What to Know and When to Worry

A pediatric infectious diseases expert explains how parents can best treat a fever in young kids and when it’s time to seek care.

With many different viruses circulating this winter, parents and caregivers may begin to worry as soon as they see the first sign of a runny nose or sore throat in their children. Is it RSV? COVID-19? The flu? But the symptom that usually makes parents most concerned is fever.

“Fever is one of the most common reasons parents call the pediatrician, and when we see an increase in infections, we see more fevers,” said Dr. Karen Acker, a pediatric infectious diseases specialist and hospital epidemiologist at NewYork-Presbyterian Komansky Children’s Hospital and assistant professor of clinical pediatrics at Weill Cornell Medicine.

According to Dr. Acker, a fever, which is defined as a body temperature of more than 100. 4° F, is a body’s normal response to fighting an illness. It means the immune system is doing its job, and in most circumstances there is no need to be worried.

Health Matters spoke to Dr. Acker to learn more about fevers, including how long they last, ways to treat them, and when parents need to seek medical care for their children.

Health Matters: What are important things a parent should know when their child has a fever?
Dr. Acker: Typically, a fever due to a run-of-the-mill virus can last from 24 hours to three to four days. Sometimes, fevers can last longer — even over a week — and it’s not necessarily a reason to be alarmed, as long as the child is not struggling with other symptoms, such as dehydration, shortness of breath, or severe lethargy or irritability. But if your child has prolonged fever for seven days or more, it is a good idea to bring your child to your pediatrician for evaluation.

It’s a myth that these typical fevers can cause brain damage.

If a child has symptoms such as shortness of breath, fast breathing, poor oral intake of fluids, fever of more than 104° F, then it’s important to see a pediatrician. When babies have difficulty breathing, it’s harder for them to breastfeed or drink from a bottle, and that puts them at risk for becoming dehydrated.

How do you know the fever is due to a common cold, RSV, the flu, or COVID-19?
These viruses can often look alike, and while there are some general differences, the only way to know for sure is to bring your child to the pediatrician to get tested. Influenza is typically accompanied by high fever (103° or 104° F), body aches, fatigue, and upper respiratory symptoms, including cough. RSV usually causes runny nose and cough, but children can get a fever, and 20% to 30% of children have faster breathing due to infection of the lower airways (known as bronchiolitis). COVID-19 can cause runny nose, cough, and fever, but it appears to be a less common cause of more severe disease and hospitalization in children compared to RSV and influenza. (For more, see symptoms chart below.)

When is it time to take your child to the emergency department?
That’s always the big question.

For infants less than 6 weeks old, a fever always warrants a visit to the emergency department, because young babies are at higher risk for infection. You can call your pediatrician and they will recommend going to the emergency room.

For older infants, you should discuss with your pediatrician. The pediatrician should always have an on-call service.

If your child is unable to drink, is dehydrated (has less than five wet diapers in 24 hours), has difficulty breathing, or if your baby is inconsolable, it is recommended to go to the emergency department.

How can parents treat fevers at home?
Treating a fever is more about treating the symptoms rather than trying to bring down the temperature.

If a child has a fever and is still playing, drinking fluid, eating, and running around, there is no need to treat it with medication.

However, it’s normal for children to feel really uncomfortable when they have a fever. Typical symptoms include feeling achy, having chills, or a headache. Over-the-counter fever reducers, such as acetaminophen (Tylenol) and ibuprofen (Advil, Motrin), can reduce a child’s temperature and help them feel better.

Remember, babies under 6 months cannot take ibuprofen – only acetaminophen.

You don’t need to give your child a cold bath (unless it makes your child feel better).

Many people believe an ice-cold bath is the answer to a fever. The truth is, that will only make your child really upset, and after the bath, the fever will go right back up again. If your child wants to take a bath, lukewarm water does gently reduce the body heat.

Can you explain what causes a febrile seizure?
We are still learning why a fever can trigger seizure activity in the brain and why certain children have febrile seizures, although it is likely due to a mix of genetic and environmental factors. For parents, it is really scary to witness, but fortunately febrile seizures are almost always benign. If your child has a seizure at the same time as a fever, you should go to the emergency room for evaluation to make sure it is a simple febrile seizure. If it is just one isolated seizure that lasts less than 15 minutes (simple febrile seizure), it will likely have no lasting effects on the brain, and it will not increase the risk for epilepsy. If there is more than one seizure in a 24-hour period or a prolonged seizure, your child may be observed for longer and be evaluated by a neurologist.

