Advertisement

Fever

Chapter
  • 1.1k Downloads
  • › 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.

Keywords

Kawasaki Disease Familial Mediterranean Fever Cerebral Spinal Fluid Hypoplastic Left Heart Syndrome Febrile Episode 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

Periodic Fever

  1. 1.
    Padeh S. Periodic fever syndromes. Pediatr Clin North Am 2005; 52: 577–609PubMedCrossRefGoogle Scholar

Manifestations of Fever

  1. 2.
    O'Dempsey TJD, Laurance BE, McArdle, et al. The effect of temperature reduction on respi ratory rate in febrile illnesses. Arch Dis Child 1993; 68: 492–95PubMedCrossRefGoogle Scholar

Potential Complications

  1. 3.
    Dubois EF. Why are fever temperatures over 106°F rare? Am J Med Sci 1949; 217: 361–8PubMedCrossRefGoogle Scholar
  2. 4.
    Tautner B W, Caviners AC, Gerlacher GR, et al. Prospective evaluation of the risk of serious bacterial infection in children who present to the emergency department with hyperpyrexia (temperature of 106°F). Pediatrics 2006; 118: 34–40CrossRefGoogle Scholar
  3. 5.
    Press S, Fawwett N P. Association of temperature greater than 41.1°C (106°F) with serious illness. Clin Pediatr 1985; 24: 21–5CrossRefGoogle Scholar
  4. 6.
    Pomerance JJ, Richardson J. Hyperpyrexia as a sign of intraventricular haemorrhage in the neonate. Am J Dis Child 1973; 126: 854–5PubMedGoogle Scholar

Fever with Localized Signs

  1. 7.
    Lieberman E, Lang J, Richardson DK, et al. Intrapartum maternal fever and neonatal out come. Pediatrics 2000; 105: 8–13PubMedCrossRefGoogle Scholar
  2. 8.
    Pantell RH, Naber M, Lamar R, et al. Fever in the first six months of life. Clin Pediatr 1980; 19: 77–82CrossRefGoogle Scholar
  3. 9.
    O'Shea JS. Assessing the significance of fever in young infants. Clin Pediatr 1978; 17: 854–6CrossRefGoogle Scholar
  4. 10.
    McCarthy PL, Dolan T F. The serious implication of high fever in infants during their first three months. Clin Pediatr 1876; 15: 794–6CrossRefGoogle Scholar
  5. 11.
    Bonadio WA, Hegenbarth M, Zachariason M. Correlating reported fever in young infants with sub sequent temperature pattern and rate of serious bacterial infections. Pediatr Infect Dis J 1990; 9: 158–60PubMedCrossRefGoogle Scholar

Fever without Localizing Signs

  1. 12.
    Teele DW, Pelton SI, Grant MJA, et al. Bacteraemia in febrile children under 2 years of age: results of cultures of blood of 600 consecutive febrile children seen in a “walk in” clinic. J Pediatr 1975; 87: 227–30PubMedCrossRefGoogle Scholar
  2. 13.
    McCabe WR, Treadwell TL, De Maria A. Pathophysiology of bacteraemia. Am J Med 1983; 75: 7–17PubMedCrossRefGoogle Scholar
  3. 14.
    Vesikari T, Janas M, Grönroos P, et al. Neonatal septicaemia. Arch Dis Child 1985; 60: 157–60CrossRefGoogle Scholar

Persistent Fever of Unknown Origin

  1. 15.
    Pertersdorf RO, Besson PB. Fever of unexplained origin: report of 100 cases. Medicine 1961; 40: 1–30CrossRefGoogle Scholar

Fetal Malformation and Fever

  1. 16.
    Ivarsson SA, Henriksson P. Septic shock and hyperthermia as possible teratogenic factors. Acta Paediatr Scand 1984; 73: 73: 855–6Google Scholar
  2. 17.
    Fraser FC, Skelton J. Possible teratogenicity of maternal fever. Lancet 1978; 3: 634CrossRefGoogle Scholar
  3. 18.
    Pleet H, Graham JM, Smith D. Central nervous system and facial defects associated with maternal hyperthermia at four to 14 weeks gestation. Pediatrics 1981; 67: 785–9PubMedGoogle Scholar
  4. 19.
    Edwards MJ. Congenital defects in guinea pigs. Acta Pathol 1967; 84: 42–8Google Scholar
  5. 20.
    Clarren SK, Smith DW, Ward HR, et al. Hyperthermia-a prospective evaluation of a possible teratogenic agent in man. J Pediatr 1979; 95: 81–3PubMedCrossRefGoogle Scholar
  6. 21.
    Andersen AN, Vastrup P, Wohlfahrt J, et al. Fever in pregnancy and risk of fetal death: a cohort study. Lancet 2002; 360: 1552–6PubMedCrossRefGoogle Scholar
  7. 22.
    Rapola J, Saxon L, Granroth G. Anencephaly and the sauna. Lancet 1978; 2: 1162CrossRefGoogle Scholar

Drug Fever

  1. 23.
    Mackowiak PA. Drug fever: mechanisms, maxims and misconception. Am J Med Sci 1987; 294: 275–86PubMedCrossRefGoogle Scholar
  2. 24.
    Liberek A, Luczak G, Korzan M, et al. Tolerance of interferon-alpha therapy in children with chronic hepatitis B. J Paediatr Child Health 2004; 40: 265–9PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2009

Personalised recommendations