Treat appropriately
Recent international travel
Suspected specific infection?
Specific serologic testing
Cause identified?
Treat appropriately
Consider Kawasaki disease pathway
Age?
Suspected Kawasaki disease?
Consider infectious disease or other subspecialty consult
Concerning signs for osteomyelitis/septic arthritis
Antibiotics are NOT routinely indicated for FUO unless the patient is ill-appearing or there is strong suspicion for a specific infection. Empiric antibiotics may mask or delay the diagnosis of serious infections.
Relevant testing for areas visited
Gastrointestinal complaints?
Cause identified?
Family to start fever diary(date/time, measurement, method of measurement, duration, associated symptoms, response to medications), re-evaluation in 3-7 days
Family history of rheumatologic disease?
Bone/joint pain or swelling?
X-rays or affected area
Kawasaki Disease primary criteria:
4-5 criteria -> Likely KD
2-3 criteria -> Possible atypical KD
Discontinue non-essential medications
Infectious causes of FUO
Brucellosis | Exposure to animals or animal products (raw cheese/mild, meat) Uveitis Hepato/splenomegaly Testicular pain |
Bartonella | Exposure to cats/kittens Localized lymphadenopathy Hepato/splenomegaly & pain Nodule at infective site |
Endocarditis | Cardiac risk factor New murmur Hepato/splenomegaly Splinter hemorrhages Conjunctival hemorrhage Petechiae |
Intraabdominal abscess | Previous abdominal surgery or infection Abdominal pain |
Leptospirosis | Exposure to animal urine or infected tissue HA, myalgia, rigors, cough Relative bradycardia Conjunctivitis |
Liver abscess | Jaundice Immunosuppression Abdominal pain |
Malaria | Exposure to malaria area Relapsing fevers Splenomegaly |
Osteomyelitis/septic arthritis | Bone/joint pain Limp |
Salmonellosis | Exposure to Eggs, reptiles GI symptoms, diarrhea HA, fatigue, urinary symptoms |
Toxoplasmosis | Exposure to feline feces Lymphadenopathy |
Tuberculosis | Exposure to endemic area Intermittent fevers Lymphadenopathy |
Tularemia | Exposure/ingestion to animal meat (rabbits, squirrels) HA, fatigue, chills, myalgias |
Typhoid | Exposure to endemic area HA, diarrhea, abdominal pain Relative bradycardia |
Urinary tract infection | Dysuria, urgency, frequency, incontinence Abdominal pain Suprapubic tenderness |
Other causes of FUO
Diabetes insipidus |
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Drug fever |
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Familial dysautonomia |
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Hemophagocytic lymphohistiocytosis |
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Inflammatory bowel disease |
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Juvenile idiopathic arthritis |
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Leukemia |
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Lymphoma |
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Periodic fever disorders |
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Systemic lupus erythematosus |
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