› 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.
KeywordsKawasaki Disease Familial Mediterranean Fever Cerebral Spinal Fluid Hypoplastic Left Heart Syndrome Febrile Episode
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Manifestations of Fever
Fever with Localized Signs
Fever without Localizing Signs
Persistent Fever of Unknown Origin
Fetal Malformation and Fever