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Clinical Spectrum of Pediatric Fever of Unknown Origin (FUO) Before and During COVID-19 Pandemic

31 Pages Posted: 29 Nov 2022

See all articles by Jin Wei Ruan

Jin Wei Ruan

Anhui Medical University - Department of Pediatrics

Man Man Niu

Anhui Medical University - Department of Pediatrics

Qi Jiang

Anhui Medical University - Department of Pediatrics

Ying Cai

Anhui Medical University - Department of Pediatrics

Cai Yun Xia

Anhui Medical University - Department of Pediatrics

Yan Fang Zhang

Anhui Medical University - Department of Pediatrics

Dao Ting Li

Anhui Medical University - Department of Pediatrics

Qian Yang

Anhui Medical University - Department of Pediatrics

Peng Hu

Anhui Medical University - Department of Pediatrics

More...

Abstract

Background: The current control and prevention strategies for COVID-19 transmission and public panics over abnormal temperature may alter the clinical spectrum of fever of unknown origin (FUO) in children. 

Methods: Hospitalized pediatric patients with complaints of prolonged fever were enrolled during the period of Jan. 2018-Jun. 2022. FUO was diagnosed according to the classical criteria by Petersdorf and Beeson, and categorized into 5 groups: infectious disease, autoimmune and auto-inflammatory disease (AID), malignancy, miscellaneous, and unknown causes. Detailed patient history, physical examination and laboratory work-up were collected.

Results: 163 from 296 children having prolonged fever were identified with FUO, including 59 pre-COVID-19 and 104 during COVID-19 pandemic. The male/female ratio was higher during COVID-19 pandemic than pre-COVID-19 pandemic (2.06 vs. 1.03, p=0.039). Significant increase was found in the proportion of infectious disease (47.46% vs. 74.04 %, χ2=11.604, p=0.001), and sharp decreases were found in the proportions of AID (20.34% vs. 6.73%, χ2,==7.276, p=0.007) and malignancy (23.73% vs. 4.80%, χ2=16.546, p=0.000) during COVID-19 pandemic. The median time of fever before hospitalization was 30 (IQR24-40) days and subjected to a significant decrease during COVID-19 pandemic (30[IQR21-32] vs. 31[IQR24-45], Z=-2.456, p=0.014). Patients with circulatory system symptoms significantly increased from 8 cases pre-COVID-19 pandemic to 28 cases during COVID-19 pandemic (χ2=5.245, p=0.022). The levels of WBC, PCT, CRP and ESR were significantly lower during COVID-19 pandemic than pre-COVID-19 pandemic, whereas the level of RF exhibited a significant increase during COVID-19 pandemic (p<0.05). Compared with pre-COVID-19 pandemic, glucocorticoid/immunosuppressor therapies significantly decreased during COVID-19 pandemic (12 cases vs. 7 cases, p=0.009; 8 cases vs.4 cases, p=0.030). On discharge, body temperature returned to normal in 50 cases (84.75%) pre-COVID-19 pandemic and 92 cases (88.46%) during COVID-19 pandemic. The proportions of normal neutrophil count and CRP on discharge significantly increased from 35.71% to 61.90%, and from 26.67% to 48.15% respectively between pre- and during COVID-19 pandemic. The absolute change of WBC significantly decreased from 4.63×109/L pre-COVID-19 to 2.12×109/L during COVID-19 pandemic (Z=-2.41, p<0.05). 

Conclusions: The occurrence of pediatric FUO tends to be higher during COVID-19 pandemic. An increased proportion of infectious disease may lead to more patients with normal body temperature on discharge; in addition, the difference in age distribution of FUO patients may contribute to a significantly decrease in the absolute changes of WBC on discharge during COVID-19 pandemic.

Funding Information: No funding was received for conducting this study.

Declaration of Interests: The authors declare no conflict of interest.

Ethics Approval Statement: Approval for the present study was acquired from the Medical Ethic Committee of the First Affiliated Hospital of Anhui Medical University and obtained consent from parents of all subjects.

Keywords: Coronavirus disease-2019, Fever of unknown origin, Infectious disease, Psychogenic fever, Retrospective study

Suggested Citation

Ruan, Jin Wei and Man Niu, Man and Jiang, Qi and Cai, Ying and Xia, Cai Yun and Zhang, Yan Fang and Li, Dao Ting and Yang, Qian and Hu, Peng, Clinical Spectrum of Pediatric Fever of Unknown Origin (FUO) Before and During COVID-19 Pandemic. Available at SSRN: https://ssrn.com/abstract=4284633 or http://dx.doi.org/10.2139/ssrn.4284633

Jin Wei Ruan

Anhui Medical University - Department of Pediatrics ( email )

Man Man Niu

Anhui Medical University - Department of Pediatrics ( email )

Qi Jiang

Anhui Medical University - Department of Pediatrics ( email )

Ying Cai

Anhui Medical University - Department of Pediatrics ( email )

Cai Yun Xia

Anhui Medical University - Department of Pediatrics ( email )

Yan Fang Zhang

Anhui Medical University - Department of Pediatrics ( email )

Dao Ting Li

Anhui Medical University - Department of Pediatrics ( email )

Qian Yang

Anhui Medical University - Department of Pediatrics ( email )

Peng Hu (Contact Author)

Anhui Medical University - Department of Pediatrics ( email )

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