Fever In Infants And Children

The relevance of fever depends on the overall clinical situation, less than the height of the fever. Some slight diseases cause high fever, some severe, however, only small increases in temperature. Although parental assessment is often clouded by the fear of fever, the home measured temperature should be assessed as well as a temperature, which is measured in practice.

Normal body temperature varies from person to person through and throughout the day. Normal body temperature is highest in children of preschool age. Several studies have shown that the maximum temperature tends to be present in the afternoon and at about 18 to 24 month old children when many normal healthy children a temperature of 38 ° C have (101 ° F), is the highest. Fever, however, as a core body temperature usually (rectal) of ? 38.0 ° C (100.4 ° F) defines the relevance of fever depends on the overall clinical situation, less than the height of the fever. Some slight diseases cause high fever, some severe, however, only small increases in temperature. Although parental assessment is often clouded by the fear of fever, the home measured temperature should be assessed as well as a temperature, which is measured in practice. Pathophysiology fever occurs in response to the release of endogenous pyogenic mediators: cytokines. Cytokines stimulate the production of prostaglandins by the hypothalamus. The prostaglandins change and increase the temperature setpoint. Fever is integrally important for fighting infection, and although it may be uncomfortable, it does not require treatment in an otherwise healthy child. Some studies even show that antipyretics extend progression of several diseases. However, fever increases the metabolic rate and the requirements on the cardiopulmonary system. Therefore fever can be harmful for children with lung or heart problems or neurological deficits. It can also be the catalyst for febrile convulsions, a benign usually childhood disease. Etiology The causes of fever (see Table: Some common causes of fever in children) differ depending on whether the fever acute (? 14 days), acute recurrent or intermittently (episodic fever, which is separated by afebrile points) or chronic (> 14 days) is what (FUO) is commonly referred to as a fever of unknown origin. Reactions to antipyretics and the amount of temperature are not directly related to the etiology or severity of the disease. Most acute acute fever in infants and young children is caused by an infection. The most common infections are viral infections of the gastrointestinal tract or the respiratory tract (common cause) Certain bacterial infections such as otitis media, pneumonia, urinary tract infections, however, the possible infectious causes acute fever vary with the age of the child. Newborns (infants <28 days) are considered functionally immunosuppressed because this are often unable to stem infection locally, and therefore are at higher risk of serious invasive bacterial infections, the most common of acquired during the perinatal organisms caused. The most common perinatal pathogen in newborns are group B streptococci, Escherichia coli (and other gram-negative enteric organisms), Listeria monocytogenes and herpes simplex virus. These organisms can cause bacteremia, pneumonia, pyelonephritis, meningitis and / or sepsis. Most febrile children aged 1 to 2 years for no apparent upon examination of infection (fever without source [FWS]) have a self-limiting viral disease. A small number of such patients, however (possibly <1% in the post-conjugate vaccine) are in the early course of severe infection (eg., Bacterial meningitis). Therefore, is a central concern in patients with FWS whether an occult bacteremia (pathogenic bacteria in the bloodstream without focal symptoms or signs, when examined). The most common cause of occult bacteremia are Streptococcus pneumoniae and Haemophilus influenzae. The widespread use of vaccines against these two organisms has made the occult bacteremia much rarer. The non-infectious causes of acute fever include Kawasaki disease, heat stroke and ingestion of toxic substances such. As anticholinergic drugs. Some vaccines may include fever, either in the first 24 to 48 hours after the vaccine is administered (z. B. at pertussis vaccination) or 1 to 2 weeks after the vaccine is administered (eg. As in measles vaccination) cause. This fever typically lasts a few hours to a day. If the child otherwise makes a good impression, no further evaluation is required. Teething does not cause significant or prolonged Fieber.Akut recurrent / periodic acute recurrent or periodic fever include fever episodes, alternating with periods of normal temperature (see table: Some common causes of fever in children) .Chronisch fever that occurs for ? 