• › Fever is a very common complaint in children accounting for as many as 20% of paediatric visits to doctors.

  • › How sick the child looks is more important than the level of fever.

  • › Normal body temperature does not preclude serious infection.

  • › Most children aged 0–36 months who have fever have a focus of infection, which can be identified by careful history and examination. A viral upper respiratory tract infection is the most common focus.

  • › Most children aged 0–36 months without an obvious focus of infection have viral infections, but they may harbor two important serious bacterial infections (SBI): urinary tract infection or bacteremia.

  • › Febrile neonates and ill-looking children, regardless of age, are at high risk for SBI and need antibiotic coverage, hospital admission, and comprehensive septic work-up. This entails blood and urine cultures, full blood cell count (FBC), C-reactive protein (CRP), and, when indicated, chest X-ray, LP and stool studies.

  • › Children aged 1–36 months without a focus may be treated more selectively: if the temperature is >39°C, WBC count is >15,000 mm−3 and CRP is >40 mg L−1; urine and blood cultures should be ordered; and a third-generation cephalosporin (ceftriaxone or cefotaxime) considered.

  • › The distribution of the diseases causing pyrexia of unknown origin (PUO) differs according to the geographic area and the socioeconomic status of the country.

  • › In PUO, atypical presentation of a common disease is more common than a rare and exotic disease.


Kawasaki Disease Familial Mediterranean Fever Cerebral Spinal Fluid Hypoplastic Left Heart Syndrome Febrile Episode 
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