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Child hospitalised for fever. No meningitis and bacteria. Red-eyes, and coughed mucous. CRP is 90. What is it?

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My baby is in hospital for 5 days because of fever (39.2 without medication, 37.0 with Paracetamol). Meningitis was ruled out by Lumbar puncture. Bacteria were not found in several culture (Petri) tests. He has red-eyes, and today he coughed and emitted significant mucous. The doctors think it's a virus, but his CRP was 35 when entering the hospital and today it was 90, and I read that 40-200 suggests a bacteria and not a virus. I am very worried because his fever is not decreasing. What can it be? Please help. XXXXXXX
Posted Sun, 19 May 2013 in Child Health
Answered by Dr. Himanshi Kashyap 2 hours later

Thanks for your query.

Since blood culture (hopefully was done before starting antibiotics)done is negative it mostly rules out bacterial infection. However to rule out bacterial infection one might need to do urine culture also.

Since your son is also coughing a chest X-ray should also be done to rule out pneumonia. CRP is quite high and I think one must start some base line antibiotics at this stage .

In some viral illness once the fever subsides the rash might appear along with eye congestion ,so keep a watch on it.

There are many more reasons for fever so one might need to be patient since the investigations are carried out in a step wise manner depending on the days of fever.Since the meningitis which is a XXXXXXX illness has been ruled out try to relax at this stage.Also if your son is active and having his regular feeds then again it might not be a bad infection.

Hope to have answered your query.
Do get back if you have more queries.

Take care.

Above answer was peer-reviewed by
Follow-up: Child hospitalised for fever. No meningitis and bacteria. Red-eyes, and coughed mucous. CRP is 90. What is it? 5 hours later
Thanks. He is under antibiotics for 5 days.
We tought of Toxoplasma or CMV or Kawasaki or Rickettsa.
What do you think?
Answered by Dr. Himanshi Kashyap 16 minutes later

The illnesses which you mentioned are not very common cause of fever.

Toxoplasmosis and Cytomegaloviral infection at this age would be part and parcel of congenital infection i.e passed from the mother in which case the status in the mother will be known during pregnancy.Since both these infection would have neurological outcomes the babies development would also be delayed.

Kawasaki and Rickettsial infection are associated with rash which the child at day 5 doesn't have .So we will have to wait for 7 days of antibiotic cover with all baseline basic investigation to start investigating on the above mentioned illness as well as others to diagnose the fever.

Hopefully your child should be better before 7 days since most of the times virals behave notoriously and disappear in maximum 7 days.

Hope to answered your query .

Take Care.
Above answer was peer-reviewed by
Follow-up: Child hospitalised for fever. No meningitis and bacteria. Red-eyes, and coughed mucous. CRP is 90. What is it? 1 hour later
I'm sorry but due to stress I didn't mention he has rash on his legs.
Does it help in diagnosis?
Answered by Dr. Himanshi Kashyap 42 minutes later

I understand your anxiety. Now that you have mentioned the rash her diagnosis could shift to viral rash, parasitic rash like Rickettsia (provided there is history of tick bite) and systemic rash like Kawasaki (provided there is along with blood shot eyes, lymphadenopathy, strawberry tongue etc.)

As of now, it might be a big challenge to pinpoint the diagnosis. Further investigation will have to be done like ECG,2-D Echo etc

There are many childhood rashes, which mimic Kawasaki like Measles, Adenovirus, EB virus, Scarlet fever, add is a high index of suspicion is always good in management and treatment. Since your son is admitted in, the hospital his doctors will make sure of leaving no stone unturned. So just relax and let us not jump to conclusion. I guess we have to wait for the illness to evolve properly for confirm diagnosis.

Take Care.
God Bless.
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