FEVER

DEFINITION
Body temperature more than 38C
*Body temperature regulated by thermosensitive neurons at the anterior hypothalamus which
respond to blood

temperature and warm and also control receptor at skin and muscle.

TYPE OF FEVER
1) Continous Fever
-persistent not vary more than 0.5C
eg : Viral infection,
UTI,
Dengue
2) Intermittent Fever

3) Remittent Fever

4) Quatidian Fever

-Temperature rise for few hours then back

to normal
eg : Malaria
*VIVAX (Tertian- 1st and 3rd)
MALARIAE (Quartian 1st and 4th)
-Temperature returns towards normal for
variable
periods but always elevated.
eg : Leptospirosis
Kawasaki
Empyema
Pelvic Abscess
-Recurrence/Spikes Daily
eg : TB

5) Undulant Fever

- Bouts of continuous /remittent fever for

several days followed by afebrile remission
lasting variable no of days.
eg : Lymphoma
Typhoid (Saddle back)

DIFFERENTIAL DIAGNOSIS FOR FEVER

ACUTE FEVER

PROLONGED FEVER

FEVER WITH RASH

1. Dengue
2. Pneumonia
3. Meningitis
4. Septic Arthritis
5. AGE
6. Leptospirosis
7. Sinusitis
8. Otitis Media
9. Pharyngitis
10.Tonsillitis
11.UTI

1. TB
2. Infective Endocarditis
3. Leukaemia
4. Lymphoma
5. SLE
6. Osteomyelitis
7. Dental Abscess
8. Polyarthritis Nodule
9. JIA
10.Vesico Ureteric Jx
Reflux
11.Kawasaki
12.ARF
13.Hepatitis
14.Pericarditis

1. Rubella
2. Chicken Pox
3. Scarlet Fever
4. Measles
5. Dengue
6. Typhoid
7. HSP
8. ARF
9. Kawasaki
10.SLE
11.HFMD
12.Herpes Zoster
13.5th Disease (B19)

APPROACH TO FEVER
1. Onset of fever? Morning/evening/ Night? At what time?
2. At that time, what child was doing? Is he active/playing well/feeding well?
3. How mother know it was fever?
-felt body warm by touch or take temperature?
-if take temperature, where? With what? How? What is the reading?
4. Intensity? (Low grade/high grade)? *high grade got chills, rigor and sweating.
5. Pattern of fever? Continuous or intermittent?
6. Diurnal variation? Fever worst at daytime or night time?
7. Anything mother does to relive fever?
- Tepid sponging? Where? Fever goes down??
- Antipyretic? Where do you get that from/buy?
- Whose drugs? How much you give? Is it the right dose? How many times
you give?
- Any improvement? When last time you give?
8. Did fever affect his sleep, appetite and playing?
9. Usually how many times child eats and drinks (before/during illness)? Any
change?
- How many ounces? How mix (one scoop to how many litres of water?
- How prepare?
10.How many hours sleeping before and during illness? Any change?
11.How many hours playing before and during illness? Any change?
12.How about urine output and bowel habit before and during illness?
- How many times go to toilet?
- How many times change diapers?
13.Any cough? Breathlessness during feeding/play? Wheezing?
(Pneumonia/Bronchiolitis)
14.Any suck pause cycle? Cyanosis? (CHD/HF/IE/Kawasaki/ARF)
15.Any Janeway lesion, Oslers node or anaemia past wan week with fever? (IE)
16.Any rash on trunk, red lips/tongue, oedema of palm/soles or desquamation?
(Kawasaki)
17.Any fleeting joint pain, abnormal movement or subcutaneous nodules? (ARF)
18. Any ear pain, discharge or pulling of ears? (OM)
19.Any nasal discharge or below eyes/ check pain? (Sinusitis)

20.Any sore throat, refusal to feed, drooling of saliva or injected throat?

(Tonsillitis/Pharyngitis)
21.Any change in urine pattern, quantity, frequency, colour, smell, dysuria,
loin/suprapubic pain, vomiting, or prolonged fever? (UTI)
22. Any headache, photophobia, sensitive to light, drowsiness, fit, blurring of
vision, neck stiffness or cyclic early morning effortless vomiting?
(Meningitis)
23.Any joint pain, redness and swelling? (Septic Arthritis)
24.Any calf pain, abdominal pain, jaundice, retro orbital headache or any recent
travel to waterfall (Leptospirosis)
25.Any WARNING sign, gum bleeding, petechial, recent fogging at
neighbourhood or from dengue prone area? (Dengue)
26.Any Ill contact, persistent coughing, or sweating/chills/rigor at night? (TB)
27. Any history of eating outside day before? (AGE)
- What did child eat?
- Other family members have same problem?
- Did they eat the same food as child?
- Is child dehydrated?
- Any vomiting, abdominal pain or loose stool?
- Type of stool, colour, smell and consistency?
28.Any recent visit to dental, any gum swelling? Dental carries? (Dental
Abscess)
29. Any swelling anywhere? History of blood problem? Frequently sick, pale
looking, lethargy or weight lost? (Leukaemia/Lymphoma)
30. Any malar rash, myalgia, alopecia or weight lost? (SLE)
31.Any muscle pain, post trauma with fracture or poor healing?
(Osteomyelitis)
32.Any rash anywhere? What day of illness?Describe each rash.
- Rubella
- Chicken pox
- Scarlet
- Measles
- Dengue
- Typhoid
- HSP
- HFMD
- Herpes
- 5th Disease
- Kawasaki