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UofL Design and Print Long-Term Health Outcomes of Patients Evaluated for Unexplained Fevers in a Pediatric Infectious Diseases Clinic Kathryn E. Weakley, MD, Gary S. Marshall, MD, Victoria A. Statler, MD MSc Department of Pediatrics, University of Louisville, Louisville, KY BACKGROUND METHODS Most children evaluated for unexplained fevers in a pediatric infectious diseases clinic who received no initial diagnosis remained well after an average 7.5 years to follow-up No children were diagnosed with infection, immunodeficiency, or cancer Children who reportedly continue to have unexplained fevers but have no fever-related diagnosis warrant further study, with particular attention to their families’ health and illness beliefs Miller LC, Sisson BA, Tucker LB, Schaller JG. Prolonged fevers of unknown origin in children: patterns of presentation and outcome. J Pediatr Infect Dis Soc.1996;129(3):419-423 Statler VA, Marshall GS. Characteristics of patients referred to a pediatric infectious diseases clinic with unexplained fever. J Pediatr Infect Dis Soc. 2016;5(3):249-256 Talano JA, Katz BZ. Long-term follow-up of children with fever of unknown origin. Clin Pediatr. 2000;39(12):715-717 Wurster VM, Carlucci JG, Feder HM, Edwards KM. Long-term follow-up of children with periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis syndrome. J Pediatr. 2011;159(6):958-964 Identified patients referred for unexplained fevers between 2008-2012 with no specific diagnosis or self-limited illnesses Scripted telephone interview with parents/guardians Patients diagnosed with PFAPA interviewed separately Telephone numbers identified using electronic medical record, primary care physician, and emergency contact At least 3 attempts Descriptive analysis STRENGTHS/LIMITATIONS RESULTS REFERENCES 17/20 patients initially diagnosed with PFAPA were interviewed 14 had resolution of fever and no other diagnosis • 9 resolved with tonsillectomy • 4 resolved spontaneously • 1 resolved with single dose of oral steroid 3 were still having fevers • 1 diagnosed with Behcet’s Disease • 2 attribute fevers to PFAPA and report decreased frequency and shorter duration Long-term Health Outcomes of Patients Referred for Unexplained Fevers Who Received No Initial Diagnosis Retrospective chart review of patients referred to a pediatric infectious diseases clinic for unexplained fevers from 2008-2012 No studies describing long-term health outcomes of patients referred for unexplained fevers in last 18 years ANA, antinuclear antibody; ASO, anti-streptolysin O; CBC, complete blood count; CMP, comprehensive metabolic panel; CMV, cytomegalovirus; CRP, C-reactive protein; CSF, cerebosprinal fluid; EBV, Ebstein- Barr virus; ESR, erythrocyte sedimentation rate; F, female; FH, family history; G-tube, gastrostomy tube; LDH, lactate dehydrogenase; PMH, past medical history ADHD, attention deficit hyperactive disorder; F, female; M, male; MRSA, methicillin-resistant Staphylococcus aureus Majority of Patients Had No Established Diagnosis or Self-Limited Illnesses Characteristics of Patients Who Report Continued Fevers Characteristics of Patients Referred for Unexplained Fevers PFAPA: Periodic fever, aphthous stomatitis, pharyngitis, adenitis Characteristics of Patients With a Fever-Related Diagnosis at Follow-Up CONCLUSIONS Selected Comments Given by 5 Different Caregivers To Explain Resolution of Fevers PFAPA: Periodic fever, aphthous stomatitis, pharyngitis, adenitis Long-term Health Outcomes of Patients Diagnosed with PFAPA Syndrome Statler VA, Marshall GS. Characteristics of Patients Referred to a Pediatric Infectious Diseases Clinic With Unexplained Fever. Journal of the Pediatric Infectious Diseases Society. 2016;5(3):249-256 PFAPA: Periodic fever, aphthous stomatitis, pharyngitis, adenitis Strengths Limitations Large cohort size 78% completion rate Response bias unlikely Single center Reporting bias “He just grew out of it.” “She started a foot detox bath. It sounds crazy, but the fevers stopped when she started it and came back when she stopped it. So we restarted it and they’ve been gone ever since.” “We moved into a new home.” “She stopped taking Singulair .” “She fractured her skull falling off a chair while playing in the infectious diseases office. Never had another unexplained fever again.”
