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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Persistent low grade fever and headache for a child. Face become red and blotchy. All vaccinations taken. CBC level normal

I have a 5 year old daughter who has been having a persistent low grade fever and headache everyday for the past month and a half. The worst headache and fever episodes are in the morning when she wakes and late afternoon, with milder episodes throughout the day. The fever stays between 99.8 and 100.8. During one of the episodes she had a rash appear on her left arm that was both raised and under the skin red bumps and dots that went away a few hours later. When she has a fever she rests on the couch, curled up in a ball, holding her pillow. Her face gets very red and blotchy and she is very hot to the touch. Her appetite hasn t changed much, but she has been requesting to eat soup almost every meal. We travel frequently and have been to India, Nepal, Taiwan, hong kong, and southern, southeastern china. We also live in Beijing, and she is up to date on vaccines. Our doctor visit didn t reveal much, except that her CBC levels were all normal. Thank you for any help.
Wed, 20 Jun 2012
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Pediatrician 's  Response
dear parent,
This has to be dealt very patiently. I want you to first put a tabular coloumn like this

M Tu W Th F S Su
I week
II week
III Week
IV week
V week
VI week
Then record on the days she had fever. 6 weeks is a long time and you are giving several other important clues. 1. Skin rash 2. Head ache. 3 Marked reduction in activity.
Now let us divide the problems into infections and non infectious problems.
Infections like Malaria Typhoid your blood investigations should have revealed. As traveller you must also think of Rickettsial infections which respond only to doxycycline and azithromycin.
Of course there is urinary tract infection.
Child hood tuberculosis is called Primary complex and will be revealed only by a Mantoux test.
Then there are two important group of non infectious conditions.
A peripheral smear study is a must to see how her red and white blood cells appear.
ESR is a test which will give a clue about a type of Rheumatoid arthritis which presents like your childs case : JIA.
There are other collagen vasuclar disorder belonging to the family of Rheumatoid arthiritis which may demand specific blood tests.
Still if the answer is not found there are some more special investigations.
Usually, these problems end well. Patiently review with your pediatrician
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Pediatrician Dr. Dilip V's  Response
hi,
with the frequent history of travelling as you say and a complete up to date vaccination, and a chronic fever of one and a half months.. could be a prolonged viral fever/ tuberculosis/ sub clinical malarial infection of mild form..
these diseases are endemic in the countries you have mentioned and a prolonged illness of mild intensity goes in favor of above conditions.. i would suggest you to go to the nearest pediatrician and request investigations to rule out tuberculosis and malaria as quickly as possible..
also coming to the headache aspect of your child it could be one of the manifestations of these above mentioned diseases if they involve the meninges (covering of brain) may lead to similar headache..

most likely in your child this seems to look like a prolonged viral illness with rash and generalized weakness but it is always better to rule out these other causes mentioned as an early detection and good medications are available for them leading to early recovery.. viral illness will run its course and will be self limited..
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Persistent low grade fever and headache for a child. Face become red and blotchy. All vaccinations taken. CBC level normal

dear parent, This has to be dealt very patiently. I want you to first put a tabular coloumn like this M Tu W Th F S Su I week II week III Week IV week V week VI week Then record on the days she had fever. 6 weeks is a long time and you are giving several other important clues. 1. Skin rash 2. Head ache. 3 Marked reduction in activity. Now let us divide the problems into infections and non infectious problems. Infections like Malaria Typhoid your blood investigations should have revealed. As traveller you must also think of Rickettsial infections which respond only to doxycycline and azithromycin. Of course there is urinary tract infection. Child hood tuberculosis is called Primary complex and will be revealed only by a Mantoux test. Then there are two important group of non infectious conditions. A peripheral smear study is a must to see how her red and white blood cells appear. ESR is a test which will give a clue about a type of Rheumatoid arthritis which presents like your childs case : JIA. There are other collagen vasuclar disorder belonging to the family of Rheumatoid arthiritis which may demand specific blood tests. Still if the answer is not found there are some more special investigations. Usually, these problems end well. Patiently review with your pediatrician