Does a fever mean a child is contagious?
Usually children with viral infections are the most contagious when they have a fever. That’s why schools have specific guidelines about kids needing to be fever-free, without medication, for a full 24 hours before returning to the classroom.

What foods or drinks are recommended when a child has a virus?
The main priority is good hydration, so make sure your child is drinking plenty of fluids. When children have a fever, they usually don’t hydrate as well. I tell parents to monitor how much the child is urinating. It’s easy with a baby because you can check the diapers, and you want at least five wet diapers in a 24-hour period. For older kids, urinating every six hours is normal.

They are probably not going to have a big appetite, and that’s OK. If your child has vomiting and diarrhea, it’s best to choose foods that are not too hard on the stomach, such as applesauce, rice, and toast. And, of course, chicken soup, which has the added benefit of helping with hydration. Parents also ask about vitamin C or zinc to fight infection. If your child has a balanced diet, they are getting the appropriate amounts of vitamin C and zinc, so supplementation is not generally recommended or thought to have any impact.

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Are children with prolonged fever at a higher risk for serious illness? A prospective observational study

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Paediatric emergency medicine

Are children with prolonged fever at a higher risk for serious illness? A prospective observational study

1. http://orcid. org/0000-0001-9671-8161Ruud G Nijman1,2,3,
2. http://orcid.org/0000-0002-1148-9716Chantal D Tan4,
3. http://orcid.org/0000-0001-9237-4904Nienke N Hagedoorn4,
4. Daan Nieboer5,
5. http://orcid.org/0000-0001-6941-6491Jethro Adam Herberg2,
6. Anda Balode6,
7. http://orcid.org/0000-0001-8411-1071Ulrich von Both7,8,
8. Enitan D Carrol9,10,
9. Irini Eleftheriou11,
10. Marieke Emonts12,13,14,
11. Michiel van der Flier15,16,17,
12. Ronald de Groot16,17,
13. http://orcid.org/0000-0003-0685-689XBenno Kohlmaier18,
14. Emma Lim12,19,
15. http://orcid.org/0000-0002-9023-581XFederico Martinón-Torres20,
16. Marko Pokorn21,
17. Franc Strle21,
18. Maria Tsolia11,
19. Shunmay Yeung22,
20. http://orcid.org/0000-0002-4093-8509Joany M Zachariasse4,
21. Dace Zavadska6,
22. Werner Zenz18,
23. Michael Levin2,
24. Clementien L Vermont23,
25. http://orcid.org/0000-0001-9304-3322Henriette A Moll4,
26. Ian K Maconochie1
27. On behalf of PERFORM consortium

1. ¹Department of Paediatric Emergency Medicine, Division of Medicine, St. Mary’s hospital – Imperial College NHS Healthcare Trust, London, UK
2. ²Faculty of Medicine, Department of Infectious Diseases, Section of Paediatric Infectious Diseases, Imperial College London, London, UK
3. ³Centre for Paediatrics and Child Health, Imperial College London, London, UK
4. ⁴Department of General Paediatrics, Erasmus MC-Sophia Children’s Hospital, Rotterdam, Netherlands
5. ⁵Department of Public Health, Erasmus University Medical Centre, Rotterdam, Netherlands
6. ⁶Department of Pediatrics, Children’s Clinical University Hospital, Rīgas Stradiņa Universitāte, Riga, Latvia
7. ⁷Division of Paediatric Infectious Diseases, Dr. von Hauner Children’s Hospital, University Hospital, Ludwig-Maximilian-University, Munich, Germany
8. ⁸Partner site Munich, German Centre for Infection Research, Munich, Germany
9. ⁹Institute of Infection and Global Health, University of Liverpool, Liverpool, UK
10. ¹⁰Alder Hey Children’s NHS Foundation Trust, Liverpool, UK
11. ¹¹Second Department of Paediatrics, P & A Kyriakou Children’s Hospital, National and Kapodistrian University of Athens, Athens, Greece
12. ¹²Paediatric Immunology, Infectious Diseases & Allergy, Great North Children’s Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
13. ¹³Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
14. ¹⁴NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Trust and Newcastle University, Newcastle upon Tyne, UK
15. ¹⁵Paediatric Infectious Diseases and Immunology, Wilhelmina Children’s Hospital, University Medical Centre Utrecht, Utrecht, Netherlands
16. ¹⁶Paediatric Infectious Diseases and Immunology, Amalia Children’s Hospital, Radboud University Medical Centre, Nijmegen, Netherlands
17. ¹⁷Section Paediatric Infectious Diseases, Laboratory of Medical Immunology, Radboud Institute for Molecular Life Sciences, Nijmegen, Netherlands
18. ¹⁸Department of General Paediatrics, Medical University of Graz, Graz, Austria
19. ¹⁹Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
20. ²⁰Genetics, Vaccines, Infections and Paediatrics Research group (GENVIP), Hospital Clinico Universitario de Santiago, Santiago de Compostela, Spain
21. ²¹Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
22. ²²Clinical Research Department, Faculty of Tropical and Infectious Disease, London School of Hygiene and Tropical Medicine, London, UK
23. ²³Department of Paediatric Infectious Diseases and Immunology, Erasmus MC-Sophia Children’s Hospital, Rotterdam, Netherlands

