Etiology and Resource Use of Fever of Unknown Origin in Hospitalized Children
Article Figures & Data
Figures
- FIGURE 1
A, Evolving etiology of pediatric FUO.5–9 FUO definitions are as follows: >38.9°C for >21 days (1972), >38.5°C for >14 days (1975), >38.3°C for >21 days (1977), >38.0°C for >21 days (1991), >38.0°C for >14 days (1998), and >38.0° for >7 days (2017). B, Evolving etiology of FUO >3 weeks.5,6,9 FUO definitions are as follows: >38.9°C for >21 days (1972), >38.3°C for >21 days (1977), >38.0°C for >21 days (1991), and >38.0° for >7 days (2018).
Tables
- TABLE 1
Patient Demographics and Duration of Fever on Admission
Demographic Total n (%) N 102 (100) Age, y 0–5 57 (55.9) 6–10 14 (13.7) >10 26 (25.5) Unknown 5 (4.9) Mean age, y 6.5 Sex Boys 58 (56.9) Race and/or ethnicity White 41 (40.2) African American 24 (23.5) Hispanic 13 (12.8) Other ethnicity 2 (2.0) Unknown ethnicity 22 (21.6) Fever on admission 37 (36.2) Fever during hospital stay 84 (82.4) Complex chronic condition 26 (25.5) Final etiologic category Autoimmune 28 (27.5) Infectious 42 (41.2) Oncologic 18 (17.7) Other or unknown 14 (13.7) - TABLE 2
Categorization of Pediatric FUO Etiologies
Infectious (n = 42) Autoimmune (n = 28) Oncologic (n = 18) Other or Unknown (n = 4/10) Acute bacterial sinusitis Autoimmune disorder of unknown etiology Acute lymphoid leukemia Drug fever Aseptic meningitis Atypical Kawasaki Hepatocellular carcinoma Autonomic instability Bartonella meningitis Bechet’s disease Hemophagocytic lymphohistiocytosis Bartonella osteomyelitis Bechet’s disease with Hughes-Stovin syndrome Macrophage activating syndrome Diskitis Crohn’s disease Unknown C difficile colitis Dermatomyositis Candida albicans infection Erythema multiforme Cytomegalovirus Juvenile idiopathic arthritis Epstein-Barr virus infection Kawasaki disease Empyema Periodic fever syndrome (unspecified) Endocarditis Vasculitis of unknown etiology Enterovirus infection Systemic lupus erythematosus Ehrlichiosis meningitis Gluteal abscess Fungemia Herpes stomatitis Infected brachial cleft cyst Intraabdominal abscess Meningitis Metapneumovirus infection Parapneumonic effusions Pneumonia Pyelophlebitis Septic joint (knee) Staphylococcus infection Tracheitis Viral illness - TABLE 3
Etiologic Category and Duration of Fever (P < .05)
Fever Duration >8–14 d, % >15–21 d, % >21 d, % Total, % Infectious disease 40.0 63.2 34.2 42.2 Autoimmune 33.3 15.8 21.1 25.5 Oncologic 20.0 15.8 15.8 17.7 Other or unknown 6.7 5.3 29.0 14.7 - TABLE 4
Diagnostic Testing by Length of Fever and Etiology
Length of Fever Etiology Total >8–14 d >15–21 d >21 d P Infectious Autoimmune Oncology Other or Unknown P Scans (%) Radiograph 70.59 66.67 57.89 81.58 .134 59.52 75.00 94.44 64.29 .047 Ultrasound 47.06 44.44 63.16 42.11 .290 35.71 64.29 61.11 28.57 .031 CT 7.84 4.44 5.26 13.16 .304 11.90 3.57 0.00 14.29 .261 MRI 9.80 8.89 5.26 13.16 .616 9.52 10.71 0.00 21.43 .248 Bone scan 5.88 0.00 0.00 15.79 .005 2.38 0.00 5.56 28.57 .001 Cultures (%) Blood 80.39 77.78 84.21 81.58 .817 78.57 78.57 88.89 78.57 .801 Urine 46.08 40.00 68.42 42.11 .094 47.62 35.71 55.56 50.00 .575 CSF 23.53 15.56 21.05 34.21 .131 19.05 14.29 44.44 28.57 .095 Fluid culture 14.85 6.67 21.05 21.62 .116 14.63 10.71 11.11 28.57 .446 Positive culture result (%) 0.00 0.00 0.00 0.00 — 0.00 0.00 0.00 0.00 .000 Viral panel (%) 43.14 51.11 36.84 36.84 .352 38.10 57.14 38.89 35.71 .373 Positive viral panel (%) 8.82 8.89 5.26 10.53 .804 11.90 7.14 5.56 7.14 .830 CSF, cerebrospinal fluid; CT, computerized tomography; —, not applicable.
Data Supplement
Etiology and Resource Use of Fever of Unknown Origin in Hospitalized Children
