Affiliations: Department of Pediatrics and Neonatology,
Sher-i-Kashmir Institute of Medical Sciences Soura, Srinagar, Kashmir, India
Note: [] Correspondence: Dr. Ahmad Ikhlas, Department of Pediatrics and
Neonatology, Sher-i-Kashmir Institute of Medical Sciences Soura, Srinagar,
Kashmir, India. Tel.: +91 9906683526; E-mail: ikhlas.paeds@gmail.com
Abstract: Although huge advances have been made in the field of medicine,
fever of unknown origin (FUO) continues to be a significant health problem and
an important cause of morbidity and mortality, especially in children. The aim
of this study was to study current spectrum of FUO, newly emerging challenges
and outcome of FUO. A prospective observational study was conducted over a 16
month period (May 2012-September 2013). 53 children aged 4 months to 15 years
met the definition of FUO and were included. Children with known
immunodeficiency disorders or other chronic disorders were excluded. A
diagnosis was reached in 47 (88.7%) patients. Infections were the commonest
cause accounting for FUO in 37 (69.8%) patients. Haematological disorders were
found in 8 (15%) and autoimmune diseases in 2 (3.8%) patients. Among
infections, the most common causes of FUO were tuberculosis (TB) (37.8%),
enteric fever (29.7%), Epstein-Barr virus (EBV) (8.1%) and brucellosis
(8.1%). TB was extra-pulmonary in 11 cases and pulmonary in 3 cases. Amongst
the haematological disorders, 3 patients had haemophagocytic
lymphohistiocytosis (HLH), 3 had leukemia, 1 had non-Hodgkin lymphoma and 1 had
autoimmune lymphoproliferative syndrome. Juvenile idiopathic arthritis with
systemic onset and polyarteritis nodosa accounted for the two cases of
autoimmune disease. Elevated C-reactive protein (CRP) levels were associated
with an infectious etiology. Bone tenderness, thrombocytopenia and neutropenia
predicted haematological malignancy. 1 patient of HLH died of complications
during initial hospitalization and 3 other patients (1 HIV, 2 TB) died on
follow up. TB, especially extrapulmonary, and enteric fever are still
significant public health problems and were the commonest causes of FUO in our
population. Due to advances in diagnostic facilities, some diseases like
urinary tract infection (UTI) and hepatitis have become less common; however,
other diseases like EBV have become more common causes of FUO. HLH is emerging
as a significant cause of morbidity and mortality in FUO patients.
