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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Child with persisting high fever. Urine, blood culture, throat culture detected virus, no improvement with Motrin, Tylenol. Any other tests required?

My daughter is 4 years old and has had a on going fever for 7 days now. She is admitted into the pediatrics ward at the moment but I think they are overlooking something. Her fevers range from 102-104.5. The 3rd day I brought her to the ER she was running 104 fever they did a chest xray and a urine culture . Urine culture came back negative and chest xray said she had slight viral bronchitis , later we found out she did not. They wrote her a pescription for a cough she did not have, using my better judgement I did not give her the meds. I continued to give her tylenol and motrin alternating every 3 hours. I could only get her temp down to 100 degrees then an hour later it would shoot back up. The next night I brought her to a different ER and they did nothing at all. No tests at all. Just said she had a virus it would pass. The 6th day I couldn t watch her lay there burning up and miserable I brought her to her pedi who then admitted her and order a rapid strep test, a throat culture , a urine culture, and a blood culture . All tests came back negative except the urine culture which they said the white blood cell count was off slightly and the dr said she may have a small uti and gave her antibiotics but took her off when the blood culture showed there was nothing wrong with the white blood cell count. They have now decided it is a virus, what virus gives a toddler moderate to high fever for 7 days? I can t help but feel that they are missing something. Her temp is still raising after motrin and tylenol. They can t get it to go down no longer than an hour. Is there any other tests they should be doing? Or should they retest something? Please help.
Mon, 11 Jun 2012
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ENT Specialist 's  Response
Hello and welcome to HCM,
First of all i would like to say that when i went through the details description of your daughter sufferings, i couldn't wait and had to pick up the question to answer. I got worried to know that a small child of 4 years is suffering from such a high peaks of fever for so long. I have repeatedly went through your question four to five times and with the information given by you, i think...

Your daughter might need -
(1) Antibiotic course (I prefer Macrolid such as Azithromycin)
(2) Multivitamin supplement
More tests, she should undergo are -
(1) Widal test
(2) Pf Pv RT Kit test (For Malaria)
I have not mentioned the drugs name and prescription details as not allowed by HCM.

Now the question is, why did i say so ???. Please allow me to explain-
I agree that virus (Particularly RSV) may be the cause of the problem, as Chest X Ray reflects it, BUT i have seen in my clinical practice that, there is also super added bacterial infections along with it. It is again not always necessarily reflects in WBC count. Also most viral fever subsides within 5 to 7 days and generally it doesn't continue long enough. All the tests done is normal in your daughters case except the CXR & Urine culture (which was also normal first time and slight change in the second only). I personally feel that its high time she should be offered an antibiotics as she touched 7 days. Whatever be the reports. Because , i always do not lean back on laboratory reports. I think on history & clinical assessments. Here only from the history you presented, i am feeling that she needs antibiotics coverage. Secondly, multivitamin will boost her nutrition and so strengthening her immunity to fight back.
As you are worried whether any tests left to be done, in my opinion, i would advise those two tests more for exclusion. Suggestions i have given here are based on my clinical experiences and day to day practice only
Lastly, from this mail, i can only say you that, have faith on God and yourself. I am sure that your daughter is strong enough to fight back with her situation and will come out from it soon. I wish her a very very early recovery and a healthy life ahead. Please do not worry
Thanks
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Child with persisting high fever. Urine, blood culture, throat culture detected virus, no improvement with Motrin, Tylenol. Any other tests required?

Hello and welcome to HCM, First of all i would like to say that when i went through the details description of your daughter sufferings, i couldn t wait and had to pick up the question to answer. I got worried to know that a small child of 4 years is suffering from such a high peaks of fever for so long. I have repeatedly went through your question four to five times and with the information given by you, i think... Your daughter might need - (1) Antibiotic course (I prefer Macrolid such as Azithromycin) (2) Multivitamin supplement More tests, she should undergo are - (1) Widal test (2) Pf Pv RT Kit test (For Malaria) I have not mentioned the drugs name and prescription details as not allowed by HCM. Now the question is, why did i say so ???. Please allow me to explain- I agree that virus (Particularly RSV) may be the cause of the problem, as Chest X Ray reflects it, BUT i have seen in my clinical practice that, there is also super added bacterial infections along with it. It is again not always necessarily reflects in WBC count. Also most viral fever subsides within 5 to 7 days and generally it doesn t continue long enough. All the tests done is normal in your daughters case except the CXR & Urine culture (which was also normal first time and slight change in the second only). I personally feel that its high time she should be offered an antibiotics as she touched 7 days. Whatever be the reports. Because , i always do not lean back on laboratory reports. I think on history & clinical assessments. Here only from the history you presented, i am feeling that she needs antibiotics coverage. Secondly, multivitamin will boost her nutrition and so strengthening her immunity to fight back. As you are worried whether any tests left to be done, in my opinion, i would advise those two tests more for exclusion. Suggestions i have given here are based on my clinical experiences and day to day practice only Lastly, from this mail, i can only say you that, have faith on God and yourself. I am sure that your daughter is strong enough to fight back with her situation and will come out from it soon. I wish her a very very early recovery and a healthy life ahead. Please do not worry Thanks