P074 Prolonged fever in children: Epidemiological and etiological profile in the eastern region of Morocco—about 119 cases
Authors: Bouhmidi M , Babakhouya A , El Ouali A , Ghannam A , Rkain M , Benajiba N 
Published: November 2021

Abstract

Background
Prolonged fevers (PF) are defined as a thermal shift &gt;38 ° C without any immediately obvious cause (fever of unknown origin). The fever is considered as prolonged when it lasts at least 7 days in children and 5 days in infants. PF constitute a frequent reason for consultation. Our Objective is to highlight the epidemiological and etiological profile of prolonged fevers in children in the eastern region of Morocco.

Material and methods
Our work is a retrospective study of 119 cases, conducted from January 1, 2015 to July 31, 2018 in the pediatric department of the C.H.U Mohammed VI Mother-Child Hospital in Oujda, Morocco.

Results
The hospital incidence of PF in this study was 2.8%. The patients average age was 49 months. A male predominance was noted (63 boys). The patients were living in urban zone in 76% of cases. The symptom duration before first consultation was 18 days. Children with a history of suspected but not confirmed infection with notion of taking antibiotics and antipyretics were noted in 30% of cases. The functional signs were dominated by digestive symptoms in 34 patients, followed by mucocutaneous signs in 26% of cases, and cardiorespiratory manifestations in 12% of cases. The main physical signs were represented by a tumor syndrome in 34 patients, and 31 cases of cutaneous involvement. The etiologic diagnosis was confirmed by an abdominal ultrasound in 48% of cases, a myelogram in 19% of cases, a chest X-ray in 17% of cases, and a cardiac ultrasound in 14.5% of cases.
At the end of the etiological investigation, the infectious causes were in 52 cases, inflammatory diseases in 32 cases, neoplasia in 27 cases, and undetermined causes 8 cases.

Discussion
The hospital incidence of prolonged fevers is difficult to estimate because of the nosological problem they pose. However, FP constitutes 0.4% to3% of the reasons for pediatric hospitalization. In our study, it was 2.8%. Regarding age, almost half of the children hospitalized for FP exploration are under the age of six. This can be explained by the high frequency of febrile diseases, in particular infectious diseases, at this age the male predominance was marked in most studies with a sex ratio ranging from 1.1–1.8. The clinical signs on admission did not allow a clear etiological orientation, and it was the repeated questioning and physical examination during hospitalization that guided the etiological investigation. The most common feature is infectious causes. There is a high percentage of neoplastic causes compared with the literature. Indeterminate causes constitute only 6.7% compared with higher figures in the literature which can be explained by the progress of examinations in the field of etiological research.

Conclusion
Prolonged fevers in children therefore remains a complex condition to handle despite advances in diagnostic means. Careful clinical examination is necessary for the management of children with PF. In fact, the patient should be regularly reassessed in search of new symptoms and other investigation leads. The reasoned prescription of additional workups and critical analysis of clinical signs are also essential steps in the etiological investigation.