Kim, Yi-Seul
(Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine)
,
Kim, Kyung-Ran
(Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine)
,
Kang, Ji-Man
(Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine)
,
Kim, Jong-Min
(Department of Pediatrics, Myoungji Hospital, Seonam University College of Medicine)
,
Kim, Yae-Jean
(Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine)
Purpose: Fever is one of the most common symptoms in children. In previous studies, infectious disease was the most common cause of pediatric fever of unknown origin (FUO). The aim of this study is to investigate the etiology, clinical characteristics and prognosis of pediatric FUO in 21 century wit...
Purpose: Fever is one of the most common symptoms in children. In previous studies, infectious disease was the most common cause of pediatric fever of unknown origin (FUO). The aim of this study is to investigate the etiology, clinical characteristics and prognosis of pediatric FUO in 21 century with more diagnostics available and to analyze the factors for certain disease categories. Methods: Among the children under 18 years old who were hospitalized at Samsung Medical Center from January 2000 to December 2014, the patients who met the criteria including fever of ${\geq}38.0^{\circ}C$ for longer than ${\geq}14days$ and failure to reach a diagnosis after one week of investigations were included. Results: Total 100 patients were identified. Confirmed diagnosis was achieved in 57 patients (57%). Among them, infectious diseases (n=19, 19%) were most common, followed by connective tissue diseases (n=15, 15%), necrotizing lymphadenitis (n=8, 8%), and malignancies (n=7, 7%). Children with fever duration over 28 days had a trend for higher frequency of connective tissue diseases (28.3%) except undiagnosed etiology. The symptoms such as arthritis, lymph node enlargement and only fever without other symptoms were significantly related with connective tissue diseases, necrotizing lymphadenitis and undiagnosed respectively (P<0.001). Ninety-two patients have become afebrile at discharge and 1 patient died (1%). Conclusion: Almost half of our patients were left without diagnosis. Although it has been known that infectious disease was most common cause of pediatric FUO in the past, undiagnosed portion of FUO have now increased due to development of diagnostic techniques for infectious diseases.
Purpose: Fever is one of the most common symptoms in children. In previous studies, infectious disease was the most common cause of pediatric fever of unknown origin (FUO). The aim of this study is to investigate the etiology, clinical characteristics and prognosis of pediatric FUO in 21 century with more diagnostics available and to analyze the factors for certain disease categories. Methods: Among the children under 18 years old who were hospitalized at Samsung Medical Center from January 2000 to December 2014, the patients who met the criteria including fever of ${\geq}38.0^{\circ}C$ for longer than ${\geq}14days$ and failure to reach a diagnosis after one week of investigations were included. Results: Total 100 patients were identified. Confirmed diagnosis was achieved in 57 patients (57%). Among them, infectious diseases (n=19, 19%) were most common, followed by connective tissue diseases (n=15, 15%), necrotizing lymphadenitis (n=8, 8%), and malignancies (n=7, 7%). Children with fever duration over 28 days had a trend for higher frequency of connective tissue diseases (28.3%) except undiagnosed etiology. The symptoms such as arthritis, lymph node enlargement and only fever without other symptoms were significantly related with connective tissue diseases, necrotizing lymphadenitis and undiagnosed respectively (P<0.001). Ninety-two patients have become afebrile at discharge and 1 patient died (1%). Conclusion: Almost half of our patients were left without diagnosis. Although it has been known that infectious disease was most common cause of pediatric FUO in the past, undiagnosed portion of FUO have now increased due to development of diagnostic techniques for infectious diseases.
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문제 정의
There has been no published research on the etiologies and clinical characteristics of pediatric FUO in Korea since20063). The aims of this study are to investigate the etiology, clinical characteristics, and prognosis of pediatric FUO and to analyze the factors that can predict certain disease categories.
제안 방법
Outside hospital data were also included for the duration of fever and hospitalization period. Laboratory data included complete blood cell count, chemistry profiles with liver function tests and kidney function tests, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), urinalysis, and urine and blood cultures. Further examinations such as autoimmune markers, immunologic work-up, viral and bacterial studies by serology tests and/or polymerase chain reaction (PCR), tuberculin skin test (TST) or interferon gamma releasing assay (IGRA), and cerebrospinal fluid (CSF) exam were performed based on the clinical context.
