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Prolonged, Recurrent, and Periodic Fever Syndromes
Book chapter

Prolonged, Recurrent, and Periodic Fever Syndromes

Kalpana Manthiram, Kathryn M. Edwards and Sarah S. Long
Principles and Practice of Pediatric Infectious Diseases, pp 123-134
2023
DOI: https://doi.org/10.1016/B978-0-323-75608-2.00015-X

Abstract

Optimal evaluation of patients with prolonged, recurring, or periodic fever requires extensive review of signs and symptoms to establish the onset and cardinal features of illness, to define the exact fever pattern, and to understand the context of illness within the patient’s environment, exposures, and family history. Defining fever patterns (Box 15.1) is the first essential step to prioritize the differential diagnosis and pace the investigation.1 A comprehensive physical examination should also target specific systems (e.g., reticuloendothelial, osteoarticular) typically affected in infectious and noninfectious diseases. In children with prolonged fever, laboratory testing should include simple screening, coupled with targeted interrogation of specific organ systems only as identified by the history, physical examination, exposures, or prioritized differential diagnosis (Box 15.2).1 For children with periodic fever, the main goal of performing screening laboratory tests is to confirm normal organ system function, direct the clinician to a specific disorder (e.g., recurrent urinary tract infection), or support the diagnosis of a noninfectious periodic fever syndrome. In evaluating children with any fever pattern, casting a broad net of imaging studies or serologic testing for unusual infectious agents is rarely fruitful in the absence of a specific exposure history or specific clinical findings. [1st paragraph]

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