Prolonged fever in children.

During a four-year period, 86 children with fever lasting for at least 6 days without diagnosis at admission after initial physical examination and preliminary laboratory tests were included in a retrospective analysis. Their ages ranged from 2 months to 16 years, and there were 55 males and 31 females. Bacterial infections occurred in 19 patients (22%), viral infections in 17 (20%), mycoplasmal infections in 3 and malaria in 1. Collagen vascular diseases were diagnosed in 13 children (15%), including 7 juvenile rheumatoid arthritis and 5 systemic lupus erythematosus. Thirteen children (15%) had neoplastic or hematological diseases, including leukemia, lymphoma, myelodysplastic syndrome, and neuroblastoma. The fevers of the other 14 patients (16%) were attributed to central fever. The overall diagnostic rate was 98%. Twenty-two children had a poor outcome, including 6 children with collagen vascular diseases and 12 with neoplasms. Diagnoses were made mainly through a complete medical history, meticulous physical examination, regular laboratory tests, and an observation of clinical course. Invasive tissue studies can be fruitful when used appropriately and should be considered for specific indication only.