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Suggest Treatment For Low Grade Fever In An Infant
Question: My baby of 3.7 years, weight 14.5 kg is having low grade fever for last one month. Blood report once showed high CRP and switch 50 antibiotics was given for 5 days 2 5ml twice. He was again given brutasafe antibiotics. The fever stopped temporarily but again started. on 17-10-2016 blood and urine was examined and blood test revealed (i) TYPHI ELISA ImG 0.574 (ii) CBC 20571 Cell/Cumm. Urine examination culture and sensitivity revealed 70000 cfu/mL of Klebsiella pneumoniae (Reports Attache) with resistance to several drugs. Doctors say the baby is suffering from typhiod and urine infection. My baby was already vaccinated from typhiod in time. I would like to know the possibility of typhiod even after vaccination. How serious is typhiod and urine infection that my baby is suffering. Shall we go for some further test like widal test before starting medication. Please suggest test if any to be sure of infection. Whether antibiotics is the only option or we can use other medicie also particularly as the baby had already been given two course of antibiotics in last one month. How serious is the resistance shown to several drugs in the urine culture and sensitivity report and its future ramification. What is the normal temperature range for a 4 year old child.Today his temperature cam down and has been in the range of 96 to 98 degrees. Though the doctors have suggested Zenocin syrup 6 ml twice for 10 days we have not yet started the medicine.
Brief Answer:
I need more information before suggesting you further
Detailed Answer:
Hi... I have gone through the case details of your son and also the investigation reports which you have uploaded.
Please answer the following questions -
1. You have mentioned one month of fever... I would like to know the exact date when the fever started?
2. Has the fever been there daily or only intermittently with the child being afebrile (without fever) for 2 to 3 days in between?
3. What is the maximum recorded temperature?
4. Have there been any symptoms of urinary tract infection like pain or burning sensation while voiding urine or high fever along with chills and rigors or vomiting or pain in the tummy?
5. Was blood culture or urine culture been performed before starting the first coast of antibiotic?
6. How is the child appetite and has there been any significant weight loss?
Regards - Dr. Sumanth
I need more information before suggesting you further
Detailed Answer:
Hi... I have gone through the case details of your son and also the investigation reports which you have uploaded.
Please answer the following questions -
1. You have mentioned one month of fever... I would like to know the exact date when the fever started?
2. Has the fever been there daily or only intermittently with the child being afebrile (without fever) for 2 to 3 days in between?
3. What is the maximum recorded temperature?
4. Have there been any symptoms of urinary tract infection like pain or burning sensation while voiding urine or high fever along with chills and rigors or vomiting or pain in the tummy?
5. Was blood culture or urine culture been performed before starting the first coast of antibiotic?
6. How is the child appetite and has there been any significant weight loss?
Regards - Dr. Sumanth
Above answer was peer-reviewed by :
Dr. Raju A.T
Thank u. As asked by you the following is the answer to your questions
(i) The fever started on 11-09-2016.
(ii) Initially fever was daily but the temperature was in the range of 99 to 101 degree and only in few occasion it went upto 102.5 degree. From 13th October there was only one day when the temperature was 1bove 102 degree i.e on 17-10-2016.From yesterday there is no fever and the temperature has been in the range of 96 to 98.5 degree.
(iii) The maximum recorded temperature may be 102.5 degree or 103 degree but only occassionaly.
(iv) The baby has not complained of any burning sensation in urine. the vomiting has been only on 31-09-2016 and 01-10-2016 and 17-10-2016 but stopped after taking Emeset syrup.
(V) first course of antibiotic was started without any blood culture and the doctor prescribed Megaclav syrup (on 12-09-2016) for 6 days @ 5 ml twice but was stopped on 14-09-2016 when the fever did not stopped w.e.f 15-09-2016 and CBC/CRP/MP/Typhoid and dengue test was done and the results were normal.
(VI) second course of antibiotics i.e Brutacef 100 syrup was prescribed on 17-09-2016 as the doctor stated that the baby is having stomach infection but without any blood or urine test. The drug was continued for 5 days @4 ml twice.
(VII) the third course of antibiotic was started on 10-10-2016 when the baby started vomiting and fever on 01-10-2016 but the vomiting stopped even though the fever came down but the temperature remained between 99 and 100.5 till 10-10-2016 and the doctor after blood and urine culture and R/E find High CRP i.e 12 and the antibiotics i.e switch 50 syrup was continued for 5 days w.e.f 10-10-2016 @ 6 ml twice. Fever came down but the temperature was in therange of 98.5 to 99.8 and sometime 100 degree.
(VIII) Last vomiting was on 17-10-2016 may be four times but stopped after emest and the temperature was 101 degree. and as per suggestion of doctor all the test were done. As per report CBC was 20570 Cell/Cumm, TYPHI ELISA IgM was 0.574 and & 70000cfu/Ml of Klebsiella pneumoniae was found in unrine and the culture and sensitivity report shown resistance to several drugs.