2 weeks daily initial cultures and other studies do not provide diagnosis and for that, considered as fever of unknown origin (FUO). The potential cause categories (see table: Some common causes of fever in children) are localized or generalized infection, connective tissue disease and cancer. Other specific causes include inflammatory bowel disease, diabetes insipidus with dehydration and impaired thermoregulation. Pseudo-FUO is probably much more common than actual FUO because frequent, smaller viral diseases can be over-interpreted. Despite the numerous possible causes of FUO in children is considered more as a rare manifestation of a common disease as a rare disease; Respiratory infections are responsible for almost half of the cases of associated with infections FUO. Some common causes of fever in children Type Examples acute therapy viral infections <1 month: TORCH infections (toxoplasmosis, syphilis, varicella, Coxsackie virus, HIV, parvovirus B19), rubella, cytomegalovirus (CMV), herpes simplex virus (HSV) ? 1 month: enterovirus and respiratory viruses (. eg respiratory syncytial virus, ParainfluenzaAdenovirus, influenza, rhinovirus, metapneumovirus), CMV, Epstein-Barr virus (EBV), HSV, human herpesvirus 6 Bacterial infections (the most common pathogens vary with the A lter) <1 month: Group B streptococci, Escherichia coli and other enteric pathogens, Listeria monocytogenes (these organisms can cause bacteremia, pneumonia, pyelonephritis, meningitis and / or sepsis; and Salmonella sp and Staphylococcus aureus [z. B. outbreaks in nurseries], which can also cause bacteremia and sepsis, infections of the soft tissues, bones and joints) 1-3 months: Streptococcus pneumoniae, group B streptococci, Neisseria meningitidis, L. monocytogenes (these organisms can cause bacteremia, pneumonia, meningitis, and / or sepsis; other common infections include otitis media [S. pneumoniae, Haemophilus influenzae, Moraxella catarrhalis] UTI [E. coli and other enteric pathogens], enteritis [Salmonella sp, Shigella and other], skin - and soft tissue infections [S. aureus, streptococci of groups A and B], bone and joint infections [S. aureus, Salmonella sp]) 3-24 months: S. pneumoniae, N. meningitidis (these organisms can cause bacteremia, meningitis and / or sepsis; other common infections include otitis media and pneumonia [S. pneumoniae, H. influenzae, M. catarrhalis], UTI [E. coli and other enteric pathogens] enteritis [Salmonella sp, Shigella and others], skin and soft tissue infections [S. aureus, group A streptococcus], bone and joint infections [S. aureus, Salmonella sp, King kingae])> 24 months: S. pneumoniae, N. meningitidis (these organisms can bacteremia, meningitis, and / or sepsis cause; other common infections are otitis media, sinusitis and pneumonia [.. S. pneumoniae, H influenzae, M catarrhalis, mycoplasma], pharyngitis or scarlet [streptococci of group A], UTI [E. coli and other enteric pathogens], enteritis [Salmonella sp, Shigella and other], skin and soft tissue infections [S. aureus, streptococci of group A], bone and joint infections [S. aureus, Salmonella sp K. kingae]) Mycobacterium tuberculosis (in exposed or risk populations rickettsial infections in appropriate geographic regions other vector-borne infectious z. B. Lyme disease) non-infectious Kawasaki disease Acute rheumatic fever heatstroke thermoregulatory disorders (Z. B. dysautonomia, diabetes insipidus, anhidrosis) ingestion of toxic doses of substances (eg. B. anticholinergic substances) Vaccinations drug fungal infections neonates or immunocompromised hosts: Candida sp most frequently (UTI, meningitis and / or sepsis) acute recurrent viral infections Frequent or successive minor viral illnesses in a young child Periodic Fever Syndrome Cyclic neutropenia Periodic fever with aphthous stomatitis, pharyngitis and adenitis (PFAPA) syndrome Familial Mediterranean fever (FMF) TNF receptor-associated periodic syndrome ( TRAPS) hyperimmunoglobulinemia-D syndrome (HIDS) Chronic (fever of unknown origin) Contagious * Viral infections (eg. B. BV, CMV, hepatitis viruses, arboviruses) sinusitis pneumonia intestinal infections (eg. As Salmonella) abscesses (intra-abdominal, liver, kidney) bone and joint infections (z. B. osteomyelitis, septic arthritis). Endocarditis HIV infection (uncommon) Tuberculosis (unusual) Parasitic infections such. B. Malaria (unusual) Cat scratch disease Lyme disease (caused, in rare cases, chronic fever) Non-Infectious Inflammatory bowel disease connective tissue diseases (eg. As juvenile idiopathic arthritis, SLE, acute rheumatic fever) cancer (most commonly lymphoreticular tumors such as lymphoma