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Recurrent Fever, Augmentin, Throat Congestion, Nasal Discharge, No Cough, Diarrhea,
Question: my son, 2 year old suffering from recurrent fever since january this year, almost six rounds of fever which comes back every 16-18 days. given augmentin on three rounds out of six when it was throat congestion with bacterial infection, nasal discharge.no cough or diarrhea. tlc elevated, chest x XXXXXXX normal. ultrasound normal, PNS x XXXXXXX shows little sinus, neck nodes swollen and tender. not eating at all. only taking liquid.
this time he got back the fever after a week's time and already on augmentin dds.
this time he got back the fever after a week's time and already on augmentin dds.
Hi XXXXXXX
Thanks for your query.
In the growing age group fever is commonly seen. But recurrent episodes of fever every 16-18 days requires a detailed clinical examination.
You have mentioned about throat congestion, nasal discharge, and no cough or diarrhea. The chest X-ray is normal. It seems your son has repeated bouts of Upper frequent upper respiratory tract infection could be:
1.A repeated series of colds or viral infections.(majority)
2. Otitis media (Ear infections)-usually associated with ear discharge, ear pain but can be totally asymptomatic.
3.Sinusitis (Para nasal sinus infection)
4.Bronchitis.
Most above causes can be ruled out from the investigations he has already had, but ear infection is a possibility. You should get your son examined by a good ENT specialist. It would be better if a detailed ear examination is done to find the cause of infection.
A proper Antibiotic is must and should be administered till prescribed date. each episode should be treated separately rather than using same antibiotic for all the episodes. The choice of Antibiotic depends on the type of presentation (clinical symptoms) and the severity. A throat swab culture and sensitivity test should also be done to find out the antibiotic to which the organism is sensitive.
Since you mentioned he is having another episode of fever and not eating at all and only on liquid diet, there is a chance that he has throat pain. I recommend consulting your Paediatrician and follow his advice.
Hope I have answered your query. If you have any follow up queries I will be available to answer them.
Regards.
Thanks for your query.
In the growing age group fever is commonly seen. But recurrent episodes of fever every 16-18 days requires a detailed clinical examination.
You have mentioned about throat congestion, nasal discharge, and no cough or diarrhea. The chest X-ray is normal. It seems your son has repeated bouts of Upper frequent upper respiratory tract infection could be:
1.A repeated series of colds or viral infections.(majority)
2. Otitis media (Ear infections)-usually associated with ear discharge, ear pain but can be totally asymptomatic.
3.Sinusitis (Para nasal sinus infection)
4.Bronchitis.
Most above causes can be ruled out from the investigations he has already had, but ear infection is a possibility. You should get your son examined by a good ENT specialist. It would be better if a detailed ear examination is done to find the cause of infection.
A proper Antibiotic is must and should be administered till prescribed date. each episode should be treated separately rather than using same antibiotic for all the episodes. The choice of Antibiotic depends on the type of presentation (clinical symptoms) and the severity. A throat swab culture and sensitivity test should also be done to find out the antibiotic to which the organism is sensitive.
Since you mentioned he is having another episode of fever and not eating at all and only on liquid diet, there is a chance that he has throat pain. I recommend consulting your Paediatrician and follow his advice.
Hope I have answered your query. If you have any follow up queries I will be available to answer them.
Regards.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear doctor
thanks for your reply
please go through the following dates of his recurrent fever and tell about what it could be now
30 XXXXXXX 2011 reached 103 deg
11 feb reached 102
28 feb stayed around 102 for 4 days, augmentin duo given
23 March around 100 augmentin duo
7 march around 101. augmentin duo
13 march - till date around 100.3 augmentin dds for 4 days... but the fever isnt down yet.....
now i have stopped augmentin dds
as it doesnt appear to be working...
with 6 days of fever what tests shud be done now... keeping in view the above episodes of fever in past......
can this be TB?
can this be Strep throat?
can this be typhoid?
can this be just upper respiratory infection?
please guide
thanks for your reply
please go through the following dates of his recurrent fever and tell about what it could be now
30 XXXXXXX 2011 reached 103 deg
11 feb reached 102
28 feb stayed around 102 for 4 days, augmentin duo given
23 March around 100 augmentin duo
7 march around 101. augmentin duo
13 march - till date around 100.3 augmentin dds for 4 days... but the fever isnt down yet.....
now i have stopped augmentin dds
as it doesnt appear to be working...
with 6 days of fever what tests shud be done now... keeping in view the above episodes of fever in past......
can this be TB?
can this be Strep throat?
can this be typhoid?
can this be just upper respiratory infection?
please guide
Dear XXXXXXX
I was going through your query and I recommend the following in addition:
1. Get an X-ray Skull lateral view for adenoid hypertrophy done. If it has already been done, what were the findings?
2. Chronic tonsillitis, otitis media can be clinically diagnosed on examination. Get it done from your local ENT Specialist.