(IX) The Child lost appetite between 13-09-2016 to 24-09-2016 but started regular fooding w.e.g 25-09-2016 to 30-09-2016. Again between 01-10-2016 to 13-10-2016 he lost appetite but after that is taking regular food. He lost 01 Kg weight during this period. His weight yesterday was 14.6 kg whereas his weight before start of the disease was 15.5 kg.
Thanks
(i) The fever started on 11-09-2016.
(ii) Initially fever was daily but the temperature was in the range of 99 to 101 degree and only in few occasion it went upto 102.5 degree. From 13th October there was only one day when the temperature was 1bove 102 degree i.e on 17-10-2016.From yesterday there is no fever and the temperature has been in the range of 96 to 98.5 degree.
(iii) The maximum recorded temperature may be 102.5 degree or 103 degree but only occassionaly.
(iv) The baby has not complained of any burning sensation in urine. the vomiting has been only on 31-09-2016 and 01-10-2016 and 17-10-2016 but stopped after taking Emeset syrup.
(V) first course of antibiotic was started without any blood culture and the doctor prescribed Megaclav syrup (on 12-09-2016) for 6 days @ 5 ml twice but was stopped on 14-09-2016 when the fever did not stopped w.e.f 15-09-2016 and CBC/CRP/MP/Typhoid and dengue test was done and the results were normal.
(VI) second course of antibiotics i.e Brutacef 100 syrup was prescribed on 17-09-2016 as the doctor stated that the baby is having stomach infection but without any blood or urine test. The drug was continued for 5 days @4 ml twice.
(VII) the third course of antibiotic was started on 10-10-2016 when the baby started vomiting and fever on 01-10-2016 but the vomiting stopped even though the fever came down but the temperature remained between 99 and 100.5 till 10-10-2016 and the doctor after blood and urine culture and R/E find High CRP i.e 12 and the antibiotics i.e switch 50 syrup was continued for 5 days w.e.f 10-10-2016 @ 6 ml twice. Fever came down but the temperature was in therange of 98.5 to 99.8 and sometime 100 degree.
(VIII) Last vomiting was on 17-10-2016 may be four times but stopped after emest and the temperature was 101 degree. and as per suggestion of doctor all the test were done. As per report CBC was 20570 Cell/Cumm, TYPHI ELISA IgM was 0.574 and & 70000cfu/Ml of Klebsiella pneumoniae was found in unrine and the culture and sensitivity report shown resistance to several drugs.
(IX) The Child lost appetite between 13-09-2016 to 24-09-2016 but started regular fooding w.e.g 25-09-2016 to 30-09-2016. Again between 01-10-2016 to 13-10-2016 he lost appetite but after that is taking regular food. He lost 01 Kg weight during this period. His weight yesterday was 14.6 kg whereas his weight before start of the disease was 15.5 kg.
Thanks
Brief Answer:
Could be partially treated enteric fever otherwise known as typhoid
Detailed Answer:
Hi....I have gone through the reports. This looks like partially treated enteric fever.
This is not urinary tract infection (UTI) as the colony count is less than 1,00,000 CFU. We need to consider it as UTI only if the colony count is significant (that is more than 1,00,000). But get a ultrasound abdomen done to be sure that there is no vesicoureteric reflux.
Typhoid IgM is positive means it could be typhoid. But this is not a confirmatory test. The confirmatory test is blood culture. But blood culture may not be positive now, as you have used 3 courses of antibiotics.
The other option now is doing a Widal test. Widal test is done in two methods - slide test and tube test.
Tube test is the better one, it will take 24 hours for the result to come. Slide test result will be available within few hours. Slide test should not be done as it is inferior to tube method.
My suggestions now -
1. Do a blood culture and widal by tube method.
2. Start on Azithromycin at 20mg/kg/day as a single dose per day for 7 days.
This is a prescription drug and you will need a doctor's prescription for this.
Regards - Dr. Sumanth
Could be partially treated enteric fever otherwise known as typhoid
Detailed Answer:
Hi....I have gone through the reports. This looks like partially treated enteric fever.
This is not urinary tract infection (UTI) as the colony count is less than 1,00,000 CFU. We need to consider it as UTI only if the colony count is significant (that is more than 1,00,000). But get a ultrasound abdomen done to be sure that there is no vesicoureteric reflux.
Typhoid IgM is positive means it could be typhoid. But this is not a confirmatory test. The confirmatory test is blood culture. But blood culture may not be positive now, as you have used 3 courses of antibiotics.
The other option now is doing a Widal test. Widal test is done in two methods - slide test and tube test.
Tube test is the better one, it will take 24 hours for the result to come. Slide test result will be available within few hours. Slide test should not be done as it is inferior to tube method.
My suggestions now -
1. Do a blood culture and widal by tube method.
2. Start on Azithromycin at 20mg/kg/day as a single dose per day for 7 days.
This is a prescription drug and you will need a doctor's prescription for this.
Regards - Dr. Sumanth
Above answer was peer-reviewed by :
Dr. Veerisetty Shyamkumar
Thank u for your advise. I have the following queries please clarify
(1) My baby was timely vaccinated for typhiod. Can typhoid germs attack inspite of vaccination.Temperature of my baby was in the range of 98-99 degree on 19.10.2016 and it has been in the range of 95.6 to 98.2 from 20.10.2016 till today without taking any medication, still there is chance of typhiod.
