Fever without focus
Dr Abhijeet
Definition
• Fever is defined as a rectal temperature
≥38°C, and a value >40°C is called
hyperpyrexia.
Pathogenesis
• Body temperature is regulated by
thermosensitive neurons located in the
preoptic or anterior hypothalamus t...
• Thermoregulatory responses include
redirecting blood to or from cutaneous
vascular beds, increased or decreased
sweating...
Mechanism of Fever
1.Pyrogens: Endogenous pyrogens include the
cytokines interleukin 1 (IL)-1 and IL-6, tumor
necrosis fac...
Causes of Fever
1. Infectious,
2. Inflammatory,
3. Neoplastic,
4. Miscellaneous.
• The pattern of the fever can provide clues to
the underlying etiology.
• Viral infections typically associated with a
sl...
• Although administration of antimicrobial
agents can result in a very rapid elimination of
bacteria, if tissue injury has...
Types of Fever
• Intermittent fever:
Temperature fluctuation is more than 1 C and
fever present only few hours in a day. E...
• Relapsing fever :
Characterized by febrile periods that are
separated by intervals of normal temperature.
• Tertian feve...
• Biphasic fever: A single illness with 2 distinct
periods (camelback fever pattern);
poliomyelitis is the classic example...
• Factitious fever or self-induced fever: May be
caused by intentional manipulation of the
thermometer or injection of pyr...
Fever Without Localizing signs
• Etiology & Evaluation of fever without
localizing signs depends upon age of the child
• N...
• Neonates without sick look & with fever have
7% risk of serious bacterial infection.
i.e. occult bacteremia, meningitis ...
Management
• Admit
• CBC, Blood culture, CSF studies, Urine analysis
Stool C/s, Chest X ray etc.
• Combination of antibiot...
1- 3 Months
• Mostly viral origin
• May be vaccine induced, if recent
immunization done in recent past.
• But can be serio...
• In contrast to bacterial infections, viral
diseases have seasional pattern.
- Winter : RSV, Influenza A
- Summer & Fall:...
Management
• Sick/ Toxic looking febrile infants should be
admitted
• CBC, Blood culture, CSF studies, Urine analysis
Stoo...
• This regimen is effective against usual bacteria
causing sepsis, UTI & Enteritis in infants.
• If meningitis is suspecte...
• A well looking infant with no clinical focus of
infection (TC < 15000, Band form< 20%, CRP
neg, urine WBC <10HPF) can be...
LOW RISK CRITERIA IN 1-3 MONTHS
OLD WITH FEVER
Boston Criteria
3-36 Months
• Risk of serious bacterial infections is 5%.
• Detailed Immunization H/O
• Sick contacts in family.
Management
• Sick looking babies – Admit.
• Prompt administration of antibiotics after
collecting Urine, blood, CSf Sample...
• Empirical antibiotic therapy is recommended
for well appearing children < 36 months who
have not received HiB & Conj. pn...
Management of Fever without
localizing signs.
THANK YOU
• Nelson 18th ed
Fever  without focus in children
Fever  without focus in children
Fever  without focus in children
Fever  without focus in children
Fever  without focus in children
Fever  without focus in children
Fever  without focus in children
Upcoming SlideShare
Loading in …5
×

Fever without focus in children

1,401 views

Published on

Published in: Health & Medicine
0 Comments
3 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
1,401
On SlideShare
0
From Embeds
0
Number of Embeds
1
Actions
Shares
0
Downloads
86
Comments
0
Likes
3
Embeds 0
No embeds

