Fever in the tropics: aetiology and clinical profile of fever of unknown origin in children-a prospective observational study in a tertiary care hospital in South India


  • Ramachandran Sumathisri Department of Pediatrics, Mahatma Gandhi Medical College and Research Institute, Bahour, Puducherry, India
  • Karuppiah Pandi Department of Pediatrics, Mahatma Gandhi Medical College and Research Institute, Bahour, Puducherry, India
  • Sadagopan Srinivasan Department of Pediatrics, Mahatma Gandhi Medical College and Research Institute, Bahour, Puducherry, India




Etiology, Fever of unknown origin, Infectious Disease, Scrub Typhus


Background: Fever of unknown origin (FUO) is an important cause of morbidity and mortality in children, especially in tropical countries with varied aetiology and clinical presentation. Aim of this study is to determine the aetiology and outcome of FUO in Indian children. Study design is Prospective, observational study.  

Methods: We enrolled 75 children aged 1 to 12 years who were admitted with fever >8 days to the paediatric department from January 2015 to August 2016. Initial evaluation included complete blood count, peripheral smear, urine analysis, chest radiography, blood culture and tuberculin test.  

Results: In 72 children (96%), a definitive diagnosis could be established, whereas 3 children (4%) remained undiagnosed. Most common aetiology of FUO was infectious disease (90.6%) followed by malignancy (4%) and collagen vascular disease (1.3%). Among the infections group, scrub typhus was found to be the commonest aetiology (52%).

Conclusions: Infections were the most common etiological factor for FUO in children aged 1-12 years of our region.


Talano JA, Katz BZ. Long-term follow-up of children with fever of unknown origin. Clin Pediatr (Phila). 2000;39(12):715-7.

Pizzo PA, Lovejoy FH, Smith DH. Prolonged fever in children: review of 100 cases. Pediatrics. 1975;55(4):468-73.

Gaeta GB, Fusco FM, Nardiello S. Fever of unknown origin: a systematic review of the literature for 1995-2004. Nucl Med Commun. 2006;27(3):205-11.

Chow A, Robinson JL. Fever of unknown origin in children: a systematic review. World J Pediatr. 2011;7(1):5-10.

Petersdorf RG. Fever of Unknown Origin. Ann Intern Med. 1969;70(4):864-6.

Kejariwal D, Sarkar N, Chakraborti SK, Agarwal V, Roy S. Pyrexia of unknown origin: a prospective study of 100 cases. J Postgrad Med. 2001;47(2):104.

Joshi N, Rajeshwari K, Dubey AP, Singh T, Kaur R. Clinical spectrum of fever of unknown origin among Indian children. Ann Trop Paediatr. 2008;28(4):261-6.

Cruz Guerrero G, Navarro González J, Cintado Bueno C. Fever of unknown origin in children. An Esp Pediatr. 1978;11(10):683-92.

Çiftçi E, İnce E, Doğru Ü. Pyrexia of unknown origin in children: a review of 102 patients from Turkey. Ann Trop Paediatr. 2003;23(4):259-63.

McClung HJ. Prolonged fever of unknown origin in children. Am J Dis Child. 1972;124(4):544-50.

Feigin RD, Shearer WT. Fever of unknown origin in children. Curr Probl Pediatr. 1976;6(10):1-65.

Lohr JA, Hendley JO. Diagnostic Review: Prolonged Fever of Unknown Origin: A Record of Experiences with 54 Childhood Patients. Clin Pediatr (Phila). 1977;16(9):768-73.

Steele RW, Jones SM, Lowe BA, Glasier CM. Usefulness of scanning procedures for diagnosis of fever of unknown origin in children. J Pediatr. 1991;119(4):526-30.

Chantada G, Casak S, Plata JD, Pociecha J, Bologna R. Children with fever of unknown origin in Argentina: an analysis of 113 cases. Pediatr Infect Dis J. 1994;13(4):260-3.

Jacobs RF, Schutze GE. Bartonella henselae as a cause of prolonged fever and fever of unknown origin in children. Clin Infect Dis Off Publ Infect Dis Soc Am. 1998;26(1):80-4.

Cogulu O, Koturoglu G, Kurugol Z, Ozkinay F, Vardar F, Ozkinay C. Evaluation of 80 children with prolonged fever. Pediatr Int Off J Jpn Pediatr Soc. 2003;45(5):564-9.

Pasic S, Minic A, Djuric P, Micic D, Kuzmanovic M, Sarjanovic L, et al. Fever of unknown origin in 185 paediatric patients: A single‐centre experience. Acta Paediatr. 2006;95(4):463-6.

Mouaket AE, El-Ghanim MM, Al-Quod N, Abd-El-Al YK. Prolonged unexplained pyrexia: a review of 221 paediatric cases from Kuwait. Infection. 1990;18(4):226-9.

Somashekar HR, Moses PD, Pavithran S, Grace Mathew L, Agarwal I, Rolain JM, et al. Magnitude and features of scrub typhus and spotted fever in children in India. J Trop Pediatr. 2005;52(3):228-9.

Mathai E, Rolain JM, Verghese GM, Abraham OC, Mathai D, Mathai M, et al. Outbreak of scrub typhus in southern India during the cooler months. Ann N Y Acad Sci. 2003;990:359-64.

Padbidri VS, Gupta NP. Rickettsiosis in India. A review. J Indian Med Assoc. 1978;71(4):104-7.

Akpede GO, Akenzua GI. Aetiology and management of children with acute fever of unknown origin. Paediatric drugs. 2001;3(3):169-93.

Jung A, Singh MM, Jajoo U. Unexplained fever-analysis of 233 cases in a referral hospital. Ind J Med Sci. 1999;53(12):535-44.






Original Research Articles