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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
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: Suggested Citation