Joshi N, Rajeshwari K, Dubey A P, Singh T, Kaur R
Department of Pediatrics, Maulana Azad Medical College, New Delhi, India.
Ann Trop Paediatr. 2008 Dec;28(4):261-6. doi: 10.1179/146532808X375413.
Fever of unknown origin (FUO) is an important cause of morbidity and mortality in children, especially in tropical and developing countries.
To determine the aetiology and outcome of FUO in Indian children.
A hospital-based, prospective, observational study was conducted over a 1-year period (2006-2007). Children aged > or =3 months to 12 years who qualified for the definition of FUO were recruited. Initial evaluation included complete blood count, peripheral smear for malarial parasites, erythrocyte sedimentation rate (ESR), urine analysis and culture, blood culture, tuberculin test and chest X-ray.
Of 49 patients evaluated, a diagnosis was reached in 43 (88%). Infections were the predominant cause of FUO in 34 patients (69%). Enteric fever was the most common infection (14), followed by visceral leishmaniasis (10) and tuberculosis (5). The next most common cause was malignancy (6, 12%). Among the six undiagnosed patients, spontaneous resolution occurred in five whereas one child continued to be febrile without an established cause at the end of the study.
Repeated, thorough clinical examination and carefully selected laboratory examinations proved useful in the diagnosis of FUO. Serology (e.g. enteric fever) and bone marrow examination (e.g. leishmaniasis, malignancy) were the most useful diagnostic tests.
不明原因发热（FUO）是儿童发病和死亡的重要原因，在热带和发展中国家尤为如此。
确定印度儿童FUO的病因及转归。
在1年期间（2006 - 2007年）进行了一项基于医院的前瞻性观察性研究。招募符合FUO定义的3个月及以上至12岁的儿童。初始评估包括全血细胞计数、疟原虫外周血涂片、红细胞沉降率（ESR）、尿液分析及培养、血培养、结核菌素试验和胸部X线检查。
在评估的49例患者中，43例（88%）得出诊断结果。感染是34例患者（69%）FUO的主要原因。伤寒热是最常见的感染（14例），其次是内脏利什曼病（10例）和结核病（5例）。第二常见的原因是恶性肿瘤（6例，12%）。在6例未确诊的患者中，5例自行缓解，而1例儿童在研究结束时仍持续发热且病因未明。
反复、全面的临床检查和精心选择的实验室检查被证明对FUO的诊断有用。血清学检查（如伤寒热）和骨髓检查（如利什曼病、恶性肿瘤）是最有用的诊断测试。
