2. BEST DEFINED AS
FEVER WITHOUT OBVIOUS SOURCE ON
CLINICAL EXAMINATION
ORAL
R
E
C
T
A
L
3. FEVER
TEMPERATURE >38 .0 degree C
(>100.4 degree F) RECTAL
TEMPRATURE
ORAL – 0.6 C LESS
AXILLARY IS 1.1 C LESS
4. What is a PUO?
1956 Age > 14
T > 37.4°C x3 or 38°C x1
Fever - predominant symptom
Insufficient symptoms / signs to localise
1961 Days > 21, T > 38.3°C
1/52 hospital investigation
1968 Days > 14
No clear diagnosis
Reid
Petersdorf
& Beeson
Dechovitz
& Moffet
5. What is a PUO now?
Now
+
2 hospital visits, or
Hospital investigations for 3 days
Neutropeni
c PUO
Neutrophils < 1.0
Diagnosis not clear at 3 days
Nosocomial
PUO
Admission infection screen negative
Diagnosis not clear at 3 days
HIV PUO HIV infected, fever for 4 weeks
Diagnosis not clear after 3 days
7. The commonest cause of PUO is:
a) A common disease presenting in an
atypical way.
b) A rare disease presenting in atypical
way.
c) A common disease presenting typically.
d) A rare disease presenting typically.
8. The answer is ..A
..The commonest cause of PUO IS
…Common disease presenting
ATYPICALLY
12. AGE GROUP
NEONATE ( 0-28 days)
YOUNG INFANT ( 1-3 months)
OLDER INFANT TO TODDLER (3 month
To 36 month)
13. NEONATE
ALL TOXIC – APPEARING INFANTS AND
ALL FEBRILE INFANTS LESS THAN 28
DAYS SHOULD BE HOSPITALIZED FOR
EVALUATION AND INITIATION OF
PROMPT PARENTAL ANTIBIOTIC
THERAPY AFTER SENDING BLOOD
CULTURE
14. FLOW CHART
AGE<28 days
OR
CLINICALLY TOXIC CHILD
YES NO
INVESTIGATION
INCLUDE LP
IV ANTIBIOTICS
HOSPITALIZATION
INVESTIGATE
CONSIDER LP
NORMAL LAB
AND X RAY
REACESS 24 HRS
LATER CLINICALLY
ABNORMAL LABS
OR CXR
IV ANTIBIOTICS
HOSPITALIZATION
15. WHY NEONATE ARE AT HIGH RISK
HIGH RISK OF DEVELOPING SBI
MAINLY BACTERIAL ( GRAM NEGATIVE)
22. AGE 3MONTHS TO 36 MONTHS
IN THIS SUB GROUP TEMPERATURE
MORE THAN 39 degree C IS DEFINED AS
FEVER
23. TEMP > 39 C
YES NO
TOXIC
Y
E
S
N
O
ADMIT
INVESTIGATION
PARENTAL ANTI.
INVESTIGATE
WITH
TC, DC
URINE
XRAY
OCCULT UTI
OCCULT
BACTEREMIA
PNEUMONIA
24. LAB CRITERIA
TLC (5 – 15000)
ABSOLUTE BAND CELL COUNT (<1500/mm)
<10 WBC PER HIGH POWER FIELD IN SPUN URINE
SEDIMENT
<5 WBC PER HIGH POWER FIELD IN STOOL
SAMPLE
25. LP – PRESENCE OF WBC IN CSF/ GRAM
STAINING
2 D ECHO – HELPS IN DIAGNOSING IE,
MYOCARDITIS
CT SCAN / MRI
26. Management of Fever – Contd..
Oral antipyretics – Well tolerated , effective
Parenteral antipyretics not indicated
Rectal suppositories – In intractable vomiting ,
post-operative state
Inform parents that antipyretics do not cure
Fever may persist despite antipyretics , especially in
first 2-3 days of even in self-limiting viral infection
29. TAKE HOME MSG..
ALL FEBRILE INFANTS WHO ARE LESS
THAN 36 months WHO HAVE TOXIC
MANIFESTATION HAS TO BE REFERRED
LESS THAN 28 DAYS HAS TO BE
REFERRED FOR PARENTRAL ANTIBIOTIC
NO LAB TEST OR ANTIBIOTIC ARE
NEEDED IN CHILD OVER 3 MONTHS
WHO HAS TEMP LESS THAN 39 C.