1. Correspondence to Dr Ruud G Nijman, Department of Paediatric Emergency Medicine, Imperial College Healthcare NHS Trust, London W2 1NY, UK; r. nijman{at}imperial.ac.uk

Abstract

Objectives To describe the characteristics and clinical outcomes of children with fever ≥5 days presenting to emergency departments (EDs).

Design Prospective observational study.

Setting 12 European EDs.

Patients Consecutive febrile children <18 years between January 2017 and April 2018.

Interventions Children with fever ≥5 days and their risks for serious bacterial infection (SBI) were compared with children with fever <5 days, including diagnostic accuracy of non-specific symptoms, warning signs and C-reactive protein (CRP; mg/L).

Main outcome measures SBI and other non-infectious serious illness.

Results 3778/35 705 (10.6%) of febrile children had fever ≥5 days. Incidence of SBI in children with fever ≥5 days was higher than in those with fever <5 days (8.4% vs 5.7%). Triage urgency, life-saving interventions and intensive care admissions were similar for fever ≥5 days and <5 days. Several warning signs had good rule in value for SBI with specificities >0.90, but were observed infrequently (range: 0.4%–17%). Absence of warning signs was not sufficiently reliable to rule out SBI (sensitivity 0.92 (95% CI 0.87–0.95), negative likelihood ratio (LR) 0.34 (0.22–0.54)). CRP <20 mg/L was useful for ruling out SBI (negative LR 0.16 (0.11–0.24)). There were 66 cases (1.7%) of non-infectious serious illnesses, including 21 cases of Kawasaki disease (0.6%), 28 inflammatory conditions (0.7%) and 4 malignancies.

Conclusion Children with prolonged fever have a higher risk of SBI, warranting a careful clinical assessment and diagnostic workup. Warning signs of SBI occurred infrequently but, if present, increased the likelihood of SBI. Although rare, clinicians should consider important non-infectious causes of prolonged fever.

• Child Health
• Emergency Care
• Epidemiology
• Infectious Disease Medicine
• Paediatric Emergency Medicine

Data availability statement

Data are available in a public, open access repository. Data are available in a public, open access repository. A data set containing individual participant data will be made available in a public data repository containing a specific DOI. The data will be anonymised and will not contain any identifiable data. The data manager of the PERFORM consortium can be contacted for inquiries ([email protected]).

http://dx.doi.org/10.1136/archdischild-2023-325343

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• Child Health
• Emergency Care
• Epidemiology
• Infectious Disease Medicine
• Paediatric Emergency Medicine

Data availability statement

Data are available in a public, open access repository. Data are available in a public, open access repository. A data set containing individual participant data will be made available in a public data repository containing a specific DOI. The data will be anonymised and will not contain any identifiable data. The data manager of the PERFORM consortium can be contacted for inquiries ([email protected]).

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Footnotes

• Twitter @rgnijman, @CarrolEnitan, @BennoKohlmaier

• Collaborators Members of the Personalised Risk Assessment in Febrile Illness to Optimise Real-life Management across the European Union (PERFORM) consortium are provided in online supplemental file 1.

• Contributors Conceptualisation, design, funding: RGN, CDT, NNH, JMZ, DN, JAH, AB, UvB, EC, IE, ME, MvdF, RdG, BK, EL, IM, FM-T, MP, FS, MT, SY, DZ, WZ, ML, CV, HAM, IKM. Data curation: RGN, CDT, NNH, JMZ, DN, JAH, AB, UvB, EC, IE, ME, MvdF, RdG, BK, EL, FM-T, MP, FS, MT, SY, DZ, WZ, ML, CV, HAM, IKM. Formal analysis: RGN, CDT. Methodology: RGN, CDT, NNH, JMZ, DN, JAH, AB, UvB, EC, IE, ME, MvdF, RdG, BK, EL, FM-T, MP, FS, MT, SY, DZ, WZ, ML, CV, HAM, IKM. Supervision: RGN, HAM, IKM, CDT. Writing—original draft: RGN, HAM, IKM, CDT. Writing—review and editing: RGN, CDT, NNH, JMZ, DN, JAH, AB, UvB, EC, IE, ME, MvdF, RdG, BK, EL, FM-T, MP, FS, MT, SY, DZ, WZ, ML, CV, HAM, IKM. Guarantor: RGN.

