FEVER of UNKNOWN ORIGIN

(FUO)
 Introduction

• Normal body temperature 36,1 -37,8°C

• Fever is defined as the elevation of core body
temperature above normal, > 37,8°C orally or
38°C rectally.
• Normal diurnal variation  maximum
temperature in the late afternoon
 Definition
• Petersdorf and Beeson as the following: a
temperature greater than 38°C (101°F), more
than 3 weeks duration of illness, and failure to
reach a diagnosis despite one week of
inpatient investigation
 Etiology
• infections (30-50%),
• Neoplastic (5-30%),
• Collagen vascular diseases (10-20%),
• Miscellaneous diseases (15-20%)
 DIAGNOSTIC APPROACH
• In general, children with FUO clearly not suffering from a rare
disease, but common diseases that have common clinical
manifestation of a-tipically (not typical, not unusual)
• Infectious diseases and vascular diseases - collagen (not
neoplastic) is the largest cause of FUO.
• Children with FUO have a better prognosis than adults.
• In children FUO, continuous patient observation and
repetition anamnesis and physical examination is often
helpful
• Keep in mind the possibility of fever caused by medications
(drug fever).
 DIAGNOSTIC APPROACH
Berhman
• The first stage, anamnesis, physical examination and certain laboratory.
After it is evaluated to determine whether there are specific signs and
symptoms or not.
• The second phase, can be divided into 2 possibilities, namely:
A. If signs and symptoms found in a particular focal additional checks
then carried out a more specific diseases leading to the suspect.
B. If there is no focal signs and symptoms, then do a complete re-
examination of blood
A and B then evaluated to proceed to stage three
• The third phase, consisting of a more complex examination and directed,
to other parts of the consultation and invasive acts performed as
needed.
 History
• Age
• Symptoms & Fever Type
• Epydemiology History :
– A history of exposure to wild or domestic animals .
– A history of travel
– Medication history
– The genetic background
 PHYSICAL EXAMINATION
• Definitive documentation of fever.Measure the
fever more than once to exclude manipulation
of thermometers.
• Repeat a regular physical examination daily
while the patient is hospitalized.
• Pay special attention to rashes, cardiac
murmurs, signs of arthritis, abdominal
tenderness or rigidity, lymph node enlargement,
funduscopic changes, and neurologic deficits.
 LABORATORY
• Complete blood cell count with a differential
WBC, urinalysis, Erythrocyte sedimentation
rate (ESR), C-reactive protein
• Radiographic examination
• Examination of the bone marrow
• Radionuclide scans
• Total body CT or MRI
• Biopsy
 Treatment
• Antimicrobial agents should not be used as antipyretics.
• Empirical trials of medication should generally be avoided.
• An exception may be the use of antituberculous treatment in
critically ill children with suspected disseminated
tuberculosis.
• Empirical trials of other antimicrobial agents may be
dangerous and can obscure the diagnosis of infective
endocarditis, meningitis, parameningeal infection, or
osteomyelitis.
• After a complete evaluation, antipyretics may be indicated to
control fever and for symptomatic relief .
 PROGNOSIS
• Children with FUO have a better prognosis than do
adults.
• The outcome in a child is dependent on the primary
disease process, which is usually an atypical
presentation of a common childhood illness.
• In many cases, no diagnosis can be established and
fever abates spontaneously.
• In as many as 25% of cases in which fever persists, the
cause of the fever remains unclear, even after
thorough evaluation.
THANK YOU FOR YOUR ATTENTION