No notes for slide

Fever without focus in children

  1. 1. Fever without focus Dr Abhijeet
  2. 2. Definition • Fever is defined as a rectal temperature ≥38°C, and a value >40°C is called hyperpyrexia.
  3. 3. Pathogenesis • Body temperature is regulated by thermosensitive neurons located in the preoptic or anterior hypothalamus that respond to changes in blood temperature as well as cold and warm receptors located in skin and muscles.
  4. 4. • Thermoregulatory responses include redirecting blood to or from cutaneous vascular beds, increased or decreased sweating, regulation of extracellular fluid volume via arginine vasopressin, and behavioral responses, such as seeking a warmer or cooler environmental temperature.
  5. 5. Mechanism of Fever 1.Pyrogens: Endogenous pyrogens include the cytokines interleukin 1 (IL)-1 and IL-6, tumor necrosis factor-α (TNF-α), interferon (IFN)-β , IFN-γ & (PG)E2. Exogenous pyrogens :Infectious pathogens and drugs. 2.Heat production exceeding loss, and 3.Defective heat loss.
  6. 6. Causes of Fever 1. Infectious, 2. Inflammatory, 3. Neoplastic, 4. Miscellaneous.
  7. 7. • The pattern of the fever can provide clues to the underlying etiology. • Viral infections typically associated with a slow decline of fever over a week, whereas Bacterial infections are associated with a prompt resolution of fever after effective antimicrobial treatment is employed.
  8. 8. • Although administration of antimicrobial agents can result in a very rapid elimination of bacteria, if tissue injury has been extensive, the inflammatory response and fever can continue for days after all microbes have been eradicated.
  9. 9. Types of Fever • Intermittent fever: Temperature fluctuation is more than 1 C and fever present only few hours in a day. Eg:filaria • Septic or hectic fever: Extremely wide fluctuations . • Sustained fever : Persistent and does not vary by more than 0.5°C/day. • Remittent fever : Persistent and varies by more than 0.5°C/day.
  10. 10. • Relapsing fever : Characterized by febrile periods that are separated by intervals of normal temperature. • Tertian fever: Occurs on the first and third days (malaria caused by Plasmodium vivax) • Quartan fever :Occurs on the first and fourth days (malaria caused by Plasmodium malariae).
  11. 11. • Biphasic fever: A single illness with 2 distinct periods (camelback fever pattern); poliomyelitis is the classic example,also characteristic of other enteroviral infections, leptospirosis, dengue fever, yellow fever, Colorado tick fever, spirillary rat-bite fever (Spirillum minus), and the African hemorrhagic fevers (Marburg, Ebola, and Lassa fevers).
  12. 12. • Factitious fever or self-induced fever: May be caused by intentional manipulation of the thermometer or injection of pyrogenic material.
  13. 13. Fever Without Localizing signs • Etiology & Evaluation of fever without localizing signs depends upon age of the child • Neonates-1 month: Challenge to evaluate because of difficulty to clinically distinguish between serious bacterial & self limiting viral illness. - Immature immune response in this period increases the significance of illness.
  14. 14. • Neonates without sick look & with fever have 7% risk of serious bacterial infection. i.e. occult bacteremia, meningitis (Caused by E.Coli, Listeria monocytogenes, Herpis simplex, enterovirus) , pneumonia, osteomyelitis, septic arthritis, enteritis & UTI.
  15. 15. Management • Admit • CBC, Blood culture, CSF studies, Urine analysis Stool C/s, Chest X ray etc. • Combination of antibiotics such as Ampicillin & Cefotaxime. • Acyclovir for suspected HSV infection (CSF pleocytosis), maternal H/O genital HSV during delivery.
  16. 16. 1- 3 Months • Mostly viral origin • May be vaccine induced, if recent immunization done in recent past. • But can be serious bacterial infections such as: Gr. B streptococcus, L. monocytogenes, Salmonella enteritis, E.Coli, S. Pneumoniae, HIB , Staph aureus • Otitis media, pneumonia, omphalitis, mastitis, skin & soft tissue infections.
  17. 17. • In contrast to bacterial infections, viral diseases have seasional pattern. - Winter : RSV, Influenza A - Summer & Fall: Enterovirus.
  18. 18. Management • Sick/ Toxic looking febrile infants should be admitted • CBC, Blood culture, CSF studies, Urine analysis Stool C/s, Chest X ray etc. • Combination of antibiotics such as Ampicillin (to cover L.monocytogenes & Enterococcus)& Cefotaxime/ Ceftriaxone.
  19. 19. • This regimen is effective against usual bacteria causing sepsis, UTI & Enteritis in infants. • If meningitis is suspected, VANCOMYCIN should be added to t/t possible Penicillinase resistant S. Pneumoniae until C/S reports come.
  20. 20. • A well looking infant with no clinical focus of infection (TC < 15000, Band form< 20%, CRP neg, urine WBC <10HPF) can be observed at home without antibiotics.
  21. 21. LOW RISK CRITERIA IN 1-3 MONTHS OLD WITH FEVER
  22. 22. Boston Criteria
  23. 23. 3-36 Months • Risk of serious bacterial infections is 5%. • Detailed Immunization H/O • Sick contacts in family.
  24. 24. Management • Sick looking babies – Admit. • Prompt administration of antibiotics after collecting Urine, blood, CSf Samples. • HiB bacteremia is characteristically associated with higher risk of localized serious infection than S. Pneumoniae. • .
  25. 25. • Empirical antibiotic therapy is recommended for well appearing children < 36 months who have not received HiB & Conj. pneumococcal vaccine& who have rectal temp > 39 C with TC > 15000
  26. 26. Management of Fever without localizing signs.
  27. 27. THANK YOU
  28. 28. • Nelson 18th ed

×