for both pediatrician and infectious diseases

2. Clinical approach toClinical approach to
prolonged feverprolonged fever
ByBy
Dr. Walaa ManaaDr. Walaa Manaa
specialistspecialist
Kafr Shekh Fever HospitalKafr Shekh Fever Hospital

3. DefinitionDefinition::
Fever more than 10-14 day
Although it is not common as SFI,
it cause greater concern for both
pt.& doctors.

4. • Q1:It is truly prolonged?
• Q2:Is there any evident cause?
• Q3:It is FUO what is the cause?

5. Q1:It is truly prolongedQ1:It is truly prolonged??
PF…should not be accepted with out carefulPF…should not be accepted with out careful
analysis ,,,,analysis ,,,,
WHY?WHY?
1)Normal temp. may be mis interpretated by1)Normal temp. may be mis interpretated by
the parent as mild fever.the parent as mild fever.
2)Dentation.2)Dentation.
3)It may be 2 SFI and not FUO.3)It may be 2 SFI and not FUO.

6. SO,SO,
Documentation of fever is importantDocumentation of fever is important
to accept the co as true feverto accept the co as true fever

7. Q2:Is there any evident causeQ2:Is there any evident cause??
Non specific finding
denoting significant
illness:
CO:anorexia wt loss
OE:*toxic look
*pallor
*cachexia
*LN.apathy
specific finding
suggesting a
particular illness:

8. specific finding suggesting aspecific finding suggesting a
particular illnessparticular illness
• History:
*Of contact with TB pt  TB
*Of medication  drug fever.
*Of rigor  septcemia
malaria
brucellosis
UTI.
???postmenopausal symp.
*Of eating rabbit meattularemia.

11. • OE:
*CNS:~~~~~~~searsh for meningitis
*chest:~~~~~~~pneumonia ,empyrma.
*heart:~~~~~~~endo-peri (carditis).
*Abd.:~~~~~~~liver abscess-hepatitis
perinephric abscess.
*Bone~~~~~~~arthritis-osteomyelitis.
*P.R.~~~~~~~~pelvic abscess.

12. Q3:It is PF, what is the causeQ3:It is PF, what is the cause??
• When hist.&OE fail to
to reveal an evident cause,
or to suggest a specific disease.
PF

13. PFPF
Pt is with good general
condition & short
history
ESR+CRP+CBP+Urine
-ve
Reassurance & folow up
Pt is with bad general
condition& long
history
Should be hositalized&
investigated.
why?

14. Why hospitalizationWhy hospitalization?.?.
(1)Documentation of fever & so exclution
of factitious fever.
(2)Avoidance of drugs.
{drug fever}temp. dec. after 3 days.
(3)Close observation:
general condition
{appetite,,activity,,,}
rigor at sp. Time.
appearance of new S&S.

15. InvestigationInvestigation
Non specific:
CBP*Leucocytosis
*Leucopenia
*Esinophelia
ESR
CRP
X-RAY
chest:pnemonia+2nd
ry
Specific:
(1)
(2)
(3)

16. ))11((
(1)Blood cultureinclude aerob. & anaerob.
it may be repeated.
(2)Urine culture.
(3)Tuberculine test.
(4)Malarial film.
(5)Common serology:*widal test,
*brucellosis
*monospot test

17. If (1) is –veIf (1) is –ve(2(2))
(1)Specific blood
culture tularemia,leptospirosis
(2)Specific serology: toxoplasmosis.
(3)BM……………..leukemic cell & culture.
(4)US……………..Liver or subpherinic .
Abscess.
(5)Echocardiograpgy specially in pre existing
. cardiac disease.

18. If(2) is –veIf(2) is –ve(3(3))
(1)LN biopsy,,,,,,,,,,,,,,,,,,,lyphoma.
(2)Radio isotop scanningosteomylitis.
(3)CT total body,,,,,,,,,,,,,hidden tumer
.
(4)MRI.

19. take home messagestake home messages
1-25% OF all cases
the cause remain unknown even after
sophisticated investigation.

20. 2-Blind antibiotic should be avoided
why?
_it mask the condition
_it make the diagnosis difficult
except in 2 condition we can use blind
antibiotic:
_severely ill pt. or septicemia.
_TB.

21. • Once physicians are satisfied that there is
no infectious cause,
they may use medications such as
NSAIDs, or corticosteroids to decrease
inflammation and diminish constitutional
symptoms