A Prospective Study of Clinical and Etiological Profile of Fever of Unknown Origin in Children

Background: Fever of unknown origin (FUO) is a common presentation in the pediatric age group worldwide. The spectrum of illness changes from one geographic location to another and also varies at different times. The current study aimed to study the clinical and etiological profile of children aged 2 months to 12 years admitted for more than 2 weeks with fevers of unknown origin in a tertiary care hospital. Methods: This cross-sectional observational study was conducted in the Department of Pediatrics. FUO was described as a fever greater than 100.4°F lasting at least 8 days in patients without a definitive diagnosis after an initial assessment in the outpatient clinic or the hospital. A thorough history, including travel history, was obtained from all patients. This was followed by a detailed general and systemic examination, repeated daily to identify potential etiological clues. Clinical and biochemical data were recorded systematically using a structured proforma. The initial investigations included Complete blood count (CBC) with erythrocyte sedimentation rate (ESR), Peripheral blood smear, Urinalysis, Routine biochemistry, Chest X-ray, Urine, stool, and blood cultures. Results: A total of 85 cases were included in the study based on the inclusion and exclusion criteria. Infections caused by bacterial pathogens accounted for 52.9% of cases in this study followed by Rickettsial pathogens were the most common in the group, accounting for 24.7%, Scrub typhus was the leading cause, identified in 21 out of 70 (30.0%) patients in the infectious group. Among bacterial infections, enteric fever (23.5%), Pneumonia (10.6%), UTI (9.4%), and sepsis (5.9%) were predominant. Malaria was diagnosed in 2 cases (2.3%) using rapid malarial card tests (LDH-based) and confirmed by thin and thick smear analysis. Conclusions: Within the limitations of the current study we concluded that infections were the primary cause of FUO in children with enteric fever and scrub typhus being the most frequent diagnosis. Early identification of the cause through specific investigations and appropriate antimicrobial treatment in bacterial diseases will be beneficial.