• Funding This project received funding from the European Union’s Horizon 2020 research and innovation programme (Grant Agreement No 668303). The research was supported by the National Institute for Health Research Biomedical Research Centres at Imperial College London, Newcastle Hospitals NHS Foundation Trust and Newcastle University. RGN was funded by NIHR ACL award (ACL-2018-021-007).

• Competing interests None declared.

• Provenance and peer review Not commissioned; externally peer reviewed.

• Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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Fever in children without any symptoms

Fever in a child is the most common symptom faced by parents. Many pathological conditions, such as infectious diseases, heat stroke, blood transfusion, can lead to an increase in body temperature.

By definition, fever is body temperature >38°C. Rectal temperature is most accurate (especially in toddlers, infants, and newborns), as underarm temperatures are less accurate.

The original purpose of fever is to stimulate the body’s defenses to fight infection. An increase in temperature also stimulates an inflammatory response, which leads to the release of protective substances and cells into the damaged or infected area. The fever itself is not harmful. However, fever causes dehydration, which requires its timely correction.

For most children with fever, it’s relatively simple: fever has clinical signs of an identifiable source of infection—viral respiratory infection, acute otitis media, gastrointestinal tract, or viral exanthema. However, about 20% of children show fever without any noticeable clinical signs of the disease.

Prolonged fever of unknown origin is a rise in temperature that lasts longer than usual. For example, more than the seven to ten days expected for a simple viral infection. In many cases, no specific cause of fever is found and it simply stops.

But, on the other hand, the cause of such, at first glance, inexplicable temperature increase can be very dangerous diseases and conditions:

• Urinary tract infection
• Nephrites
• Bacteremia,
• Pneumonia
• Bacterial meningitis.

The most common cause (5%) is an occult urinary tract infection, especially in children under 2-3 years of age. The higher the temperature. The higher the probability of a child having a latent dangerous infection – on average, for every 0.5 degrees, the diagnostic probability of such an infection increases by 50%. But children with an infection as the cause of a fever almost never have a high enough and dangerous temperature (>41.5°C). Such a high temperature is usually observed only with non-infectious causes of hyperthermia.

Unusual diseases such as rheumatological or oncological diseases can also cause prolonged hyperthermia (fever), for 2-3 weeks.

If the child’s vital signs and clinical presentation continue to be of concern even after the child’s temperature has returned to normal, occult infections should also be suspected. However, if the child has normal vital signs and is clinically healthy after the temperature has returned to normal, then the likelihood of infections is very small, and parents can be sure that the fever itself is not dangerous.

If the child develops tachycardia (increased heart rate) after the temperature drops, dehydration and sepsis should be considered. Normally, a child’s heart rate increases by about 10 beats per minute and breathing rate by 5 breaths per minute for every degree Celsius temperature increase in a fever >38°C.

Diagnosing Hidden Causes of a Baby’s Fever

If a doctor examines a child during the first three to five days and finds no other symptoms, they may decide to simply observe your child after a complete physical examination, depending on how whether your child looks healthy or sick. After that, if the fever persists, the pediatrician will likely run additional tests, such as a streptococcal test and a complete blood count.

When diagnosing causes of prolonged fever without an obvious cause, the doctor will evaluate the duration of the fever, recent surgery, comorbidities, previous infections, immunization status (especially at 2 and 4 months of age).

During the physical examination, the doctor will look at the child’s behavior and mental state, assess how the child walks (to rule out septic arthritis/osteomyelitis), and carefully examine the skin, joints, and abdomen. A detailed physical examination may provide additional clues. The pediatrician may especially look for mouth ulcers, rashes, swollen lymph nodes, or classic symptoms of childhood illnesses such as Kawasaki disease.

The doctor will look at the main six causes of an occult bacterial infection that can lead to a fever without noticeable symptoms: 6

Septic arthritis or osteomyelitis.

