in children...
February 2017: Pediatric Clinics of North America
E Rossi, A Perrone, D Narese, M Cangelosi, S Sollai, A Semeraro, M Mortilla, C Defilippi
Cat-scratch disease (CSD) is a zoonosis in children, result of infection by Bartonella henselae, a gram-negative bacillus. Infection is generally characterized by regional and self-limited lymphadenopathy after exposure to a scratch or bite from a cat. Rarely, B. henselae is cause of fever of unknown origin (FUO), with dissemination to various organs, most often involving the reticuloendothelial system (liver, spleen, bone marrow), mimicking an inflammatory rather than a lymphoproliferative disease. Whole-body Magnetic Resonance Imaging (WBMRI), in association with diffusion-weighted imaging (DWIBS), allows a comprehensive evaluation of pediatric patients, without the risks inherent to ionizing radiation...
July 2016: La Clinica Terapeutica
Catherine E Foster, Erin G Nicholson, Angela C Chun, Maya Gharfeh, Sara Anvari, Filiz O Seeborg, Michael A Lopez, Judith R Campbell, Lucila Marquez, Jeffrey R Starke, Debra L Palazzi
Fever of unknown origin (FUO) in children is frequently caused by infectious diseases. Angiostrongylus cantonensis, while a primary cause of eosinophilic meningitis, is rarely a cause of FUO. We present 2 pediatric cases of FUO caused by Angiostrongylus cantonensis acquired in Houston, Texas, outside its usual geographic distribution.
December 1, 2016: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
Sarah S Long
The incidence and likely causes of fever of unknown origin (FUO) have changed over the last few decades, largely because enhanced capabilities of laboratory testing and imaging have helped confirm earlier diagnoses. History and examination are still of paramount importance for cryptogenic infections. Adolescents who have persisting nonspecific complaints of fatigue sometimes are referred to Pediatric Infectious Diseases consultants for FUO because the problem began with an acute febrile illness or measured temperatures are misidentified as "fevers"...
July 5, 2016: Journal of Infection
Ya-Li Chien, Fang-Liang Huang, Chung-Ming Huang, Po-Yen Chen
BACKGROUND/PURPOSE: Fever of unknown origin (FUO) can be caused by many clinical conditions and remains a diagnostic challenge in clinical practice. The etiology of FUO varies markedly among different age groups, geographic areas, and seasons. A four-stage investigative protocol for FUO is widely applied in clinical practice. The aim of this study was to evaluate the usefulness of this four-stage protocol for identifying the etiology of FUO in children. METHODS: We enrolled children younger than 18 years of age who were admitted to the Taichung Veterans General Hospital during the period from January 2006 to December 2014 with FUO persisting for more than 3 weeks...
December 2017: Journal of Microbiology, Immunology, and Infection, Wei Mian Yu Gan Ran za Zhi
Dan Zhu, Yanling Zhang, Xuemei Zhong, Xin Ma, Huijuan Ning, Yang Yang
OBJECTIVE: To present six cases of Brucella infection in children, analyze the characteristics of the disease, diagnostic and therapeutic process. METHOD: The clinical manifestations, laboratory test results and diagnostic process of 6 confirmed cases of brucellosis seen between 2011-2012 were retrospectively analyzed and domestic and foreign literature was reviewed. RESULT: All the 6 children had a history of either exposure to, travelling to endemic area, or consuming infected lamb/beef...
June 2015: Zhonghua Er Ke za Zhi. Chinese Journal of Pediatrics
Metin Demirkaya, Deniz Tugcu, Arzu Akcay, Gönül Aydogan, Ferhan Akıcı, Zafer Salcioglu, Hakan Ekmekci, Betül Sevinir, Ozlem Balci Ekmekci
In this study, we aimed to determine serum adrenomedullin levels and compare them with levels of C-reactive protein (CRP) and procalcitonin (PCT). Cancer patients aged 0-18 years who experienced febrile neutropenia attacks were included in the study. Adrenomedullin, CRP, and PCT were analyzed at admission, day 3, and days 7-10 later. Fifty episodes of febrile neutropenia that developed in 37 patients were analyzed in this study. The mean age of the patients was 7.5 ± 4.7 (1-18) years. The patients had leukemia (73%), solid tumors (19%), and lymphoma (8%)...
2015: Pediatric Hematology and Oncology
Ching-Yi Cho, Chou-Cheng Lai, Ming-Luen Lee, Chien-Lun Hsu, Chun-Jen Chen, Lo-Yi Chang, Chiao-Wei Lo, Sheng-Fong Chiang, Keh-Gong Wu
BACKGROUND: Fever of unknown origin (FUO) was first described in 1961 as fever >38.3°C for at least 3 weeks with no apparent source after 1 week of investigations in the hospital. Infectious disease comprises the majority of cases (40-60%). There is no related research on FUO in children in Taiwan. The aim of this study is to determine the etiologies of FUO in children in Taiwan and to evaluate the relationship between the diagnosis and patient's demography and laboratory data. METHODS: Children under 18 years old with fever >38...
