Distinguishing among prolonged, recurrent, and periodic fever syndromes: Approach of a pediatric infectious diseases subspecialist

Abstract

Most children with the perceived problem of prolonged, recurrent, or periodic fever are healthy and have self-limited, common illnesses. With careful delineation of specific features of the illness, confirmation of maintenance of growth and sense of well-being, and reassurance of normal findings on physical examination, the primary care practitioner usually can reassure families and continue to reassess the patient as circumstances dictate. For a child with true fever of unknown origin, a pediatric infectious diseases subspecialist should be consulted. For the unusual child with a course compatible with a noninfectious periodic fever syndrome, referral to a subspecialist is important because condition-specific diagnostic tests and interventions are available or are under study, genetic counseling may be important, and follow-up for evolution of disease or sequelae is crucial. The consultant might be a pediatric immunologist, rheumatologist, infectious diseases consultant, or hematologist depending on findings and expertise of available consultants. For the rare child with a suspected immunologic defect, referral to an immunologist (or infectious diseases subspecialist in some geographic areas) is necessary to begin complex evaluations, which often lead to lifesaving therapies. © 2005 Elsevier Inc. All rights reserved.