or leukemia as well as neuroblastoma or sarcoma) Drug therapy heat control disorders (eg. as dysautonomia, diabetes insipidus, anhidrosis) pseudo FUO fever certificate (z. B. artificial disease over another) * There are many infectious causes of chronic fever. This list is not exhaustive. Clarification History The history of the current disease should the degree and duration of fever, the measurement methods, if necessary, the dose and frequency of administration of antipyretics documented. Among the important accompanying symptoms that may indicate a serious condition include loss of appetite, irritability, lethargy and changing the cry pattern (z. B. duration and type). Accompanying symptoms that can infer the cause, are vomiting, diarrhea (including blood or mucus in the stool), cough, difficulty breathing, favoring a limb or a joint, strong or foul-smelling urine. The medication should be checked for evidence of drug-induced fever. Factors that may cause an infection are identified. In newborns, these factors premature birth, delayed rupture of membranes, maternal fever and positive prenatal tests are (usually for group B streptococcal infections, cytomegalovirus infections or sexually transmitted diseases). Applies that predisposing factors should be investigated for all children, in particular should by recent exposure to infection ((both within the family and other caregivers), both durable worn medical devices such as catheters or ventriculoperitoneal shunt operations, travel and environmental factors such. B . in endemic areas, ticks, mosquitoes, cats, farm animals or reptiles), and known or suspected immune defects are asked. The review of organ systems should cover symptoms that are a possible cause inference. These include: runny nose and swollen nasal mucosa (viral infection of the upper respiratory tract), headache (sinusitis, Lyme disease, meningitis), ear pain or waking up at night with signs of discomfort (otitis media), coughing or wheezing (pneumonia, bronchiolitis) abdominal pain (pneumonia, streptococcal pharyngitis, gastroenteritis, urinary tract infections, abdominal abscess), back pain (pyelonephritis), joint swelling or redness (Lyme disease, osteomyelitis). A history of repeated infections (immunodeficiency) or symptoms that suggest a chronic illness such. As poor weight gain or weight loss (TB, cancer) is documented. Certain symptoms can help to raise the suspicion of infectious causes. These include u. a. Palpitations, sweating and heat intolerance (hyperthyroidism), recurrent or cyclical symptoms (rheumatoid or inflammatory disease or genetic disease). In the history of the history previous episodes of fever or infection should be recorded, as well as known predisposition to infections such. As congenital heart disease, sickle cell anemia, cancer or immune deficiency. Even after a family history of autoimmune disease or other inherited conditions (eg. As familial dysautonomia, familial Mediterranean fever) are asked must. Previous vaccinations are reviewed to identify patients suffering from a disease that should be avoided können.Körperliche Exam Vital signs are reviewed with particular attention to anomalies in temperature and respiratory rate would by vaccination. In children who are apparently in poor condition, and the blood pressure should be measured. The temperature should be measured rectally in infants in order to achieve a higher degree of accuracy. Every child with cough, tachypnea or labored breathing requires a pulse oximetry. The general appearance and the reactions of the child to the investigation are important. A feverish child who appears remarkably docile or involuntarily, is greater cause for concern than one that is uncooperative. But an infant or a child who is irritable and inconsolable, may be cause for concern. A feverish child who looks pretty sick, v. a. even when the temperature has decreased, cause for great concern and a comprehensive evaluation and ongoing monitoring should be. On the other hand, children who seem to be more comfortable after a fever-reducing treatment, not necessarily a benign condition. The rest of the physical examination should follow the underlying disease research (see table: Investigation of the febrile child). Investigation of the febrile child range finding Possible cause skin non-bleaching rash (ie, petechiae or purpura) variety of infections, including enterovirus, meningococcemia and Rocky Mountain spotted fever Disseminated intravascular coagulation due to Vesicular of sepsis lesions varicella virus, herpes simplex virus Lacy maculopapular rash on the trunk and extremities with geröte th cheeks erythema infectiosum Local rash with swelling, induration and tenderness