February 2017: Journal of Microbiology, Immunology, and Infection, Wei Mian Yu Gan Ran za Zhi
Norimasa Tada, Eriko Tanaka, Yaeko Motoyoshi
A 14-year-old boy was admitted to a general hospital because of prolonged fever of unknown origin. After Enterococcus feacalis was detected from his urine and abdominal contrast enhanced computed tomography and 99m-Tc dimercaptosuccinic acid scintigram showed multiple focal defects, he was diagnosed as acute focal bacterial nephritis (AFBN). His condition recovered as a result of Ampicillin (ABPC)and Cefotaxime infusion. There was no specific finding in voiding cystography. Six months later, his fever recurred and he was diagnosed as refractory AFBN because Enterococcus feacalis was detected in his urine again...
2015: Nihon Jinzo Gakkai Shi
Benedikt Horn
Patients with fever and rash/exanthema generally are "small emergencies", rarely needing emergency transport or intensive care in a hospital. Low experience of most parents and doctors (who never have seen Measles, Rubella or Varicella) result in non-necessary extensive laboratory tests (e.g. PCR in Meales), while looking for Koplik-Sport is even not mentioned in official guidelines. "Red flags" such as Petechia, Erysipela, necrotizing faszilitis or severe allergic reaction warrant, that "fever and exanthema" remains a permanent challenge for doctors on duty...
January 2015: Therapeutische Umschau. Revue Thérapeutique
Rajeshwar Dayal, Dipti Agarwal
Fever is the most common symptom in children and can be classified as fever with or without focus. Fever without focus can be less than 7 d and is subclassified as fever without localizing signs and fever of unknown origin (FUO). FUO is defined as a temperature greater than 38.3 °C, for more than 3 wk or failure to reach a diagnosis after 1 wk of inpatient investigations. The most common causes of FUO in children are infections, connective tissue disorders and neoplasms. Infectious diseases most commonly implicated in children with FUO are salmonellosis, tuberculosis, malaria and rickettsial diseases...
January 2016: Indian Journal of Pediatrics
Si-Dan Li, Yong-Bing Chen, Zhi-Gang Li, Run-Hui Wu, Mao-Quan Qin, Xuan Zhou, Jin Jiang, Rui-Dong Zhang, Jing Xie, Xiao-Li Ma, Rui Zhang, Bin Wang, Ying Wu, Hu-Yong Zheng, Min-Yuan Wu
BACKGROUND: Infections remain a major cause of therapy-associated morbidity and mortality in children with acute lymphoblastic leukemia (ALL). METHODS: We retrospectively analyzed the medical charts of 256 children treated for ALL under the CCLG-2008 protocol in Beijing Children's Hospital. RESULTS: There were 65 infectious complications in 50 patients during vincristine, daunorubicin, L-asparaginase and dexamethasone induction therapy, including microbiologically documented infections (n = 12; 18...
February 20, 2015: Chinese Medical Journal
N Kacenelenbogen
In general medicine, a febrile state is involved in one pediatric consultation out of three. Whenever he encounters a child with a fever of 38 degrees C or more without any other symptoms, the stake for the family doctor will be to detect a severe bacterial infection (SBI), which would need to be monitored in a pediatric emergency unit, while in 99% of the cases, it will be a benign pathology only requiring simple measures. Based on a review of recent publications, this summary paper provides a decision-making algorithm on the basis of factors readily available in first line care, such as the child's age, his personal history, environment, the intensity and duration of the fever, the possible presence of dyspnea, the level of parental concern and the physician's clinical impression...
September 2014: Revue Médicale de Bruxelles
Petra Dytrych, Petra Krol, Dytrych Petra, Krol Petra, Michaela Kotrova, Daniela Kuzilkova, Kotrova Michaela, Kuzilkova Daniela, Petr Hubacek, Ladislav Krol, Hubacek Petr, Krol Ladislav, Rami Katra, Ondrej Hrusak, Katra Rami, Hrusak Ondrej, Zdenek Kabelka, Pavla Dolezalova, Kabelka Zdenek, Dolezalova Pavla, Tomas Kalina, Eva Fronkova, Kalina Tomas, Fronkova Eva
PURPOSE: PFAPA syndrome is a benign, recurrent inflammatory disease of childhood. Tonsillectomy is one of the therapeutic options with a yet unexplained biological mechanism. We tested whether specific lymphocyte subsets recruited from blood to human tonsils participate in PFAPA pathogenesis. METHODS: Paired tonsils/peripheral blood (PB) samples were investigated (a) from children with PFAPA that successfully resolved after tonsillectomy (n=10) (b) from children with obstructive sleep apnoea syndrome as controls (n=10)...
May 2015: Molecular Immunology
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