The child with prolonged fever: when to think zebras

Fever is a very common paediatric presentation and usually has an identifiable infectious aetiology. However, for the child with prolonged fever it is sometimes necessary to look beyond the usual suspects and consider the ‘zebra’ diagnoses – that is, the unusual ones. This update of our 2020 article addresses when to consider rarer and potentially life-threatening infective, autoimmune or malignant causes of prolonged fever and their immediate management. The advent of the COVID-19 pandemic (and thus the need to consider paediatric inflammatory multisystem syndrome temporally associated with COVID-19), the increase in tuberculosis and the resurgence in measles have been considered in the re-working of this paper.