Etiological profile of fever of unknown origin in children between 1 month to 12 years admitted in an urban referral centre

Thiagarajan, N (2006) Etiological profile of fever of unknown origin in children between 1 month to 12 years admitted in an urban referral centre. Masters thesis, Madras Medical College, Chennai.


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Etiology of fever of unknown origin varies from region to region, and also with age. Although the relative frequencies are some what different, the three most commonly identified causes of fever of unknown origin in children are: Infectious diseases, Rheumatological disorders and Malignancies. The adage that a fever of unknown origin is more likely to be caused by an unusual manifestation of a common disorder than by a common manifestation of a rare disorder is true in pediatrics. Early identification of exact etiology will help in better management of similar cases in future. Hence to know the exact etiology of fever of unknown in children between 1 month - 12 years, in this region this study has been planned. OBJECTIVES: 1 To study the etiological profile, of fever of unknown origin in children between 1 month to 12 years. 2. To utilize the outcome of the present study in the management of similar cases in future so as to shorten the delay. MATERIALS AND METHODS: METHODOLOGY Study Design: Descriptive study. Study Place: Institute of child health and hospital for children, Egmore, Chennai. Study Period: August 2004 to March 2006. Sample Size: n - 182 cases. Case Definition: Children with a fever documented by a health care provider and for which the cause could not be identified after 3 wks of evaluation as an outpatient or after 1 wk of evaluation in hospital Inclusion criteria: 1. A documented fever of more than 38oC which is present at least twice weekly for longer than three weeks for outpatients. 2. A child with fever more than 38oC with no apparent diagnosis even after one week of inpatient investigations. All children who are satisfying above criteria are included. Exclusion criteria: 1. Immunocompromised children as defined by; a. Neutropenia: (WBC count <1000 per microlitre and or neutrophil count <500 per microlitre) b. Known HIV patient. c. An intake of immunosuppressive drugs or prednisolone more than 2mg/kg/day at least for 2 weeks/>20mg if weight >10kg. 2. Nosocomial FUO, is a hospital-associated disorder in which patients first manifest fever after having been hospitalized for at least 24hours, not present or incubating on admission 3. All children with insufficient basic work up on admission. 4. Etiologic diagnosis already established by referring physician. CONCLUSION: * A total of 182 children between 1 month-12 years with fever of unknown origin have been studied. Out of these, 106 were male and 76 were female. * Children in the age group of 3-6 years constitute the majority of the study population 26.9%. * Infections were the most common cause of FUO constituting 37.4%. * Among infections tuberculosis was the commonest one causing 12% of FUO. Typhoid (6.6%) and UTI (6.6%) were the next common infections. * The extrapulmonary tuberculosis was the commonest form tuberculosis observed. Of these extrapulmonary forms, abdominal tuberculosis was most commonly observed. * Brucellosis was observed as cause of FUO in six cases. The triad of fever, arthralgia / arthritis, and hepatosplenomegaly was observed in all six cases. * All the three culture negative infective endocarditis cases were diagnosed with the help of duke criteria. * Malignancy was the second most common cause of FUO occurring in 24.2%. In this group, acute lymphoblastic leukemia (16%) was most commonly observed as a cause FUO, followed by acute myeloid leukemia (3.8%) and Hodgkins lymphoma (2.2%). * Non infectious inflammatory disorders were the next common cause of FUO, occurring in 22%. Of these Juvenile Rheumatoid arthritis (13.7%) was the commonest, followed by SLE (5.5%) and non – specific vasculitis (2.2%). * Non invasive methods helped in arriving at decisive diagnosis in 102 (67.1%) cases, invasive method helped in diagnosis in 50 cases (32.8%). * The diagnostic workup of FUO remains complex; however, considerable evidence exists to guide empiric testing. The diagnostic workup should begin with a thorough history review and physical examination. Routine noninvasive investigations, are recommended in all patients prior to identifying a patient as having FUO.

Item Type: Thesis (Masters)
Uncontrolled Keywords: Etiological profile ; fever ; unknown origin in children ; 1 month to 12 years ; urban referral centre.
Subjects: MEDICAL > Paediatrics
Depositing User: Subramani R
Date Deposited: 22 Aug 2017 04:24
Last Modified: 23 Jul 2018 01:47

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