"Masks" of fever of unknown genesis in children

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Relevance. An increase in temperature is one of the common symptoms of various diseases in children and the most common reason for visiting a pediatrician. Despite modern diagnostic methods, making an accurate diagnosis is difficult. In pediatric practice, it is important to differentiate fever from hyperthermia. Hyperthermia is an increase in body temperature due to overheating and some metabolic shifts, not caused by thermoregulatory processes [1]. Fever is a non-specific protective and adaptive reaction of the body that occurs in response to the effects of pathogenic irritants and is characterized by a restructuring of thermoregulatory processes, which leads to an increase in body temperature [2]. The biological significance of fever is an increase in the natural reactivity of the body. In this case, metabolic changes occur: an increase in the level of glucose and globulins in the blood, acetone in the urine (febrile ketonuria), a decrease in glycogen stores, cholesterol levels, hydrochloric acid (decreased appetite), saliva production, intestinal motility. In clinical practice, fever of unknown origin (FUO) is understood as a constant or periodic (4 or more times a day) increase in body temperature above 38.3 °C for 3 or more weeks, provided that routine research methods do not allow establishing the cause of this condition [1]. The concept of "FUO" should be distinguished from the concept of "fever without apparent source of infection" (FUII), defined as a fever lasting less than 7 days without establishing a diagnosis during this period based on a thorough examination of the child [3]. Diagnosis of FUO requires the involvement of specialists in various fields. In the structure of causes, infections occur under the guise of FUO in 35-60% of cases, systemic diseases of connective tissue and vasculitis - in 20%, hemato-oncological diseases - in 5%, autoinflammatory diseases - in 5% [4]. The aim of the work is to study the nosological structure, clinical course features, diagnostic stages of fever of unknown genesis in children of different ages by analyzing 31 patient histories. Materials and methods of the study. A statistical analysis of the medical records of children hospitalized in the infectious diseases department of the State Healthcare Institution of the Vologda Region, Regional Children's Clinical Hospital No. 2 in 2024 was carried out. Out of 1890 patients in 2024, 31 patients aged from 1 year 1 month to 17 years 1 month were referred for inpatient treatment to the infectious diseases department with a preliminary diagnosis of "Fever of unknown genesis". All patients underwent examination in 3 stages. Stage 1: complete blood count; general urine analysis; enterobiasis scraping, tuberculin skin test; chest X-ray; electrocardiogram (ECG), biochemical blood test; bacteriological cultures of feces, urine for pathogenic flora; blood cultures for sterility; conducting serological reactions to detect serum antibody titers against salmonellosis, typhoid fever and paratyphoid fever; examination of a blood smear for malaria. Stage 2: additional tests - general blood test and general urine test over time (every 5-7 days, even with previously normal values); repeated bacteriological blood cultures, including special media to detect both aerobic and anaerobic pathogens; study of serum antibody titers against infectious disease pathogens in serological reactions (brucellosis, tularemia, yersiniosis, borreliosis, leptospirosis, ornithosis, typhus, Q fever, West Nile fever, toxoplasmosis, respiratory viruses, enteroviruses; human immunodeficiency virus (HIV), Epstein-Barr virus (EBV), cytomegalovirus (CMV); markers of parenteral hepatitis B, C, D; determination of rheumatoid factor (RF), anti-streptolysin-O (ASLO); ultrasound examination (US) of the abdominal cavity and pelvis. Stage 3: X-ray examination of bones, paranasal sinuses, gastrointestinal tract; electroencephalography; magnetic resonance imaging (MRI) of the brain, electroneuromyography (ENMG), echocardiography (ECHO-KG). Statistical analysis of the obtained data was carried out using the application package "STATISTICA" - version 10 (StatSoft Inc.), Excel 2019. Research results. During the study, 31 medical histories of children were analyzed, including 15 boys and 16 girls. The average age of patients was 11 (8.4; 12.5) years. The average length of hospital stay was 9 (7; 10.5) bed-days. In the group of children studied, the number of patients discharged with the final diagnosis of "Acute upper respiratory tract infection" was 18 people (58.1%), of which the following were infected with viruses: cytomegalovirus - 15 people (48.4%), Epstein-Barr virus - 14 people (45.2%), herpes virus type 6 - 11 people (35.5%), adenovirus - 3 people (9.7%), influenza and parainfluenza - 2 people (6.5%), herpes virus types 1 and 2 - 2 people each (6.5%), mixed herpesvirus infection - 1 person (3.2%), adenovirus - 1 person (3.2%), metapneumovirus - 1 person.

About the authors

Elizabeth Vladislavovna Skorikova

Voronezh State Medical University named after N. N. Burdenko

Author for correspondence.
Email: skorikova555@mail.ru
ORCID iD: 0009-0007-4108-2283

4th year student of the pediatric faculty

Russian Federation, 12 Studencheskaya Street, 394036 Voronezh, Russian Federation

Anna Sergeevna Ivannikova

Burdenko Voronezh State Medical University

Email: ivannikofff@mail.ru
ORCID iD: 0000-0002-3664-6394

candidate of medical sciences, associate professor of the department of faculty and palliative pediatrics

Russian Federation, 12 Studencheskaya Street, 394036 Voronezh, Russian Federation

Vera Sergeevna Ledneva

Burdenko Voronezh State Medical University

Email: lvsmed@yandex.ru
ORCID iD: 0000-0002-8819-3382

Scientific supervisor – doctor of medical sciences, head of the department of faculty and palliative pediatrics

Russian Federation, 12 Studencheskaya Street, 394036 Voronezh, Russian Federation

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