The causes of FUO were categorized into 6 groups: infectious diseases, CTD, malignancies, necrotizing lymphadenitis, miscellaneous, and undiagnosed. Data were analyzed by IBM SPSS Statistics ver.
대상 데이터
From January 2000 to December 2014, children younger than 18 years of age who were evaluated for prolonged fever at Samsung Medical Center, Seoul, South Korea, were identified. Among them, the patients who met the inclusion criteria of fever ≥38.
A total of 392 patients were evaluated for prolonged fever and 292 patients were excluded for the following reasons: duration of fever less than 14 days, total hospitalization less than 7 days, and diagnosis reached before 1 week of investigation. As a result, 100 patients were included in this study.
1. Eight patients (8%) were less than 1 year old; among these patients, the diagnosis of 3 patients were confirmed to be atypical Kawasaki disease, hemophagocytic lymphohistiocytosis (HLH), and hereditary sensoryautonomic neuropathy (HSAN), and the remaining 5 patients were undiagnosed. These 5 undiagnosed patients less than 1 year old recovered from fever without any sequelae.
The patient with the longest fever became afebrile without a definite diagnosis after 80 days of fever. This patient was a 17-year-old girl with a headache who was transferred from an outside hospital where she received extensive FUO evaluation for infection, autoimmune disease, and malignancy, including bone marrow examination. After hospitalization in our hospital, similar investigations were performed again.
Its presentation includes periodic bone pain, fever, and the appearance of multiple bone lesions that can occur in any skeletal site. This patient with chronic recurrent multifocal osteomyelitis was an 11-year-old girl who suffered from bilateral knee pain. Her MRI showed diffuse bone marrow signal change in both tibias and suspected osteomyelitis or leukemic infiltration.
This study investigated the etiology and clinical characteristics of pediatric FUO patients from a single center in Korea for 15 consecutive years from 2000 to 2014. The present study showed that no diagnosis (43%) was the most common etiology.
Methicillinsensitive staphylococcus aureus was recovered from the blood culture of one patient, while the other patient had a blood culture that was negative, but bacterial DNA identification PCR of heart vegetation confirmed the presence of Haemophilus parainfluenzae. There was 1 patient with culture-negative septic arthritis who received empiric antibiotic treatment before proper cultures were obtained at an outside hospital because the patient was in septic shock and was transferred to our intensive care unit. The patient recovered with broad-spectrum antimicrobial treatment in our hospital.
데이터처리
The causes of FUO were categorized into 6 groups: infectious diseases, CTD, malignancies, necrotizing lymphadenitis, miscellaneous, and undiagnosed. Data were analyzed by IBM SPSS Statistics ver. 21.0 (IBM Co., Armonk, NY, USA) and statistical analysis was performed using the Fisher exact test for categorical variables. To analyze the continuous variables (CRP, WBC, and ESR), Kruskal-Wallis test with Bonferroni correction was used.
이론/모형
, Armonk, NY, USA) and statistical analysis was performed using the Fisher exact test for categorical variables. To analyze the continuous variables (CRP, WBC, and ESR), Kruskal-Wallis test with Bonferroni correction was used. A value of P<0.
성능/효과
0%) remained undiagnosed. Among the patients with a confirmatory diagnosis, infectious diseases were the most common causes of FUO (n=19, 19.0%), followed by CTD (n=15, 15.0%), necrotizing lymphadenitis (n=8, 8.0%), miscellaneous (n=8, 8.0%), and malignancies (n=7, 7.0%).
In conclusion, the most common etiology of pediatric FUO in our study is no diagnosis, followed by infectious diseases. Mortality was observed in 1% of patients and appears to be lower than in previous reports.
후속연구
The original studies on pediatric FUO from the 1970s reported a mortality rate of 6% to 9%4), but the etiologies and mortality rates may have changed since then. Therefore, further study is needed to understand the trends in mortality and overall outcomes associated with pediatric FUO.
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