cellulitis, abscess Vanishing erythematous, morbilliform rash on the trunk and proximal extremities Juvenile Idiopathic Arthritis erythema migrans, single or multiple lesions disease Erythematous, sandpaper-like rash scarlet fever (Group A streptococcal infection) Erythroderma toxic shock syndrome, transmitted by toxins diseases fontanelle (infants) bulge meningitis or encephalitis ears Red, bulging middle ear membrane, confusion and loss of mobility otitis media nose swelling of the nasal mucosa, vaginal discharge Imfektion upper respiratory sinusitis Fla LEAVES the nostrils while breathing infection of the lower respiratory tract Throat redness or swelling Sometimes exudate Sometimes drooling pharyngitis (infection of the upper respiratory tract or streptococcal infection) retropharyngeal peritonsillar Focal neck adenopathy with overlying redness, warmth and tenderness; possible torticollis lymphadenitis, the infection with Staphylococcus aureus or Streptococcus Group A is secondary focal adenopathy with limited or no redness, warmth, or tenderness cat scratch disease Generalized, cervical adenopathy lymphoma Viral infection (especially Epstein-Barr virus) pain or resistance to flexion ( meningism *) meningitis lungs cough, tachypnea, rattling, wheezing, decreased At emgeräusche, wheezing infection of the lower respiratory tract (eg. As pneumonia, bronchiolitis, chronic foreign body) Heart New marbles, particularly mitral or aortic reflux Acute rheumatic fever endocarditis abdomen sensitivity, distension No bowel sounds gastroenteritis appendicitis pancreatitis abdominal abscess mass tumor hepatomegaly hepatitis Splenomegaly In newborns, infection with Epstein-Barr virus, TORCH infections (toxoplasmosis, syphilis, varicella, Coxsackie virus, HIV, parvovirus B19) leukemia, lymphoma genitourinary Costovertebrale tenderness (less reliable in younger children) pyelonephritis tenderness of the testicles epididymitis, orchitis extremities joint swelling, redness, warmth, tenderness, limited range of motion Septic arthritis (very loosely) Lyme Arth ritis rheumatoid or inflammatory disease Focal tenderness bone osteomyelitis swelling of the hands or feet Kawasaki syndrome * meningism is not always in children <2 years with meningitis determine. Warnings The following findings are of particular importance: age <1 month lethargy, listlessness or toxic appearance breathlessness petechiae or purpura Not to calm assessment of findings Although serious diseases do not always cause high fever and in many cases high fever is caused by viral infections by itself stop a temperature of ? 39 ° C in children <2 years can mean a higher risk for occult bacteremia. Other vital signs are also significant. Hypotension should increase the concern about hypovolemia, sepsis or myocardial dysfunction. Tachycardia in the absence of hypotension can be caused by fever (increase by 10 to 20 beats / minute per degrees above normal temperature) or hypovolemia. An increased respiratory rate may be a response to fever, indicate a pulmonary origin of the disease or the respiratory compensation for metabolic acidosis. Acute fever is contagious in most cases and of these, most are viral. History and physical examination are generally in children> 2 years who are apart from the fever in good condition and have no symptoms of poisoning, enough for a diagnosis. Typically, they have a viral respiratory disease (arbitrarily contact with sick people, runny nose, wheezing or coughing) or a gastrointestinal disorder (recent contact with sick people, diarrhea and vomiting). Other findings point to other specific causes (see Table: Analysis of the febrile child). In infants who are <24 months old, but there is the possibility of occult bacteremia. Moreover, the frequent absence of Fokalbefunden requires a different diagnostic approach in neonates and young infants with severe bacterial infections. The evaluation varies depending on the age group. The following categories have been proven: Newborn (? 28 days), infants (1-3 months) and toddlers and children (3-24 months). Regardless of the clinical findings requires a newborn with a fever immediate hospitalization and tests to rule out dangerous infections. In infants, hospitalization may be necessary, depending on the results of laboratory tests and the likelihood that they will be dropped off again to check. Acute recurrent or periodic fever and chronic fever require a lot of attention for the many possible causes. However, certain findings may suggest the underlying disorder. These include: aphthous stomatitis, pharyngitis and adenitis (PFAPA syndrome); intermittent headaches with colds or clogged sinuses (sinusitis), weight loss, exposure to pathogens, night