Persistent and Recurrent Fever Without Focus in Children: A Contemporary Evidence-Based Approach for Pediatricians

Persistent or recurrent fever without a clear source (fever without focus, FWF) in children under 10 years presents a significant diagnostic and therapeutic challenge, especially in high-burden urban settings like Bangalore. This comprehensive review synthesizes current evidence on the epidemiology, evolving infectious etiologies, diagnostic strategies, and management principles. Emphasizing a structured, tiered approach informed by recent advances in molecular diagnostics and prediction models, it advocates for judicious use of resources and antimicrobial stewardship. The article highlights region-specific factors influencing etiologies, including emerging viral infections, tuberculosis, enteric fever, and rickettsial diseases. This evidence-based framework supports clinical decision-making and interdisciplinary collaboration to optimize patient outcomes and reduce unnecessary interventions.