Mycoplasma pneumoniae Relapsing fever (Borrelia recurrentis, other Borrelia) Salmonellosis Spirillum minus (rat-bite fever) Streptobacillus moniliformis (rat-bite fever)
Causes of Fever of Unknown Origin in Children—cont’d
Juvenile idiopathic arthritis (systemic onset, Still disease) Inflammatory bowel disease (Crohnʼs disease, ulcerative colitis) Kawasaki disease Polyarteritis nodosa Rheumatic fever
Castleman disease Chronic active hepatitis Cyclic neutropenia Deafness, urticaria, amyloidosis syndrome
Periodic fever syndromes Poisoning Postoperative (pericardiotomy, craniectomy)
Modified from Nield LS, Kamat D: Fever without a focus. In Kliegman RM, Stanton BF, St. Geme III JW, et al: Nelson Textbook of Pediatrics, ed 19, Philadelphia, 2011, Saunders.
sedimentation rate, C-reactive protein, hepatic transaminase and B. henselae antibody. Consultation with infectious dis-levels, urinalysis, cultures of urine and blood, chest radio-ease, immunology, rheumatic disease, or oncology specialists graph, and evaluation for rheumatic disease with antinuclear should be considered. Further tests may include lumbar puncantibody, rheumatoid factor, and serum complement (C3, C4, ture for cerebrospinal fluid analysis and culture; computed CH50). Additional tests for FUO may include throat culture, tomography or magnetic resonance imaging of the chest, stool culture, tuberculin skin test or interferon-gamma release abdomen, and head; radionuclide scans; and bone marrow assay, HIV antibody, Epstein-Barr virus antibody profile, biopsy for cytology and culture.
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Rashes are a common manifestation of many infections; this chapter describes five common childhood viral exanthems characterized by fever and rash. Rash distribution and appearance provide important clues to the differential diagnosis, including other infectious agents (Table 97-1).
Measles (rubeola) is highly contagious and is caused by a single-stranded RNA paramyxovirus with one antigenic type. Humans are the only natural host. Measles virus infects the upper respiratory tract and regional lymph nodes and is spread systemically during a brief, low-titer primary viremia. A secondary viremia occurs within 5 to 7 days as virus-infected monocytes spread the virus to the respiratory tract, skin, and other organs. Virus is present in respiratory secretions, blood, and the urine of infected individuals. Measles virus is transmitted by droplets or the airborne route and is highly contagious. Infected persons are contagious from 1 to 2 days before onset of symptoms—from about 5 days before to 4 days after the appearance of rash—and immunocompromised persons can have prolonged excretion of contagious virus.
Measles remains endemic in regions of the world where measles vaccination is not available and is responsible for about 1 million deaths annually. Since 2000 there typically have been fewer than 100 cases reported annually in the United States, although outbreaks resulting from imported virus after international travel occur. Infections of nonimmigrant children during outbreaks may occur among those too young to be vaccinated or in communities with low immunization rates. Most young infants are protected by transplacental maternal antibody until the end of their first year.