Differential Diagnosis (DD) of Febrile Diseases
#x203A; Establishing a diagnosis from several clinical presentations is a common challenge in paediatrics that needs knowledge and experience to solve. This chapter provides clinicians with a guide to clinical and laboratory means to reach a diagnosis of
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Establishing a diagnosis from several clinical presentations is a common challenge in paediatrics that needs knowledge and experience to solve. This chapter provides clinicians with a guide to clinical and laboratory means to reach a diagnosis of the most common febrile diseases. Infection is the most likely diagnosis in a child with fever, where the fever is usually of short duration and is associated with a focus in about three quarters of cases and without a focus in the majority of the remaining cases. Viral infections, affecting mainly the upper respiratory tract (URT), are the cause of fever in about 90-95% of febrile children. It is the physician’s primary role to identify the remaining 5-10% of children who have a bacterial infection and who may require antibiotic treatment. Nowadays, most cases of tonsillitis, otitis media and pneumonia, during the first years of life, are caused by a viral infection. In the tropics, bacterial and parasitic infections are more common than in developed countries and are important causes of mortality of millions of children. Pyrexia of unknown origin is considered when fever persists for more than one week: it’s cause is unknown despite investigation. In contrast to adults, PUO in children is mostly due to infection followed by collagen and vascular causes. The diagnosis of fever of non-infectious origin is considered after excluding an infection. This is done by history, physical examination and laboratory tests. Persistent and/or insidious fever of a low degree (< 39.5oC), the absence of chills and diurnal rhythm of fever are suggestive of non-infectious fever. An important cause of elevated body temperature is heatstroke, which is due to a combination of heat, high humidity, excessive wrapping and lack of fluids.
A.S. El-Radhi et al. (Eds.) Clinical Manual of Fever in Children. Doi: 10.1007/978-3-540-78598-9, © Springer-Verlag Berlin Heidelberg 2009
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12 Differential Diagnosis (DD) of Febrile Diseases
12.1 Differentiating Fever of Infectious and Noninfectious Origin Main causes of fever: ●
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Infections (Bacterial, virus, TB, parasitic, rickettsia) are by far the most common cause of fever in children. Infection remains the likely diagnosis in a febrile child until proven otherwise. Noninfectious (collagen/vascular, malignancy, drugs, allergy, recent immunization, periodic fevers).
Diagnosis that fever is caused by an infection is supported by the following: ●
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Underlying conditions predisposing to infections (e.g., Immunocompromised status, splenectomy, sickle cell anemia, neonates and young infants, intravascular catheters) Fever of 40°C or greater, presence of chills, diurnal fluctuation of fever A focus for infection (e.g., tonsillitis, pneumonia). In case of fever without a focus, the diagnosis can usually be rapidly established by laboratory means (e.g., UTI, malaria) Short duration of fever occuring, for example, in viral infections Rapid response to antibiotics in bacterial infections Concomit
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