sweats (tuberculosis), weight loss or poor weight gain, heart palpitations and sweating (hyperthyroidism) and weight loss, loss of appetite and night sweats (cancer) .Tests tests should age and appearance be dependent on the child and whether the fever is acute or chronic. In acute fever, the tests directed at infectious causes for the child's age. As a rule, children need <36 months a thorough search in order to prevent serious bacterial infections (eg. As meningitis, sepsis), even those who do not seem very sick, and those who have an apparent source of infection (eg. As otitis media ). In this age group is an early follow-up (by phone and / or outpatient visit) important for everyone to be treated at home. In all febrile children <1 year, a complete blood count with differential has performed blood and urine cultures taken and the urine will be analyzed. Care should be taken to ensure that the urine by catheterization and is not picked up externally. In addition, the CSF is with culture and appropriate PCR testing rates (eg. As herpes simplex, enterovirus), as is indicated by risk factors in history. A chest radiograph is performed in patients with respiratory manifestations and stool swabs on leukocytes, and stool cultures in patients with diarrhea. Newborn babies are hospitalized and receive an empirical i.v. antibiotic coverage of the most common neonatal pathogens (eg with ampicillin and gentamycin or ampicillin and cefotaxime.); Antibiotics are continued until blood, urine and Liquorkulturen for 48 to 72 hours are negative. Acyclovir should be administered when newborns look sick, have mucocutaneous vesicles, a maternal history of genital herpes virus (HSV) infection, or have seizures; Acyclovir is discontinued if the results of the CSF HSV PCR testing are negative. Febrile children from 1 to 3 months are distinguished by their temperature, their clinical appearance and their laboratory data. Typically, a complete blood count should be all done with differentiation, blood and urine cultures taken and the urine will be analyzed. Care should be taken to ensure that the urine by catheterization and is not picked up externally. A chest radiograph is performed in patients with respiratory manifestations and stool swabs on leukocytes, and stool cultures in patients with diarrhea. A lumbar puncture with evaluation of the CSF, including culture, is also carried out other than in infants in the age of 61 to 90 days that look healthy, have a rectal temperature of <38.5 ° C, a normal urinalysis and normal white blood cell count (5,000 to 15,000 / ul) have and have the knowledgeable nurses, reliable transportation and established follow-up investigation; some experts differ, the cerebrospinal fluid testing even at similar looking healthy infants aged 29 to 60 days, although there are no set guidelines regarding the minimum necessary tests in this age group. Febrile infants 1-3 months that look sick, have an abnormal crying or have a rectal temperature of ? 38.5 ° C, have a high risk for serious bacterial infections (SBI), regardless of the initial laboratory results. Such infants should be hospitalized and receive an empirical antibiotic therapy, which is performed in the age group of 29 to 60 days with ampicillin and cefotaxime or ceftriaxone in the age group 61-90 days, until the results of blood, urine and Liquor-Kulturen vorliegen. Gesund aussehende Säuglinge zwischen 1 und 3 Monaten mit Liquorpleozytose, einer abnormen Urinanalyse oder abnormen Röntgenaufnahme des Thorax oder einer peripheren Leukozytenzahl ? 5000/?l oder ? 15.000/?l sollten zur Behandlung mit altersspezifischen empirischen Antibiotika wie oben beschrieben ins Krankenhaus eingewiesen werden. Wenn empirische Antibiotika gegeben werden müssen, sollte eine Liquoranalyse durchgeführt werden (falls noch nicht geschehen). Gesund aussehende, fiebrige Säuglinge zwischen 1 und 3 Monaten mit einer rektalen Temperatur von < 38,5° C und einer normalen Leukozytenzahl und Urinanalyse (und Liquoranalyse und Röntgenthorax, falls durchgeführt) haben ein geringes Risiko für SBI. Solche Säuglinge können ambulant behandelt werden, wenn eine verlässliche Nachfolge innerhalb von 24 Stunden telefonisch oder durch Gegenbesuch, wenn die Vorkulturergebnisse überprüft worden sind, erfolgt. Wenn die soziale Situation der Familie nahe legt, dass die Nachfolge innerhalb von 24 Stunden problematisch sein könnte, sollten die Säuglinge ins Krankenhaus eingeliefert und beobachtet werden. Wenn Säuglinge nach Hause geschickt werden, rechtfertigen eine Verschlechterung des klinischen Zustands oder Verschlimmerung des Fiebers, eine positive Blutkultur,

Health Life Media Team

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