3. If the diagnosis is pharyngitis vs tonsillitis, this may be due to adenoids (which explains the nasal discharge and sinusitis, too). Does he have a history of mouth breathing or snoring during sleep?
4. However, many children have these conditions and yet do not suffer such recurrent attacks of fever in quick succession. You need to investigate thoroughly. Has he had rashes? Have you had white blood cell counts done in all these episodes? If so, then what are the results? His recurrent attacks of fever suggest some underlying infection or tissue destruction. Do you use anti fever medication or sponging? Any other medications?
5. I agree with Dr. XXXXXXX N. that a throat swab is now essential. Augmentin is a good antibiotic, however it seems to be less effective in your case now. If his throat swabs are repeatedly negative, TB, Typhoid, Malaria and other conditions can be tested for. Certain other conditions such as Periodic Fever, Urinary tract Infection, Reye's Syndrome and other rare conditions can be looked into, where antibiotics are not the only option.
6. You can discuss this with your treating physicians.
Regards
I was going through your query and I recommend the following in addition:
1. Get an X-ray Skull lateral view for adenoid hypertrophy done. If it has already been done, what were the findings?
2. Chronic tonsillitis, otitis media can be clinically diagnosed on examination. Get it done from your local ENT Specialist.
3. If the diagnosis is pharyngitis vs tonsillitis, this may be due to adenoids (which explains the nasal discharge and sinusitis, too). Does he have a history of mouth breathing or snoring during sleep?
4. However, many children have these conditions and yet do not suffer such recurrent attacks of fever in quick succession. You need to investigate thoroughly. Has he had rashes? Have you had white blood cell counts done in all these episodes? If so, then what are the results? His recurrent attacks of fever suggest some underlying infection or tissue destruction. Do you use anti fever medication or sponging? Any other medications?
5. I agree with Dr. XXXXXXX N. that a throat swab is now essential. Augmentin is a good antibiotic, however it seems to be less effective in your case now. If his throat swabs are repeatedly negative, TB, Typhoid, Malaria and other conditions can be tested for. Certain other conditions such as Periodic Fever, Urinary tract Infection, Reye's Syndrome and other rare conditions can be looked into, where antibiotics are not the only option.
6. You can discuss this with your treating physicians.
Regards
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
thanks for your reply doctor
i have got swab test done today. in two days time the report will be out. as my son didnt get fever today so i will prefer to wait for 3 days to go for further tests.... may b i will wait till next recurrence of fever.
wat do you say? should i go for the blood test immediatly or shud i wait for recurrence?
which all other rare diseases we should be careful about? as pricking the child again and again is traumatic for both child and parent.
if he requires some more testing please let me knw, i want to see my child out of the problem at the earliest.... we already had 4 months of hit and trial methods of antibiotics and guesses.....
would be obliged if you consider this issue...
1. x XXXXXXX for adenoid done. no hypertrophy
2. tonsils hypertrophy is there but no ear infection... got it checked from 2 ENT.
3. he does sleep with mouth open oftenly. but not every time.... on the 3rd episode of fever (28 th feb )when 10 days of augmentin was given as his CRP was positive, congessted throat, fever, highly irritated, runny nose, very very high TLC & DLC (17 th and 28 thou resp). sgot sgpt increased as 238, 377 resp. ASO negative, swab test negative, malaria negative
4. He doesnt have rashes, only redish right cheek during fever. On 8th april during this episode, his TLC was around 14 thousand.... DLC normal, sgot-pt normal, blood culture-negative, swab-negative...
