PE31.9 | Fever Approach — Summary & Reflection

KEY TAKEAWAYS

Fever (axillary >37.4°C) is the most common paediatric presentation; the first step is identifying IMNCI danger signs, then systematic history (pattern, duration, contact, travel). FUO = fever >38.3°C, ≥3 occasions, >14 days, undiagnosed after 1 week of workup. The pyrexia cascade (exogenous pyrogen → IL-1/IL-6/TNF → hypothalamic PGE2 → raised set-point) is the mechanism; paracetamol blocks COX-2 → reduces PGE2. Enteric fever: step-ladder fever, relative bradycardia, leucopenia; gold standard = blood culture; treatment = ceftriaxone IV (hospitalised) or azithromycin oral; complications — perforation, haemorrhage. Dengue: saddle-back fever, leucopenia, thrombocytopenia + rising haematocrit; NS1 antigen days 1–5, IgM from day 5; 7 warning signs signal plasma leakage → hospitalise + IV fluids; NEVER aspirin. Malaria: peripheral smear is gold standard; falciparum = small ring forms, banana gametocytes, no RBC enlargement → ACT (NVBDCP); vivax = enlarged RBCs, Schüffner's dots → chloroquine + primaquine (check G6PD before primaquine).

REFLECT

Return to the 7-year-old girl with dengue in the opening scenario. She had 5 days of fever, worsening on day 5, with haematocrit rising from 36% to 42% and platelet count of 54,000. Having studied the dengue warning signs and management: (1) List every warning sign she demonstrates from the WHO 2009 criteria. (2) Her mother wants to give her aspirin she has at home for the fever — how would you counsel her, and what is the specific risk? (3) Outline the fluid management over the next 12 hours, including target parameters for haematocrit and urine output. (4) On day 7, the fever breaks and the platelets begin to rise rapidly — explain what is happening physiologically and what new risk now emerges (note: the recovery phase carries its own complication). Reflect on how fever is not a single entity but a clinical syndrome whose outcome depends entirely on recognising which organism is responsible and responding to the specific warning signs of each.