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Fever of Unknown Origin (FUO) in childrens

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 two pediatric cases of FUO caused by Angiostrongylus cantonensis acquired in Houston, Texas, outside of its usual geographic distribution.
August 30, 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...
October 9, 2015: 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...
January 30, 2015: 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
Anna Pirker, Matthias Pirker
Fever is one of the most common reasons for encounter in pediatrics. This article gives information on how to judge the condition of a feverish child or infant correctly: Special emphasis should be put on the general condition of the patient and the clinical course of symptoms over time. With a few skills and tools severe pitfalls can be avoided. General practitioners administer antibiotics in febrile children more often than pediatricians do. The decision of giving antibiotics in an ambulatory setting should not exclusively be based on elevated inflammatory markers in the blood without a sufficient clinical proof of bacterial infection...
January 2015: Therapeutische Umschau. Revue Thérapeutique
Nary Ly, Rafal Tokarz, Nischay Mishra, Stephen Sameroff, Komal Jain, Agus Rachmat, Ung Sam An, Steven Newell, Dustin J Harrison, W Ian Lipkin
BACKGROUND: Fevers of unknown origin constitute a substantial disease burden in Southeast Asia. In majority of the cases, the cause of acute febrile illness is not identified. METHODS: We used MassTag PCR, a multiplex assay platform, to test for the presence of 15 viral respiratory agents from 85 patients with unexplained respiratory illness representing six disease clusters that occurred in Cambodia between 2009 and 2012. RESULTS: We detected a virus in 37 (44%) of the cases...
2014: Virology Journal
Fraia Melchionda, Stefania Varani, Filomena Carfagnini, Tamara Belotti, Trentina Di Muccio, Roberto Tigani, Rosalba Bergamaschi, Andrea Pession
BACKGROUND: Visceral leishmaniasis (VL) is a severe disease caused by Leishmania infantum in the Mediterranean basin, and is associated with considerable morbidity and mortality. Infantile VL may begin suddenly, with high fever and vomiting, or insidiously, with irregular daily fever, anorexia, and marked splenomegaly. Delays in diagnosis of VL are common, highlighting the need for increased awareness of clinicians for VL in endemic European countries. CASE PRESENTATION: We report 4 cases of young children in northern Italy presenting with persistent fever of unknown origin and diagnosed with VL by serological and molecular methods...
2014: BMC Infectious Diseases
Emmanuel Ameyaw, Samuel B Nguah, Daniel Ansong, Iain Page, Martine Guillerm, Imelda Bates
BACKGROUND: Over-diagnosis of malaria among African children results in mismanagement of non-malaria infections. Limited laboratory capacity makes it difficult to implement policies that recommend pre-treatment confirmation of infections so a new approach with a package for on-the-spot management of fevers was evaluated. METHODS: Febrile children presenting to outpatient clinic were randomized to receive either a 'test-treat' package (history with clinical examination; point-of-care tests; choice of artesunate-amodiaquine, co-amoxiclav and/or paracetamol) or routine outpatient care in a secondary health care facility in Kumasi, Ghana...
2014: Malaria Journal
J F Moreau, John A Ozolek, P Ling Lin, Todd D Green, Elaine A Cassidy, Veena L Venkat, Andrew R Buchert
Chronic granulomatous disease (CGD) is a rare inherited immunodeficiency syndrome that results from abnormal nicotinamide adenine dinucleotide phosphate (NADPH) oxidase function. This defect leads to recurrent catalase-positive bacterial and fungal infections as well as associated granuloma formation. We review the case of a 2-year-old boy who presented with ascites and fever of an unknown origin as manifestations of CGD. Cultures were negative for infection throughout his course, and CGD was suspected after identification of granulomas on peritoneal biopsy...
2013: Case Reports in Immunology
Rita van den Tooren-de Groot, Mark Ottink, Elly Huiskes, André van Rossum, Bibian van der Voorn, Jennichjen Slomp, Masja de Haas, Leendert Porcelijn
AIM: The aim of this study was to provide an overview of foetal/neonatal alloimmune neutropenia (FNAIN), together with advice on the clinical management. METHODS: Neutrophil serology in the Netherlands is centralised at Sanquin Diagnostic Services. We examined FNAIN cases between January 1, 1991, and July 1, 2013, to determine the number of cases diagnosed, the relationship with human neutrophil antigen (HNA) antibody, the clinical presentation and therapeutic interventions...
November 2014: Acta Paediatrica
Weimin Zhou, Xinyi Tan, Yamin Li, Wenjie Tan
BACKGROUND: Few reports have examined the viral aetiology of fever of unknown origin (FUO). OBJECTIVE: This study determined the prevalence of human herpes virus (HHV) DNA in blood of Chinese patients with classic FUO using the polymerase chain reaction (PCR) and explored the possible role of HHV. STUDY DESIGN: Blood samples were collected from 186 patients (151 children, 35 adults) with classic FUO and 143 normal individuals in Beijing during the years 2009-2012...
2014: PloS One
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