Differential Diagnosis (DD) of Febrile Diseases

  • #x203A; Establishing a diagnosis from several clinical presentations is a common challenge in paediatrics that needs knowledge and experience to solve. This chapter provides clinicians with a guide to clinical and laboratory means to reach a diagnosis of the most common febrile diseases.

  • › Infection is the most likely diagnosis in a child with fever, where the fever is usually of short duration and is associated with a focus in about three quarters of cases and without a focus in the majority of the remaining cases.

  • › Viral infections, affecting mainly the upper respiratory tract (URT), are the cause of fever in about 90–95% of febrile children. It is the physician’s primary role to identify the remaining 5–10% of children who have a bacterial infection and who may require antibiotic treatment.

  • › Nowadays, most cases of tonsillitis, otitis media and pneumonia, during the first years of life, are caused by a viral infection.

  • › In the tropics, bacterial and parasitic infections are more common than in developed countries and are important causes of mortality of millions of children.

  • › Pyrexia of unknown origin is considered when fever persists for more than one week: it’s cause is unknown despite investigation. In contrast to adults, PUO in children is mostly due to infection followed by collagen and vascular causes.

  • › The diagnosis of fever of non-infectious origin is considered after excluding an infection. This is done by history, physical examination and laboratory tests.

  • › Persistent and/or insidious fever of a low degree (< 39.5°C), the absence of chills and diurnal rhythm of fever are suggestive of non-infectious fever.

  • › An important cause of elevated body temperature is heatstroke, which is due to a combination of heat, high humidity, excessive wrapping and lack of fluids.


Juvenile Idiopathic Arthritis Kawasaki Disease Lyme Disease Cerebral Malaria Febrile Seizure 
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    The Paediatric Accident and Emergency Research Group. RCPCH Guideline Appraisal & Summary (Decreased Conscious Level), Nov 2005Google Scholar

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© Springer-Verlag Berlin Heidelberg 2009

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