Pasic Srdjan, Minic Aleksandra, Djuric Predrag, Micic Dragan, Kuzmanovic Milos, Sarjanovic Ljudmila, Markovic Milanka
Department of Paediatric Immunology and Infectious Diseases, Mother and Child Health Institute Dr Vukan Cupić, Belgrade, Serbia and Montenegro.
Acta Paediatr. 2006 Apr;95(4):463-6. doi: 10.1080/08035250500437549.
We conducted a prospective study to evaluate the causes and outcome in children with fever of unknown origin (FUO).
From 1990 to 1999, 185 children with FUO were evaluated. Initial evaluation included routine haematological analysis, Epstein-Barr virus (EBV) serology, urine, stool or blood cultures, chest X-ray and tuberculin probe.
In 131 (70%) patients diagnosis was established, and 70 (37.8%) had infectious disease. EBV infection was the most common infection followed by visceral leishmaniasis (VL), urinary tract infection (UTI) and tuberculosis. Autoimmune disorders were diagnosed in 24 (12.9%), Kawasaki disease in 12 (6.4%), malignant diseases in 12 (6.4%) and miscellaneous conditions in 15 (8.1%) patients. In the remaining 54 (30%) patients, diagnosis was not established and most of them had self-limited disease. During the investigation, 26 (14%) patients developed serious organ dysfunction and five patients (two with virus-associated haemophagocytic syndrome, one with VL and two unknown) died.
The most important infectious causes of FUO in our study were EBV infection and VL. Kawasaki disease represented a significant cause of FUO at the beginning of our study because it was not recognized by primary-care physicians. We report myelodysplastic syndrome as another emerging cause of paediatric FUO. Repeated clinical examination and careful use of specific laboratory examinations, invasive diagnostic procedures or imaging are crucial in approaching paediatric FUO.
我们进行了一项前瞻性研究，以评估不明原因发热（FUO）儿童的病因及转归。
1990年至1999年，对185例不明原因发热儿童进行了评估。初始评估包括常规血液学分析、EB病毒（EBV）血清学检查、尿液、粪便或血液培养、胸部X线检查和结核菌素试验。
131例（70%）患者确诊，70例（37.8%）患有感染性疾病。EB病毒感染是最常见的感染，其次是内脏利什曼病（VL）、尿路感染（UTI）和结核病。24例（12.9%）诊断为自身免疫性疾病，12例（6.4%）为川崎病，12例（6.4%）为恶性疾病，15例（8.1%）为其他杂症。其余54例（30%）患者未确诊，其中大多数为自限性疾病。在调查过程中，26例（14%）患者出现严重器官功能障碍，5例患者（2例为病毒相关性噬血细胞综合征，1例为VL，2例病因不明）死亡。
本研究中不明原因发热最重要的感染性病因是EB病毒感染和VL。在我们研究开始时，川崎病是不明原因发热的一个重要病因，因为基层医疗医生未认识到该病。我们报告骨髓增生异常综合征是儿童不明原因发热的另一个新出现的病因。反复的临床检查以及谨慎使用特定的实验室检查、侵入性诊断程序或影像学检查对于处理儿童不明原因发热至关重要。
