Fever resident survival guide (pediatrics)

Resident Survival Guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Marufa Marium, M.B.B.S[2]

Synonyms and keywords:

Fever resident survival guide (pediatrics) Microchapters
Overview
Causes
FIRE
Diagnosis
Treatment
Do's
Don'ts

Overview

Fever in Children is exceptionally recurrent presenting complaints in pediatric department or emergency department or primary care comprising of 15-25%. Most of the parents has immense concern regarding this complaints. Physiologic thermoregulatory elevation of body core temperature above the standard quotidian temperature may termed as fever. As an ancient presenting complaints fever is thought to be an evil spirits by most of the ancient civilizations for example Egyptian, Greek, Mesopotamian etc. There were various ideology regarding fever as the Roman used to worship a God of fever, whereas in the middle age, by Persian famous scholar Avicenna, fever was explained as increased temperature produced by heart diffusing throughout the whole body. 'The Medical renaissance' removed the confusion by describing fever as a physiologic response of an infection in eighteenth century. A number of factor influences fever for instances Chronological age, stage of activity, durational variations(lower body temperature in morning, and higher in late afternoon), food intake etc. The body core temperature is estimated from different parts of body. American Academy of pediatrics has provided information on the accuracy of rectal temperature in infants under four years. But due to its uneasiness of patients oral temperature is the most preferred method in usual population whereas in children under 5 years axillary temperature is sensitive in clinical settings. The mechanism of fever comprises of several components, it includes-Toxic insult/ Infection / inflammatory mediatiors → Macrophage/endothelial cells → Pyrogens(Exogenous: LPS from Gm- organism/ Toxin from Microorganism and EndogenousIL-6/IL-1/IFN-a/TNF-a/Ciliary neurotropic factor/Muramyl Dipeptidase/Enterotoxins) and Cryogens(IL-10, Hormones like MSH, CRH, Neuropeptide Y, Bombesisn, Thyroliberin) → endothelial cells of Hypothalamus → PGE2 → Cyclic AMP → Elevation of Thermoregulatory set point → Heat conservation and production by → fever. The most common cause of fever is infection of any variety like bacterial, viral, fungal, parasitic, other causes are due to malignancy, autoimmune, medications etc.

Causes

Life Threatening Causes

Life-threatening causes of fever includes red flag symptoms or signs (Impaired intake of food, Fussiness, Irritability, Inconsolable crying, Lethargy, Poor moto stimuli response, pallor or cyanosis or or ruddiness mottling of skin, tachycardia, tachypnea, Delayed CRT/ Hypovolemia with reduction in urine output, Bulging fontanelle, Petechial or purpuric or blanching rash, Nuchal rigidity, Rigors, Drooling, tripod position, Vomiting) along with high body core temperature that may result in death or permanent disability within 24 hours if left untreated.

• Sepsis
• Toxic Shock Syndrome
• Scalded Skin Syndrome
• Meningitis
• Pneumonia
• Influenza
• Stevens-Johnson syndrome/ Toxic Epidermal Necrolysis
• Acute Rheumatic Fever
• Typhoid Fever
• Malaria, Dengue, West Nile Fever
• Encephalitis
• Osteomyelitis
• Septic Arthritis
• Mastoiditis
• Retropharyngeal Abscess
• Kawasaki Disease
• UTI
• Orbital Cellulitis
• Central line associated fever

Common Causes

• Infectious causes are bacterial, viral, parasitic, fungal whereas noninfectious causes include autoimmune disease, malignancy, drug fever, congenital cause.
• Infectious:
  • Bacterial: Tonsillitis, abscess, sinusitis, tuberculosis, cellulitis/erysepelas, endocarditis, pyelonephritis, Shigellosis/bacilary dysentry, staphylococcal food poisoning, V.Parahemolyticus/ V.vulnificus/V.Cholerea infection, mycoplasma, listeriosis, brucellosis, bartonella, leptospirosis etc.
  • Viral: Adenovirus, RSV, CMV, EBV, HIV, HSV, Hepatitis virus, Parvo Virus, Enterovirus, Measles Virus, Mump Virus, Parainfluenza, Noro virus etc.
  • Fungal: Cryptosporidium, Candia, Blastomycosis, Histoplasmosis, Pneumocystis Jiroveci.
  • Parasitic: Malaria, Toxoplasmosis, Amebiasis, Ehrlichiosis, Q fever, Leishmaniasis, Helminthiasis, Lyme disease, Rocky Mountain spotted fever.

Non-infectious:

• • Malignancy / Hematologic: Leukemia, Lymphoma, Sickle cell anemia, hemophilia, cyclic neutropenia, Langerhans cell histiocytosis.
  • Genetic / Congenital: Familial Mediterranean fever, TNF associated periodic fever syndrome, Neonatal Onset multisystem inflammatory disorder (NOMD), Familial cold autoinflammatory syndrome, familial dysautonomia.
  • Autoimmune: Systemis juvenile idiopathic arthritis/still disease, granulomatosis with polyangitis, behcet disease, polyarteritis nodosa, henoch-scholen purpura, antiphospholipid antibody syndrome, SLE, sarcoidosis, hyperthyroidism, benogn giant cell lymhnode hyperplasia/castleman disease, , juvenile dermatomyositis.
  • Other: Diabetes incipidus, pancreatitis, serum sickness, drug fever etc IG4 related disease, facttious fever, hypothalamic dysfunction.

Complete Diagnostic Approach

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Treatment

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Do's

• The content in this section is in bullet points.

Don'ts

• The content in this section is in bullet points.