Prolonged fever of unknown cause
A fever without apparent cause
that has persisted for >21 days is defined as ‘prolonged fever of unknown
cause’. An explanation is found eventu-ally in the majority of cases. One-third
of these will be infectious, and the remaining due to other causes, e.g.:
•
Rheumatological: juvenile rheumatoid arthritis,
systemic lupus eythematosus,
rheumatic fever, vasculitis; periodic fever syndromes.
•
IBD.
•
Malignancy.
•
Drug fever.
•
Factitious illness.
A thorough history and examination
are required. Also consider other fac-tors such as travel, geography, age, and
significant exposures. Appropriate investigations include:
•
Blood: FBC, CRP, ESR, LFTs and renal
function tests, albumin.
•
Serology: CMV, EBV, brucella, and Q fever.
•
Culture: at least 3 serial adequate volume
blood cultures, urine culture, stool
culture, and consider need for lumbar puncture and bone marrow culture.
•
Imaging: of sinuses in the older child and
CXR.
•
Bone scan or MRI: to exclude osteomyelitis.
•
Echocardiography: to exclude endocarditis.
•
Skin and blood tests: for TB and blood test for HIV after counselling.
•
Antibiotics: these are best avoided until a
site of infection has been found.
However, in many cases they will have been prescribed already. Remember that
antibiotics may be the drug agent causing fever. If the child is critically ill
then empiric antibiotics are given.
•
Antipyretics: these are best avoided during the
period of assessment of fever. For
example, blood cultures should be taken when the patient is febrile. One can
also determine whether there is a specific pattern to the fever.
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