5. UTI has been ruled out during every episode of fever through urine routine and culture....
6. The treating physician is calling it viral as the antibiotic didnt work... and fever came back during antibiotic course... and the fever now is gone since yesterday....
but i am not convinced...
one thing which i observed today is that his lymph nodes on the side of neck have shrinked a lot... earlier they could be seen over the skin as a lump of 2 cm each...
other areas of concern are
1. his appetite is still low, not swallowing confidently
2. is very weak now, not walking or running properly
3. not happy at all
4. still scratching back of his head and put fingers in his ears
how should we follow it now....
warm regards
XXXXXXX
i have got swab test done today. in two days time the report will be out. as my son didnt get fever today so i will prefer to wait for 3 days to go for further tests.... may b i will wait till next recurrence of fever.
wat do you say? should i go for the blood test immediatly or shud i wait for recurrence?
which all other rare diseases we should be careful about? as pricking the child again and again is traumatic for both child and parent.
if he requires some more testing please let me knw, i want to see my child out of the problem at the earliest.... we already had 4 months of hit and trial methods of antibiotics and guesses.....
would be obliged if you consider this issue...
1. x XXXXXXX for adenoid done. no hypertrophy
2. tonsils hypertrophy is there but no ear infection... got it checked from 2 ENT.
3. he does sleep with mouth open oftenly. but not every time.... on the 3rd episode of fever (28 th feb )when 10 days of augmentin was given as his CRP was positive, congessted throat, fever, highly irritated, runny nose, very very high TLC & DLC (17 th and 28 thou resp). sgot sgpt increased as 238, 377 resp. ASO negative, swab test negative, malaria negative
4. He doesnt have rashes, only redish right cheek during fever. On 8th april during this episode, his TLC was around 14 thousand.... DLC normal, sgot-pt normal, blood culture-negative, swab-negative...
5. UTI has been ruled out during every episode of fever through urine routine and culture....
6. The treating physician is calling it viral as the antibiotic didnt work... and fever came back during antibiotic course... and the fever now is gone since yesterday....
but i am not convinced...
one thing which i observed today is that his lymph nodes on the side of neck have shrinked a lot... earlier they could be seen over the skin as a lump of 2 cm each...
other areas of concern are
1. his appetite is still low, not swallowing confidently
2. is very weak now, not walking or running properly
3. not happy at all
4. still scratching back of his head and put fingers in his ears
how should we follow it now....
warm regards
XXXXXXX
Hi XXXXXXX ,
Thanks for your follow up query.
Good to hear that fever had come down and the shrinkage of the lymph nodes of neck are suggestive of the remission of this episode.
You had mentioned that Swab test is negative, the negative might be because of the previous antibiotic usage,the test relevance should be co-related with clinical findings, then only the result is significant.
Appetite is usually low after recovering from fever. since you mentioned that tonsils are enlarged it might be causing difficulty in swallowing. Start him with semisolid and soft foods like nicely cooked and smashed rice and add dhal , it also be cooked in same manner so that it wont be difficulty in swallowing and meanwhile it meets his energy needs.
Give him small but frequent servings.
Clean , boiled and cooled water should be provided for drinking.
Rest is must but he can be made to move around in the home when he starts accepting food properly.
If you are giving him milk in milk bottles stop giving in the milk bottle.It can acts as a source of infection.You can give milk through spoon or in small cups, Play with kid give colorful toys as these things will cheer him.
Since the usual causes of fever are ruled out . Wait and watch is good for now and i suggest you to take second opinion(Paediatrician) regarding his investigations.
Hope I have answered your query.
All the best .
Thanks for your follow up query.
Good to hear that fever had come down and the shrinkage of the lymph nodes of neck are suggestive of the remission of this episode.
You had mentioned that Swab test is negative, the negative might be because of the previous antibiotic usage,the test relevance should be co-related with clinical findings, then only the result is significant.
Appetite is usually low after recovering from fever. since you mentioned that tonsils are enlarged it might be causing difficulty in swallowing. Start him with semisolid and soft foods like nicely cooked and smashed rice and add dhal , it also be cooked in same manner so that it wont be difficulty in swallowing and meanwhile it meets his energy needs.
Give him small but frequent servings.
Clean , boiled and cooled water should be provided for drinking.
Rest is must but he can be made to move around in the home when he starts accepting food properly.
If you are giving him milk in milk bottles stop giving in the milk bottle.It can acts as a source of infection.You can give milk through spoon or in small cups, Play with kid give colorful toys as these things will cheer him.
Since the usual causes of fever are ruled out . Wait and watch is good for now and i suggest you to take second opinion(Paediatrician) regarding his investigations.
Hope I have answered your query.
All the best .
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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