Periodic Fever syndromes

Overview of Systemic Autoinflammatory Diseases

Systemic autoinflammatory diseases (SAID) are a growing family of disorders of the innate immune system. Over the years, there have been changes in the definition, classification and nomenclature of SAID as new syndromes and pathophysiologic mechanisms continue to be described. Recognizing the clinical manifestations of SAID is important for their early diagnosis and management. The field continues to advance with potential new therapies underway.

Fifteen-minute consultation: The infant with frequent infections

Children with frequent or recurrent infections commonly present to medical practitioners in both primary and secondary care. Here we provide a structured approach to the consultation of the infant under 2 years of age with frequent infections. The key is a focused history and examination to elicit red flags to an underlying diagnosis, while at the same time seeking benign explanations for the frequency of infections, which account for the majority of children, thereby avoiding unnecessary investigations.

Severe phenotypic spectrum of mevalonate kinase deficiency with minimal mevalonic aciduria

Mevalonate kinase deficiency is a rare autosomal recessively inherited organic aciduria with a complex multi-systemic phenotype. We describe two deceased patients with clinically severe mevalonate kinase (MK) deficiency confirmed by MK mutation analysis. The phenotype in our patients ranged from neonatal hydrops in the first patient to severe failure to thrive, hepatosplenomegaly, recurrent febrile episodes and lymphadenopathy in the second. Both infants excreted relatively low amounts of mevalonic acid intermittently.

Current challenges in the diagnosis and management of fever

PURPOSE OF REVIEW

We review recommendations from recent publications on the management of fever with antipyretics, the classification and diagnosis of fevers of unknown origin (FUO), and the evaluation of fever in infants under 90 days of age.

RECENT FINDINGS

Anxiety about fever persists in the population, while the toxicity of antipyretics is an increasing concern. The numerous opportunities for overdosing with antipyretics have been emphasized by the American Academy of Pediatrics (AAP). The practice of alternating acetaminophen and ibuprofen has limited value. Nonclassic FUO and pseudo-FUO are as important to consider as true FUO, and clinicians should become familiar with the variety of periodic fever syndromes. The clinical utility of low-risk criteria to identify febrile infants at low risk for serious bacterial infection (SBI) was demonstrated in a systematic review of studies.

SUMMARY

Pediatricians should spend more time educating parents about fever and antipyretic use. Not all persistent fever is FUO, and testing should be targeted to the child's clinical condition. Existing low-risk criteria should be used to identify febrile infants who can be managed without extensive work-up and antibiotics. Adherence to evidence-based recommendations will lessen the morbidity and mortality associated with febrile illnesses in children.