Approach to a Child with Fever of more than 72 hours' duration without Obvious Cause: a Review.

Abstract

Summary: Pyrexia of undetermined origin (PUO) is defined as fever with a temperature of over 38°C of more than three weeks' duration whose source is not determined after a careful history and physical examination. Clinical handling is different and depends on the age of the child. Acute episodes of fever represent between 10 and 20 percent of outpatient paediatric consultations, occurring on the average between four and six times annually. There is usually an increase in the winter months corresponding to an increase in respiratory and gastrointestinal viral infections. Different scales of observation have been developed that are aimed at identifying those children with underlying bacterial or viral ilnesses. The diagnosis of PUO is determined by careful evaluation of the presenting picture. The handling of a prolonged episode of fever should be on individual basis and should include the evaluation of the risks of serious bacterial infection. The use of antibiotics is generally not indicated except in the neonate when they are administered parenterally following appropriate investigations, including lumbar puncture. 

Keywords: Fever, child, diagnostic evaluation, therapy.