Urinary tract infections of childhood are most likely if there is a history of previous similar diseases, fever >39°C for no apparent reason for more than 24 hours, sickly appearance of the child, tenderness in the suprapubic region (or dysuria and back pain or new urinary incontinence in older children). Urinary tract infections are more common in girls and uncircumcised boys. In all cases, it is recommended to pass a urine test (with culture), which will confirm or exclude the alleged diagnosis. Also, for diagnostic purposes, ultrasound of the kidneys and cystourethrography are performed.

A few weeks after the child becomes ill, an additional examination is carried out. This may include an abdominal ultrasound or CT scan to look for an occult abscess, a stool culture, an arthritis test, a thyroid function test, and antibody testing. If everything is normal, testing for non-infectious causes of fever, such as juvenile rheumatoid arthritis, malignancies, and inflammatory bowel disease, usually follows.

Children under 2 months of age and with seizures may need hospitalization. The treatment is carried out with the help of antibiotics and control of the hydration of the child’s body. Options for the use of antibiotics depend on the resistance of the pathogen. In a hospital setting, ampicillin and gentamicin are used. For home use by mouth, a doctor may prescribe cephalexin for most children or cefixime for infants 2-6 months of age, especially if there are urinary tract complications or abnormalities.

If the examination excludes a urinary tract infection, then further diagnostics is carried out in the form of a chest x-ray to rule out pneumonia. In this case, the indication is fever with no apparent source for more than 5 days, or cough for more than 10 days, or persistent high fever (> 40), or leukocytosis without any other cause. For example, mycoplasma pneumonia can cause high fever for one to three weeks. Also, a sign of latent pneumonia may be a respiratory rate that exceeds the expected value at an elevated temperature.

If the cause of the fever is unknown, a blood culture may be done to check for bacteremia. Children under 28 days of age are recommended for a complete septic examination, including lumbar puncture, as they are at the highest risk of developing latent dangerous infections. They do blood tests and cultures, urinalysis and cultures, lumbar puncture (cell count, protein, glucose, culture, Gram stain and culture, virus testing).

To help doctors narrow down the causes of your child’s fever, consider the following questions and possible sources of fever:

1. Are there animals at home? (salmonellosis from reptiles and psittacosis from birds)
2. Has anyone in the family experienced something like this after trips to the Mediterranean? Is there something similar in the family? (familial Mediterranean fever)
3. Does your child have a heart murmur? (bacterial endocarditis)
4. Has your child been around farm or wild animals? (brucellosis, tularemia)
5. Was your child bitten by a tick? (Lyme disease, Q fever)
6. Was your child scratched by a kitten? (cat-scratch disease)
7. Did they take any medication? (drug fever)
8. Has your child eaten any raw or undercooked foods or drank unpasteurized milk or juice?
9. Has your child had similar episodes before and was it associated with mouth ulcers? (Marshall Syndrome)
10. Has your child missed any routine vaccinations? (Your doctor may not think about vaccine-preventable diseases, believing that your child should be vaccinated and protected from them. )
11. Has your child recently left the country? (malaria or other infectious diseases)
12. In addition to fever, did they have other symptoms such as night sweats and weight loss? (lymphoma)

What drugs can reduce fever?

Children should be treated for fever equal to or greater than 39°C. Children between 6 months and 5 years of age may develop seizures due to high fever (called febrile seizures). If your child does have a febrile seizure, there is a chance that the seizures will recur, but as a rule, children will outgrow the febrile seizures. Febrile seizures do not mean your child has epilepsy.

Research indicates that ibuprofen may be a better choice than acetaminophen for pain and fever in children compared to acetaminophen. It is recommended to use no more than 3 doses of ibuprofen 10 mg/kg per day or 4 doses of 15 mg/kg acetaminophen per day. At the same time, the child should drink water to reduce the risk of drug toxicity. Some experts suggest prescribing antipyretics for fever only once a day to avoid potential complications when taken as scheduled, such as liver complications in children treated with acetaminophen every 4 hours, and kidney complications in children treated with ibuprofen every 6 hours.

Aspirin and the risk of Reye’s syndrome in children

Do not give your child aspirin without first talking to their doctor. Aspirin use in children has been linked to Reye’s syndrome, a potentially serious or fatal condition. Therefore, pediatricians do not recommend the use of aspirin (or any medication containing aspirin) to treat any viral illness in children.

Other ways to reduce temperature

Dress your child lightly. Excess clothing will trap body heat and cause a rise in temperature.

Encourage your child to drink plenty of fluids such as juices, sodas, punch or popsicles.

Give your child a warm bath.

