Patient history should be more detailed than that obtained for
acute illnesses, carefully examining family history, previous illnesses,
recent symptoms, current medications, travel, and exposure to pets
or humans with potential communicable pathogens. Weight loss, failure
to thrive, or decreased activity during afebrile periods are more
ominous systemic signs that will usually require a more rapid diagnostic
evaluation. Prolonged fever and bone pain may be the only manifestations
of bone tumors, leukemia, osteomyelitis, syphilis, cat-scratch disease,
tuberculosis, or Langerhans cell histiocytosis. In the presence
of documented fever and constitutional symptoms, a history of abdominal
pain necessitates evaluation for autoimmune diseases, pyelonephritis,
Crohn disease, and hepatitis, as well as abdominal abscesses and
tumors.