(2) The medicine prescribed by u has to be started immediately or after the widal test confirms the typhoid. If it has to be started immediately shall we stop if the widal test does not confirm typhoid.
(3) The urine culture report showed resistance to various antiviotics. Is it a cause of concern and its future ramifications.
(4) How often antibiotics can be given to a kid I.e how many course in a year which is safe without raising the risk of resistance in future.
(5) what is the normal temperature range of a hearthy child.
Thanks
With high regards
(1) My baby was timely vaccinated for typhiod. Can typhoid germs attack inspite of vaccination.Temperature of my baby was in the range of 98-99 degree on 19.10.2016 and it has been in the range of 95.6 to 98.2 from 20.10.2016 till today without taking any medication, still there is chance of typhiod.
(2) The medicine prescribed by u has to be started immediately or after the widal test confirms the typhoid. If it has to be started immediately shall we stop if the widal test does not confirm typhoid.
(3) The urine culture report showed resistance to various antiviotics. Is it a cause of concern and its future ramifications.
(4) How often antibiotics can be given to a kid I.e how many course in a year which is safe without raising the risk of resistance in future.
(5) what is the normal temperature range of a hearthy child.
Thanks
With high regards
Brief Answer:
Suggestions on queries
Detailed Answer:
Hi...coming to your queries directly -
1. Typhoid can come even after vaccination. Vaccine is not 100% effective for typhoid.
2. If there is no fever you can wait without going ahead with my advice.
3. Please not start with any test or medicine as there is no fever now.
4. As the urine culture is not showing significant colony count - you need not worry about the antibiotic resistance.
5. Normal temperature is 97.5 to 99.6 degrees Fahrenheit.
Regards - Dr. Sumanth
Suggestions on queries
Detailed Answer:
Hi...coming to your queries directly -
1. Typhoid can come even after vaccination. Vaccine is not 100% effective for typhoid.
2. If there is no fever you can wait without going ahead with my advice.
3. Please not start with any test or medicine as there is no fever now.
4. As the urine culture is not showing significant colony count - you need not worry about the antibiotic resistance.
5. Normal temperature is 97.5 to 99.6 degrees Fahrenheit.
Regards - Dr. Sumanth
Above answer was peer-reviewed by :
Dr. Veerisetty Shyamkumar
Hi, I have provided some attachments. Please review them.I have conducted widal test and urine culture test as advised by the doctor. The doctor is saying widal test is negative but there is infection in urine. Colony count in current urine report is 100000 whereas it was 70000 in previous report.
Please review the report .As the colony count has increased from 70000 to 100000 does it mean the baby is having infection. This time the urine was first urine of the Morning as against the urine sample of day time taken previously. Please advise.
Please review the report .As the colony count has increased from 70000 to 100000 does it mean the baby is having infection. This time the urine was first urine of the Morning as against the urine sample of day time taken previously. Please advise.
Brief Answer:
Looks like urinary tract infection with significant colony count
Detailed Answer:
Hi....with the new urine culture report showing a significant colony count of more than 1,00,000, I feel that we need to treat in the lines of urinary tract infection.
Suggestions -
1.Hospitalize the kid.
2. Start the child on antibiotic - Piperacillin Tazobactam at 75mg/kg/ dose every 6th hourly for 7 days.
3. Get an ultrasound abdomen done to look for any vesicoureteric reflux.
4. After 5 days of antibiotic therapy please take a urine culture again, but this time with catheterized urine sample.
5. If this second urine culture is sterile then please go ahead with micturating cysto urethrogram or MCU.
Get back to me after this and then I will suggest you further.
Coming to your queries -
1. Increasing Colony count in the urine culture is not a sign of severity of urinary tract infection.
2. Hope widal test has been done in tube method and so this will be reliable and typhoid infection is unlikely and its almost ruled out.
Regards - Dr. Sumanth
Looks like urinary tract infection with significant colony count
Detailed Answer:
Hi....with the new urine culture report showing a significant colony count of more than 1,00,000, I feel that we need to treat in the lines of urinary tract infection.
Suggestions -
1.Hospitalize the kid.
2. Start the child on antibiotic - Piperacillin Tazobactam at 75mg/kg/ dose every 6th hourly for 7 days.
3. Get an ultrasound abdomen done to look for any vesicoureteric reflux.
4. After 5 days of antibiotic therapy please take a urine culture again, but this time with catheterized urine sample.
5. If this second urine culture is sterile then please go ahead with micturating cysto urethrogram or MCU.
Get back to me after this and then I will suggest you further.
Coming to your queries -
1. Increasing Colony count in the urine culture is not a sign of severity of urinary tract infection.
2. Hope widal test has been done in tube method and so this will be reliable and typhoid infection is unlikely and its almost ruled out.
Regards - Dr. Sumanth
Note: For further queries related to your child health, Talk to a Pediatrician. Click here to Book a Consultation.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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