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American Academy of Pediatrics
Research Articles

Etiology and Resource Use of Fever of Unknown Origin in Hospitalized Children

James W. Antoon, David C. Peritz, Michael R. Parsons, Asheley C. Skinner and Jacob A. Lohr
Hospital Pediatrics March 2018, 8 (3) 135-140; DOI: https://doi.org/10.1542/hpeds.2017-0098
James W. Antoon
aDepartment of Pediatric and Adolescent Medicine, Children’s Hospital, University of Illinois Hospital & Health Sciences System, Chicago, Illinois;
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David C. Peritz
bDivision of Cardiovascular Medicine, University of Utah School of Medicine, Salt Lake City, Utah;
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Michael R. Parsons
cDepartment of Pediatrics, Johns Hopkins Children’s Center, Baltimore, Maryland;
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Asheley C. Skinner
dDepartment of Pediatrics, Duke University School of Medicine, Durham, North Carolina; and
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Jacob A. Lohr
eDepartment of Pediatrics, University of North Carolina at Chapel Hill School of Medicine and North Carolina Children’s Hospital, Chapel Hill, North Carolina
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  • FIGURE 1
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    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).

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    TABLE 1

    Patient Demographics and Duration of Fever on Admission

    DemographicTotal n (%)
    N102 (100)
    Age, y
     0–557 (55.9)
     6–1014 (13.7)
     >1026 (25.5)
     Unknown5 (4.9)
    Mean age, y6.5
    Sex
     Boys58 (56.9)
    Race and/or ethnicity
     White41 (40.2)
     African American24 (23.5)
     Hispanic13 (12.8)
     Other ethnicity2 (2.0)
     Unknown ethnicity22 (21.6)
    Fever on admission37 (36.2)
    Fever during hospital stay84 (82.4)
    Complex chronic condition26 (25.5)
    Final etiologic category
     Autoimmune28 (27.5)
     Infectious42 (41.2)
     Oncologic18 (17.7)
     Other or unknown14 (13.7)
    • View popup
    TABLE 2

    Categorization of Pediatric FUO Etiologies

    Infectious (n = 42)Autoimmune (n = 28)Oncologic (n = 18)Other or Unknown (n = 4/10)
    Acute bacterial sinusitisAutoimmune disorder of unknown etiologyAcute lymphoid leukemiaDrug fever
    Aseptic meningitisAtypical KawasakiHepatocellular carcinomaAutonomic instability
    Bartonella meningitisBechet’s diseaseHemophagocytic lymphohistiocytosis
    Bartonella osteomyelitisBechet’s disease with Hughes-Stovin syndromeMacrophage activating syndrome
    DiskitisCrohn’s diseaseUnknown
    C difficile colitisDermatomyositis
    Candida albicans infectionErythema multiforme
    CytomegalovirusJuvenile idiopathic arthritis
    Epstein-Barr virus infectionKawasaki disease
    EmpyemaPeriodic fever syndrome (unspecified)
    EndocarditisVasculitis of unknown etiology
    Enterovirus infectionSystemic 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
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    TABLE 3

    Etiologic Category and Duration of Fever (P < .05)

    Fever Duration
    >8–14 d, %>15–21 d, %>21 d, %Total, %
    Infectious disease40.063.234.242.2
    Autoimmune33.315.821.125.5
    Oncologic20.015.815.817.7
    Other or unknown6.75.329.014.7
    • View popup
    TABLE 4

    Diagnostic Testing by Length of Fever and Etiology

    Length of FeverEtiology
    Total>8–14 d>15–21 d>21 dPInfectiousAutoimmuneOncologyOther or UnknownP
    Scans (%)
     Radiograph70.5966.6757.8981.58.13459.5275.0094.4464.29.047
     Ultrasound47.0644.4463.1642.11.29035.7164.2961.1128.57.031
     CT7.844.445.2613.16.30411.903.570.0014.29.261
     MRI9.808.895.2613.16.6169.5210.710.0021.43.248
     Bone scan5.880.000.0015.79.0052.380.005.5628.57.001
    Cultures (%)
     Blood80.3977.7884.2181.58.81778.5778.5788.8978.57.801
     Urine46.0840.0068.4242.11.09447.6235.7155.5650.00.575
     CSF23.5315.5621.0534.21.13119.0514.2944.4428.57.095
     Fluid culture14.856.6721.0521.62.11614.6310.7111.1128.57.446
    Positive culture result (%)0.000.000.000.00—0.000.000.000.00.000
    Viral panel (%)43.1451.1136.8436.84.35238.1057.1438.8935.71.373
    Positive viral panel (%)8.828.895.2610.53.80411.907.145.567.14.830
    • CSF, cerebrospinal fluid; CT, computerized tomography; —, not applicable.

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Hospital Pediatrics: 8 (3)
Hospital Pediatrics
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1 Mar 2018
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Etiology and Resource Use of Fever of Unknown Origin in Hospitalized Children
James W. Antoon, David C. Peritz, Michael R. Parsons, Asheley C. Skinner, Jacob A. Lohr
Hospital Pediatrics Mar 2018, 8 (3) 135-140; DOI: 10.1542/hpeds.2017-0098

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Etiology and Resource Use of Fever of Unknown Origin in Hospitalized Children
James W. Antoon, David C. Peritz, Michael R. Parsons, Asheley C. Skinner, Jacob A. Lohr
Hospital Pediatrics Mar 2018, 8 (3) 135-140; DOI: 10.1542/hpeds.2017-0098
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