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What Causes High Grade Fever And Nose Blockage?
Question: Hi, My 1 yr Son is having high grade 102-103*F since last 3 days. On day 1, I gave paracetamol 15mg/kg but fever remained above 102*F even 1 hr after medications. Then I switched to Paracetamol + Ibuprofen, Fever responded and now its every 8 hrs spike of 102-103*F. There is no cough, rashes, loose motion, abdominal discomfort, headache or bodyache. He has non tender liver enlargement 2 cm, and Spleen non tender 1 cm below costal margin. There is no cervical, axillary or inguinal lympadenopathy. He has occasional nose blockage at night with no nasal discharge/running nose. In between fever spike, he is active and taking oral diets/milk.
What could be probable diagnosis ?? Is it just a Viral fever or atypical enteric fever/UTI???
I have started Azithromycin 10mg/kg once daily and Cefopoxime proxetil 5mg/kg twice daily since last 2 days. Do I need to switch to Cefixime or Amoxycillin ???
I have not done any blood or urine investigations till now.
What could be probable diagnosis ?? Is it just a Viral fever or atypical enteric fever/UTI???
I have started Azithromycin 10mg/kg once daily and Cefopoxime proxetil 5mg/kg twice daily since last 2 days. Do I need to switch to Cefixime or Amoxycillin ???
I have not done any blood or urine investigations till now.
Brief Answer:
It's non specific viral infection
Detailed Answer:
Hi
Welcome to Healthcare-Magic
Greetings of the day
Namasthe
Dear Mr XXXXXXX
From the description given by you so far it's non specific viral infection.
Liver and spleen are usually palpable in children under 5 years of age, so they being palpable is not significant.
If there is no excessive crying while passing urine and urine is clear it's unlikely to be urinary tract infection.
As you have mentioned he is active otherwise, no other obvious system involvement the fever is unlikely to be of any concern. As the intensity of fever has reduced things seem to be falling in right place.
Also there is definitely no need for shifting to any antibiotics. As you have already started , continue giving it
Do keep me updated about his progress
Wishing you and your family a very happy and healthy life.
Take care
Best Regards
Dr Deepak Kishore
MBBS, MS, MCH
Consultant Pediatric Surgeon
It's non specific viral infection
Detailed Answer:
Hi
Welcome to Healthcare-Magic
Greetings of the day
Namasthe
Dear Mr XXXXXXX
From the description given by you so far it's non specific viral infection.
Liver and spleen are usually palpable in children under 5 years of age, so they being palpable is not significant.
If there is no excessive crying while passing urine and urine is clear it's unlikely to be urinary tract infection.
As you have mentioned he is active otherwise, no other obvious system involvement the fever is unlikely to be of any concern. As the intensity of fever has reduced things seem to be falling in right place.
Also there is definitely no need for shifting to any antibiotics. As you have already started , continue giving it
Do keep me updated about his progress
Wishing you and your family a very happy and healthy life.
Take care
Best Regards
Dr Deepak Kishore
MBBS, MS, MCH
Consultant Pediatric Surgeon
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Hello Dr XXXXXXX
Thank you so much for your prompt reply.
My son has no urine discomfort, so UTI is highly unlikely.
What bothers me is His High grade fever pattern. No, its intensity has not decreased, its still high grade. Duration has increased to 6-8 hrs and that too once I started Paracetamol + Ibuprofen because his fever was not responding to only Paracetamol (15mg/kg dose).
Non specific Viral infection is a vague and diverse group and since my son is having no URTI symptoms (mild nose crusting is being there since last 3-4 weeks). Its high grade intermittent spiking fever 6-8 hrs responding to antipyretics, no immune defiency disorder per se, no other systemic involvement makes non specific viral infection highly unlikely possibility. Though, active and feeding when afebrile is a positive indication for Viral infection. (You could say that's why its non specific viral fever ). If you think its a non specific viral infection, why should I continue antibiotics ??? (just because I started it ??)
Hope you understand my worries. (Being a pediatrician myself )
Should I wait for 1 more day and watch for fever pattern hoping its viral infection or should I go for detailed blood and radiological investigations ?
It would be highly appreciated if you could suggest me some likely differential diagnosis.
Thanks & Regards
XXXXXXX
P.S - Healthcaremagic team.... I payed for Specialist Pediatrician opinion.
Thank you so much for your prompt reply.
My son has no urine discomfort, so UTI is highly unlikely.
What bothers me is His High grade fever pattern. No, its intensity has not decreased, its still high grade. Duration has increased to 6-8 hrs and that too once I started Paracetamol + Ibuprofen because his fever was not responding to only Paracetamol (15mg/kg dose).
Non specific Viral infection is a vague and diverse group and since my son is having no URTI symptoms (mild nose crusting is being there since last 3-4 weeks). Its high grade intermittent spiking fever 6-8 hrs responding to antipyretics, no immune defiency disorder per se, no other systemic involvement makes non specific viral infection highly unlikely possibility. Though, active and feeding when afebrile is a positive indication for Viral infection. (You could say that's why its non specific viral fever ). If you think its a non specific viral infection, why should I continue antibiotics ??? (just because I started it ??)
Hope you understand my worries. (Being a pediatrician myself )
Should I wait for 1 more day and watch for fever pattern hoping its viral infection or should I go for detailed blood and radiological investigations ?
It would be highly appreciated if you could suggest me some likely differential diagnosis.
Thanks & Regards
XXXXXXX
P.S - Healthcaremagic team.... I payed for Specialist Pediatrician opinion.
Brief Answer:
Cbc and peripheral smear will be helpful
Detailed Answer:
Namasthe
Good morning
Being a parent myself I understand your concern and apprehension.
You would also be aware being a Pediatrician, that in the absence of any localizing points pointing towards any system involvement, the fever should subside. All that is required is supportive care and antipyretics.
Enteric fever is less likely at this age group.
I do occasionally encounter Dengue fever even in children under 1 year of age without associated rash. Getting a Complete Blood count (including platelet count ) will be very reassuring.
Getting Complete Blood count along with peripheral smear will suffice as the initial investigation. Clinically if the chest is clear and no localizing signs to chest, getting chest X ray will not provide anything.
Do keep me updated .
Do not worry he will be fine.
Take care
Best Regards
Dr Deepak
Cbc and peripheral smear will be helpful
Detailed Answer:
Namasthe
Good morning
Being a parent myself I understand your concern and apprehension.
You would also be aware being a Pediatrician, that in the absence of any localizing points pointing towards any system involvement, the fever should subside. All that is required is supportive care and antipyretics.
Enteric fever is less likely at this age group.
I do occasionally encounter Dengue fever even in children under 1 year of age without associated rash. Getting a Complete Blood count (including platelet count ) will be very reassuring.
Getting Complete Blood count along with peripheral smear will suffice as the initial investigation. Clinically if the chest is clear and no localizing signs to chest, getting chest X ray will not provide anything.
Do keep me updated .
Do not worry he will be fine.
Take care
Best Regards
Dr Deepak
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Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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