Professional Documents
Culture Documents
Fever
The most frequent complaint, usually
alarms parents
The clinical manifestations varies
Age : neonatal to adolescent
Problems if fever with no apparent
source
Fever definiton
Pathophysiological and Clinical term
Pathophysiological term
Body temperature increase above normal as
the result of a coordinated response to a
pathological insult in the thermoregulation
centre
Clinical term
Rectal temperature 38.0 C
Axillary temperature
37.4C
Tympanic membrane
Hueter SE ,Defriez CB: Pathophysiology The Basis for Disease in Adults and Children;2006
Class
Commones Usual
t Cause
Fever
Duration
Fever with
Localizing Signs
(FWLS)
URTI
< 1 week
Fever without
Localizing Signs
(FWOLS)
Viral
Infection, UTI
< 1 week
Fever of Unkown
Origin
(FUO/PUO)
Infection,JIA
> 1 week
FWLS
Pulmonary
Pnemonia, Bronchiolitis
Gastrointestinal
Gastroenteritis, Hepatitis,
Appendicitis
CNS
Meningitis, Encephalitis
Exantems
Measles, Chickenpox
Collagen
Neoplasma
Leukemia, lymphoma
Tropics
Kala
azar Manual of Fever in Children. 2009
El-Radhi AS
:Fever;Clinical
Bacteriemia / Sepsis
Most viruses (HH-6,EBV)
UTI, Malaria
Infection, Collagen ,
Neoplasma
Neoplasma
Leukemia, Lymphoma
Post Vaccination
Drug Fever
DPT,measles
Antibiotics, Cytotoxic,
Antiepileptics
El-Radhi AS :Fever;Clinical Manual of Fever in Children. 2009
Causes
Infection
Localized
Systemic
Collagen Diseases
Neoplasma
Miscellaneous
Diseases
( 60-70 %)
Sinusitis ,Endocarditis ,Occult
abscess
EBV Viral, TBC, Brucellosis
(20%)
(5%)
( 5-10%)
JIA,SLE
Leukaemia, Lymphoma.
Neuroblastoma
Drug Fever
Fever
Most are beneficial : enhancing infection
Antipyretic s
External Cooling
Parents Fever Phobia
Lorin MI.Fever and Its Treatment;Oskis Essential Pediatrics.2004
El-Radhi AS :Management of Fever ;Clinical Manual of Fever in Children. 2009
Poerwo Soedarmo S dkk :Buku Ajar Infeksi & Pediatri Tropis;2008
Ward MA : Patient information: Fever in children ; UpToDate CD-ROM 17.2 .2009
overdoses
Low interaction with other medications, rare
contraindications
Safe and cost effective
Choices : Paracetamol
and Ibuprofen
El-Radhi AS :Management of .Fever ;Clinical Manual of Fever in Children. 2009
Isaacs D. Fever. Evidence Based Pediatric Infectious Diseases. 2007
Aronoff SC:Fever in Infant andtoddler:;http://emedicine.com.Updated Agustus 2009
External cooling
Warm water, Total body surface
cooling
Tepid water (30 C)
Temp > 40 C
One hour after antipyretic
Duration 30 minutes
Fisher RG : Fever and Shock Syndrome;Moffets Pediatric Infectious Diseases.2005
Ward MA: Fever Pathogenesis and Treatment . Pediatric Infectious Diseases; 2009
comfort (child/parent)
Try tepid sponging first
Use paracetamol or ibuprofen (not >
48 hrs/3 days)
Ibuprofen is not recommended for
babies < 6 mo old
Isaacs D. Fever. Evidence Based Pediatric Infectious Diseases. 2007
infection focus
The presence or absence of
toxicity
Isaacs D. Fever. Evidence Based Pediatric Infectious Diseases. 2007
SBI :
Meningitis,Bacteriemia
/Sepsis,Enteritis,
Pnemonia,Pericarditis,Osteomyelitis,Se
ptic arthritis,Cellulitis
S pneumoniae
N meningitidis
H influenzaetype b
L monocytogenes
E coli
Tolan RW :Fever Without a Focus . http://emedicine.com.Updated: Jan 22, 2009
Granetto JW:Pediatric Fever. http://emedicine.com.Updated: Jan 22, 2009
Appear toxic
Suspected SBI
Skin petechiae
children (ABCD)
A
B
C
D
:
:
:
:
Antibiotic indications :
bacterial disease
Neonates and ill looking children
Fever > 40 C ,< 36 months , without focus
infection
Without infection focus, screening test are
abnormal
Depend on :
AGE
ANTIBIOTICS
DOSE mg/kg
BW
0-3 mos
Amox/Ampicillin
Plus
Gentamicin
50
IV/6 hourly
7,5
IV /daily
Benzylpenicillin
OR
Ceftriaxone
30/50.000U
IV/6 hourly
50
IV/IM daily
4 mos 4
yrs
Over 4 yrs
The COMBINATION
OF
30/50.000U
IV/6 hourly
Benzylpenicilin
50
IV/6 houly
PLUS
Di/Flucl/Nafcillin
50
IV/8 hourly
OR as A SINGLE
50
IV/IM daily
AGENT
Cefotaxim OR
Isaacs D. Fever. Evidence Based Pediatric Infectious Diseases. 2007
Ceftriaxon