Table 3.

Factors to consider when examining a child with prolonged, recurrent, or periodic fever

Clinical history
  • Age of onset, duration, frequency, prodrome, and peak of fever

  • If recurrent or periodic pattern, determine the interval between febrile episodes and whether the child is well between episodes

  • Exposures and potential triggers (eg, contact with someone who is ill, animals, or insects; travel history; recent immunizations; use of prescription medications, supplements, herbal products)

  • Associated systemic signs and symptoms, including the following: weight loss; night sweats; malaise; lymphadenopathy; serositis; and ocular (eg, conjunctivitis, episcleritis), oropharyngeal (eg, aphthous ulcers), gastrointestinal (eg, abdominal pain, bloating, diarrhea), dermatologic (eg, rash, urticaria, pyogenic lesions), musculoskeletal (eg, arthralgias, weakness), and neurologic (eg, sensorineural deafness) manifestations

  • If recurrent or periodic pattern, determine whether associated features are similar and predictable

  • Clinical state during disease-free intervals

  • Nutrition (including consumption of dairy products)

  • Growth and development (including growth chart)

  • Infections caused by unusual or opportunistic pathogens suggestive of immunodeficiency

  • Frequent localization of infections to the same organ system suggestive of anatomic anomalies

  • Ethnicity and family history (eg, recurrent fevers, unexplained deafness, renal failure, amyloidosis); consider detailed pedigree chart of at least 3 generations to explore mode of inheritance

  • Genetic testing (if done in other family members)

Physical examination
  • Focused organ-specific examination

  • Notation of oropharyngeal changes, lymphadenopathy, skin changes, musculoskeletal findings

  • Complete blood count with differential

  • Inflammatory markers (eg, CRP, ESR)

  • Screening serum chemistry tests (eg, uric acid and lactate dehydrogenase if suspicious of malignancy)

  • Serum quantitative immunoglobulin levels

  • Urine culture and urinalysis

  • Blood culture

  • Antinuclear antibodies

  • Antineutrophil cytoplasmic antibody

  • Appropriate imaging as directed by examination

  • Biopsy of affected tissue

  • CRP—C-reactive protein, ESR—erythrocyte sedimentation rate.