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What Causes Persistent High Fever In A Child?

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Posted on Mon, 13 Nov 2017
Question: My 6 year old (17kg) boy is running a high temperature (103+) for 6th straight day.

Yesterday we had blood test + urine test and dengue profile tests done.

All were ok. Dengue negative. Counts were all ok (WBC 7K+; platelet 2L+). Only CrP was high at 39.
We started him on augmentine DDS just tonight.

However with 6th straight day of high fever we are now very worried. What other test can we do to identify any underlying cause that we may be missing?

Want to add that for past 2 days his activity level is down substantially and he's been lethargic. He is cummunicating coherently but just feels sleepy and doest get out of bed or play even when fever is controlled using crocin
doctor
Answered by Dr. Pradeep Kumar Jain (35 minutes later)
Brief Answer:
Wait for 48 hours, blood culture can be sent

Detailed Answer:
Hello

Thanks for asking on this platform

I have gone through the query, also seen the reports and do understand your concern.
Here CRP which is an indicator of bacterial infection is moderately raised but this also is not corroborated by complete blood count where the total count and neutrophil count both are normal(should be raised in bacterial infection). The urine report is showing ketone that can be there in any febrile illness and is not of much concern.
The serum iron and saturation level is low while the ferritin (indicator of body reserve) is normal. This low iron level is still not manifested by low hemoglobin as body reserve is adequate.
As there is fever for 6 days and activity has also decreased with moderately raised CRP (more suggestive of bacterial rather than viral infection)it is good that antibiotic has been started.
Here we could have sent the blood culture report to know the bacteria which has caused this infection.
Now as antibiotic has been started the report may alter.
I would like to continue the paracetamol with antibiotic and monitor the temperature and activity of baby closely for next 48 hours. With effect of antibiotic the fever should show a declining trend.
If fever remains of high grade or the child gets more lethargic or irritated better consult your pediatrician again for re-evaluation (CRP may need to be repeated or antibiotic up gradation might be needed).
Try to give fluids as much as possible with small frequent feeds of his choice.
I hope this helps.
Please let me know if you have any more questions.
Regards

Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Pradeep Kumar Jain (20 hours later)
As the fever continues today with no signs of improvement - we revisited our pediatrician. He used a pulse oximeter to check pulse (135) and saturation (90). He examined my son and said there seems to be congestion in the chest area.
Based on this he ordered an immediate chest X-ray (attached) which showed mild haziness. He feels it would be a case of mild pneumonia which would also explain his frequent bought a of cough and associated vomitting (cough resulting in vomitting and not committing by itself).
He started him on nebulization (3 times daily)


Other facts and concerns:
Whenever his temperature is bought under control either through Crocin or meftal P his hands and feet continue to remain very warm.
He shivers as his temperature rises
He has now been complaining of a stomach pain for which we have administered a dose of Nutrolin B
He is generally irritable and lethargic throughout the day.
At 1 a.m is temperature was 101.2 and be administered 5 ml of Crocin. at 2 a.m. is temperature goes to 103.7 despite the Crocin. We have now started dabbing him. Any suggestions on our next course of action?


His pediatrician has suggested repeated tests on Monday.

My concern / question is - why wait until Monday?
Also should we do blood culture immediately - even after 48 hours of antibiotics? Would it have any value?
doctor
Answered by Dr. Pradeep Kumar Jain (5 hours later)
Brief Answer:
If symptoms don't improve after 48-72 hours better to repeat the test

Detailed Answer:
Hi

Blood culture usually helps when there is no localisation of infection. As now there are respiratory symptoms and chest X-ray is showing mild haziness it indicates this fever is due to respiratory infection.
Augmentin covers well the organisms of respiratory infection. But if there is no improvement even after 2-3 days of antibiotic or if condition deteriorates like fast breathing, chest retraction, irritability or persistent high grade fever I would like to get a repeat investigation(CBC, CRP and chest X-ray done). Depending on treatment may need to be changed.
So wait for 72 hours(after starting the antibiotic) for see the improvement or consult your pediatrician earlier if condition worsens.

Regards
Above answer was peer-reviewed by : Dr. Yogesh D
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Answered by
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Dr. Pradeep Kumar Jain

Pediatrician, Cardiology

Practicing since :2006

Answered : 2069 Questions

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What Causes Persistent High Fever In A Child?

Brief Answer: Wait for 48 hours, blood culture can be sent Detailed Answer: Hello Thanks for asking on this platform I have gone through the query, also seen the reports and do understand your concern. Here CRP which is an indicator of bacterial infection is moderately raised but this also is not corroborated by complete blood count where the total count and neutrophil count both are normal(should be raised in bacterial infection). The urine report is showing ketone that can be there in any febrile illness and is not of much concern. The serum iron and saturation level is low while the ferritin (indicator of body reserve) is normal. This low iron level is still not manifested by low hemoglobin as body reserve is adequate. As there is fever for 6 days and activity has also decreased with moderately raised CRP (more suggestive of bacterial rather than viral infection)it is good that antibiotic has been started. Here we could have sent the blood culture report to know the bacteria which has caused this infection. Now as antibiotic has been started the report may alter. I would like to continue the paracetamol with antibiotic and monitor the temperature and activity of baby closely for next 48 hours. With effect of antibiotic the fever should show a declining trend. If fever remains of high grade or the child gets more lethargic or irritated better consult your pediatrician again for re-evaluation (CRP may need to be repeated or antibiotic up gradation might be needed). Try to give fluids as much as possible with small frequent feeds of his choice. I hope this helps. Please let me know if you have any more questions. Regards