Prolonged unexplained pyrexia: a review of 221 paediatric cases from Kuwait.

Over a three year period (January 1985 through December 1987), 221 children with prolonged pyrexia were admitted to the paediatric departments in two regional hospitals in Kuwait. Infections, connective tissue diseases and malignancies constituted 78%, 5% and 2%, respectively, and 15% of the cases remained undiagnosed. Brucella was the most common infectious agent encountered (38% of all cases), followed by typhoid fever (9%). The duration of fever was more helpful in the differential diagnosis than its height or pattern. The erythrocyte sedimentation rate and the white blood count were of limited value, and the C-reactive protein was positive in bacterial infections, malignancies and connective tissue diseases. Since a child presenting with prolonged pyrexia in this country has over a 70% chance of having a bacterial infection, both diagnostic and therapeutic procedures should be performed as an emergency measure. Particular emphasis should be put on the exclusion of brucellosis.