UpToDate
UpToDate خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده: 4

Suggested approach to initial laboratory and imaging evaluation for fever of unknown origin in children*

Suggested approach to initial laboratory and imaging evaluation for fever of unknown origin in children*
Diagnostic test Potential significance of results
Complete blood count, differential and smear
  • Anemia: Malaria, tuberculosis, infective endocarditis, JIA, SLE, IBD
  • Cytopenia in ≥1 cell line and/or bizarre or immature WBCs: Leukemia, hemophagocytic lymphohistiocytosis, SLE, Kikuchi-Fujimoto disease
  • Leukocytosis or bandemia: Increased risk of bacterial infection, infective endocarditis, JIA, drug fever, infantile cortical hyperostosis
  • Neutropenia: Tuberculosis, Dengue fever, EBV, CMV, HIV, SLE, leukemia, human granulocytic anaplasmosis
  • Atypical lymphocytes: Viral infections (eg, EBV, CMV), Kikuchi-Fujimoto disease
  • Lymphocytosis: Cat scratch disease, EBV, toxoplasmosis
  • Lymphocytopenia: Brucellosis, malaria, tuberculosis, typhoid fever, HIV, SLE
  • Eosinophilia: Parasitic or fungal infection; allergic disorder; neoplasm; immunodeficiency
  • Thrombocytosis: JIA, Kawasaki disease
  • Thrombocytopenia: EBV, CMV, HIV, parvovirus, varicella, leptospirosis, tularemia, rickettsial infection, SLE, Kikuchi-Fujimoto disease
ESR and CRP
  • Elevated: Nonspecific indication of inflammation; may warrant more rapid evaluation; factitious fever unlikely
  • Normal: Reassuring; evaluation can proceed at deliberate pace; does not exclude noninflammatory conditions (eg, familial dysautonomia, ectodermal dysplasia, etc)
Aerobic and anaerobic blood culturesΔ
  • Bacteremia; infective endocarditis
Urinalysis and urine culture
  • Pyuria and bacteriuria: Urinary tract infection
  • Sterile pyuria: Intra-abdominal infection, genitourinary tuberculosis, Kawasaki disease◊
  • Hematuria and/or proteinuria: Infective endocarditis, leptospirosis, SLE
  • Low specific gravity or osmolality: Diabetes insipidus
Chest radiograph
  • Infiltrate: Pneumonia
  • Lymphadenopathy: Tuberculosis
  • Mediastinal mass: Leukemia, lymphoma, neurogenic tumor, rhabdomyosarcoma
  • Small nodular densities: Leptospirosis
Serum electrolytes, BUN, and creatinine
  • Hypernatremia: Diabetes insipidus, dehydration
  • Hyponatremia: Leptospirosis, tularemia
  • Elevated BUN/Cr: Kidney function impairment (SLE), dehydration
Hepatic aminotransferases
  • Elevated: Brucellosis, tularemia, hepatitis, JIA, Kikuchi-Fujimoto disease, adenovirus, EBV

BUN: blood urea nitrogen; CMV: cytomegalovirus; Cr: creatinine ratio; CRP: C-reactive protein; EBV: Epstein-Barr virus; ESR: erythrocyte sedimentation rate; FUO: fever of unknown origin; IBD: inflammatory bowel disease; IGRA: interferon gamma release assay; JIA: juvenile idiopathic arthritis; SLE: systemic lupus erythematosus; WBC: white blood cell.

* Additional tests may be indicated if the history, examination, or initial diagnostic tests suggest a diagnosis or diagnoses.

¶ ESR may be lowered artifactually in conditions involving consumption of fibrinogen; ESR may be artifactually raised in hypergammaglobulinemia.

Δ Special media or environmental conditions, or longer incubation, may be necessary for specific pathogens (eg, Brucella, Leptospira, Spirillum).

◊ The white blood cells in Kawasaki disease are monocytic cells; because they are, not polymorphonuclear neutrophils they are not detected by dipstick tests for leukocyte esterase.

Graphic 111287 Version 5.0

آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