Clinico-epidemiological aspects of fever of unknown origin in children: tertiary hospital study

Abstract

Background Fever of unknown origin (FUO) is one of the most complex diagnostic quandaries in infectious diseases and tropical medicine. When treating patients having prolonged opaque fever, clinicians should base their diagnostic decisions on the frequency distribution of the illnesses that cause FUO. Patients reported with FUO are extremely given unnecessary excessive investigations and antimicrobial treatments, making FUO a difficult problem in clinical practice. There is no gold standard protocol for establishing the cause of FUO. Aim The aim of the current study was to determine the common causes of fever of unknown origin in children and its prevalence according to demographic data which may guide the pediatricians to narrow the diagnostic approach and the priority of work-up. Patients and methods This was an observational retrospective study conducted on a total of 134 children aged 1 to 17 years old, of both sexes admitted at Mansoura University Children’s Hospital (MUCH) from January 2015 to December 2020 and fulfilling the FUO definition (Classic FUO is as fever with a body temperature greater than and equal to 38.3°C for at least 3 weeks duration with a failure to reach a diagnosis after 1 week of inpatient investigations. Results Total 134 patients were identified. Confirmed diagnosis was attained in 108 patients (80.6%). Among them, infectious diseases (n=50, 37.3%) were the most common, followed by collagen vascular diseases (n=15, 11.2%), malignancies (n=10, 7.5%), and miscellaneous (n=33, 24.6%). Whereas 19.4% of cases (n=26, 19.4%) remained undiagnosed. Respiratory infections were the most common among the infectious diseases, juvenile idiopathic arthritis and acute leukemia were common causes of collagen vascular diseases and malignancies, respectively. Conclusion The current study concluded that; infectious diseases were the main cause for fever of unknown origin in children and respiratory infections were the most infectious cause.