RECURRENT FEVER

Recurrent Fevers in Children: Differential Diagnosis
Dr Widodo Judarwanto, peditrician

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Differential Diagnosis in the Child with Recurrent Fever

  • Fever occurring at regular intervals
  • Fever typically occurs at regular intervals
  • PFAPA syndrome (21 to 28 days)*
  • Cyclic neutropenia (21 to 28 days)
  • Relapsing fever (Borrelia spp. other than Borrelia burgdorferi, 14 to 21 days)
  • Undiagnosed cause*
  • Fever occasionally occurs at regular intervals
  • Familial Mediterranean fever (7 to 28 days)
  • Hyper-IgD syndrome (14 to 28 days)
  • Epstein-Barr virus (6 to 8 weeks)
  • Undiagnosed cause*
  • Fever occurring at irregular/unpredictable intervals
  • Infectious
  • Viral
  • Repeated viral infections*
  • Epstein-Barr virus
  • Parvovirus B19
  • Herpes simplex viruses 1 and 2 (?)
  • Bacterial/mycobacterial
  • Repeated bacterial infections/occult bacterial infection* (must exclude urinary tract infection)
  • Relapsing fever (Borrelia spp. other than B. burgdorferi)
  • Chronic meningococcemia
  • Occult dental abscess
  • Brucellosis
  • Yersinia enterocolitica
  • Mycobacteria, nontuberculous (e.g., Mycobacterium chelonai)
  • Parasitic
  • Relapsing malaria (Plasmodium vivax, Plasmodium ovale)
  • Reactivation of Plasmodium malariae.
  • Inflammatory/immunologic
  • Inflammatory bowel disease, usually Crohn’s disease*
  • Still’s disease (systemic-onset juvenile rheumatoid arthritis)*
  • Behçet’s disease
  • Hereditary periodic fevers
  • Familial Mediterranean fever
  • Hyper-IgD syndrome
  • TRAPS
  • Familial cold urticaria
  • Muckle-Wells syndrome
  • Neoplasm
  • Lymphoma
  • Other

Undiagnosed cause

  • Drug fever
  • Factitious fevers
  • Central nervous system abnormalities (hypothalamic dysfunction, agenesis of corpus callosum)
  • PFAPA = periodic fever, aphthous ulcers, pharyngitis, and adenopathy; TRAPS = tumor necrosis factor receptor―associated periodic syndrome.

 

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