Place cold washcloths on areas of the body where blood vessels are close to the surface of the skin, such as the forehead, wrists and groin.

When to call a doctor with a temperature?

Call your child’s doctor right away if your child is less than 2 months old and any of the following conditions are present:

• Fever over 40ºC
• Your baby is crying inconsolably
• Your baby is hard to wake up
• Your baby’s neck is stiff
• Your baby has cramps
• Any purple spots are present on the skin
• Breathing is difficult and does not improve after you clear your nose
• your child cannot swallow anything and is salivating
• your child looks very sick (if possible, check your child’s appearance one hour after taking the appropriate dose of acetaminophen)

Call your child’s doctor within 24 hours if your child is 2 to 4 months old and has any of the following conditions:

• Fever greater than 40°C (especially if your child is younger than 2 years old)
• Burning when urinating or pain
• Your child has had a fever for more than 24 hours with no apparent cause or infection.
• Your child has a fever for more than 72 hours
• The fever went away for more than 24 hours and then came back

Your child has a history of febrile seizures.

Call a doctor at home
To make an appointment with a doctor
or call +7 (812) 331-17-74

On the issue of differential diagnosis of fever of unspecified origin in children: a special case

Ukrainian Journal of Perinatology and Pediatrics. 2019. 3(79): 49-57; doi 10.15574/PP.2019.79.49

E.A. Oshlyanskaya, N.N. Music, T.N. Archakova, T.G. Nadtochiy, A.A. Doroshenko
National Medical Academy of Postgraduate Education named after P.L. Shupika, Kiev, Ukraine
Institute of Pediatrics of Obstetrics and Gynecology named after academician E.M. Lukyanova NAMS of Ukraine”, Kyiv

For cit iro van and i: Oshlyanskaya EA, Muzyka NN, Archakova TN, Nadtochiy TG et al. (2019). On the issue of differential diagnosis of fever of unspecified origin in children: a special case. Ukrainian Journal of Perinatology and Pediatrics. 3(79): 49-57. doi 10.15574/PP.2019.79.49
Received June 25, 2019, accepted September 15, 2019

Fever is the most common complaint when examining pediatric patients, most often due to viral or bacterial infections. However, in some clinical situations, determining the cause of fever is significantly difficult and may require a wide range of differential diagnosis, which includes numerous laboratory tests and various specific imaging methods for various structures of the child’s body. In rare cases, persistent fever remains a fever of unknown origin for a long time. Fever of unspecified origin is understood as a pathological condition, the main manifestation of which is an increase in body temperature above 38.3 ° C with repeated rises for 3 weeks or more, the etiology of which has not been established, despite the complex diagnostic studies. Fever of unspecified origin is one of the most difficult clinical situations for medical professionals, since there is not a single diagnostic “gold” standard and still remains a challenge for every doctor and requires a careful approach to each specific case. The main direction of diagnostic search in a child with a prolonged increase in body temperature remains the exclusion of three groups of diseases: autoimmune, oncological and infectious. A clinical case is presented with the onset of the disease with a fever of unspecified origin in a child. The peculiarity of this case is the absence for a long time of a sufficient number of clinical diagnostic criteria for inflammatory bowel diseases. The sequential process of differential diagnostics is considered.
The study was carried out in accordance with the principles of the Declaration of Helsinki. The study protocol was approved by the Local Ethics Committee (LEC) of all participating institutions. The informed consent of the child’s parents was obtained for the study.
The authors declare no conflict of interest.
Key words: children, fever, inflammatory bowel disease.

LITERATURE

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3. Ministry of Health of Ukraine. (2016). Unification of the clinical protocol of primary, secondary (specialized) and tertiary (highly specialized) medical care. Inflammatory disease of the intestines (krone ailment, virazkovy colitis): approved by the order of the Ministry of Health of Ukraine No. 90, dated 11. 02.2016. URL: http://mtd.dec.gov.ua/images/dodatki/2016_90_Krona/2016_90_YKPMD_Kron.pdf.

4. Ostrovsky MM, Stovban MP. (2013). Evaluation of the problem of fever of unknown origin in clinical practice. Galician medical bulletin. 20, 2: 158–164. URL: http://nbuv.gov.ua/UJRN/glv_2013_20_2_56.

5. Shlapak IP, Bondar MV, Kharchenko LA, Tsvik IM et al. (2015). Diagnosis of the causes of fevers of unknown origin. Emergency medicine. 3:20–25. URL: http://nbuv.gov.ua/UJRN/Medns_2015_3_5.

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