Chapter 6 Fever in infancy and childhood Case 6.1 A 2-year-old girl presents with the development of fever over the last 3 hours, and dyspnoea over the last 30 minutes. On examination, there is nasal flaring, and indrawing of the intercostal and supraclavicular spaces. On auscultation, stridor is heard. Questions 1. What does this information tell you about the cause of her problem? 2. What is the most likely diagnosis? Why? 3. Does this patient require referral to a medical practitioner or a hospital? How urgent is the situation? 4. List the possible causes of fever in an infant or child. Case 6.2 A 9-year-old girl presents with a fever and upper abdominal discomfort, which is worse on the right side. The pain has been present for 2 days. One week ago, she started to complain of nausea and anorexia. There was some transient vomiting and diarrhoea. She was taken to her general practitioner after the first 2 days of illness, who reassured her mother that her symptoms were probably due to ‘something that she ate’, or ‘an infection of some kind’. Relevant history includes a recent family trip to Vietnam 4 weeks ago. Questions 1. Do you think that the doctor’s initial assessment was reasonable? 2. If she went back to her doctor now, do you think that the differential diagnosis may alter? What are the possibilities? 3. For each disorder you named in question 2, state the other clinical features that may be present — or likely to occur — that would support your diagnosis. Case 6.3 Jade is a 1-year-old who presents with ‘sores’ and swelling in and around the oral cavity. They have been present for 2 days, and seem to be getting worse. Jade’s mother states that her child has had a fever for a ‘few’ days. Since the sores have developed, she has been reluctant to eat and drink, and is very irritable. She is starting to become very concerned, and wonders if she should go to see her local doctor. On examination, there is significant swelling and hyperaemia of the lips, gums and tongue, as well as a number of papular and vesicular lesions. There are no other areas of her body with similar pathology. Questions 1. What is meant by the terms ‘papular’ and ‘vesicular’ lesions? 2. What is your differential diagnosis? 3. What question(s) might you ask to differentiate between your differential diagnosis? 4. Assuming that Jade’s mother has recently had a ‘blister-like’ lesion on her lip, what is the most likely diagnosis? 5. What is the causative agent? 6. Approximately how long will Jade’s symptoms last, assuming no complications or secondary infection? 7. Can Jade expect further episodes of this problem? Case 6.4 You have been contacted by a friend who asks you for urgent advice. Her 5-month-old daughter Jane has had a cold for a few days, but overnight has become more distressed. A hacking type of cough has developed, and she seems to be breathing quite rapidly. Jane also has a fever and does not want to feed. Your friend can also hear some wheezing sounds, and has observed that the parts of her chest wall between her ribs seems to be intermittently drawn inwards. She asks you if you think that Jane has asthma. Questions 1. Do you think that this is asthma? Why or why not? 2. What do you tell your friend to do? Why? 3. Two days later your friend informs you that Jane is now stable, but was hospitalised requiring oxygen and hydration. She had been informed that her condition was due to a viral infection. What is the most likely diagnosis? 4. What type of virus causes this disorder? 5. What is the common age distribution of this disorder? How common is it? Case 6.5 While travelling on a bus, you observe a pre-pubescent schoolboy who has significant erythema of his cheeks. You also notice that a similar confluent rash is present on his upper limbs. It has a slightly elevated appearance. Questions 1. What disorder is classically described by this clinical presentation? 2. Name the causative agent. 3. Is it contagious? 4. What are the possible consequences if it occurs in a pregnant woman? Case 6.6 The child of your friend has been diagnosed with herpangina. She is concerned that her daughter now has ‘herpes’. Questions 1. Is your friend correct about the diagnosis of herpes? 2. Name the most likely causative agent of this disorder. 3. Describe the typical clinical presentation of this condition. 4. How does it differ clinically from ‘hand, foot and mouth disease’? Case 6.7 A 1-year-old child presents with a high fever, which has been present for the last 24 hours. He is alert, active, and does not seem to be in any distress. His mother is puzzled, as she is concerned about the fever, but his behaviour is normal. He is eating and drinking normally, has not vomited or had any bowel changes. There has been the usual number of wet nappies. On examination, you can find no localising signs. Temperature is 39.9°. Questions 1. What precautions do you need to ensure in this situation? 2. Assuming serious causes have been ruled out by the medical practitioner, what disorder is typical of this presentation? 3. What is the causative agent? 4. How many days does the fever typically last in this disorder? 5. What sign may appear once the body temperature returns to normal? Case 6.8 Ivan is a 9-year-old who presents to your office with his mother, complaining of a sore throat, fever, and headache that has been present for the last 2–3 days. Yesterday, an itchy rash on his chest developed, which commenced as spots of redness, then changed over a few hours to become elevated and then blister-like. Some even appear to have crusted over. More ‘spots’ are now developing on his abdomen and on his back. Medical history is otherwise unremarkable. Ivan has not had any of the usual childhood diseases, nor has he had all of his childhood vaccinations. Three weeks ago he returned from a recreational spring camp. Questions 1. What is your differential diagnosis? Which is the most likely? Why? 2. Is it possible that Ivan was infected by someone at the camp? 3. In what other areas of the body can you often find the blisters? Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: Eating disorders, substance abuse and behavioural disturbances in adolescence Miscellaneous cases in infancy and childhood Sports injuries Acute joint pain Acute back pain Upper limb pain Stay updated, free articles. 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Chapter 6 Fever in infancy and childhood Case 6.1 A 2-year-old girl presents with the development of fever over the last 3 hours, and dyspnoea over the last 30 minutes. On examination, there is nasal flaring, and indrawing of the intercostal and supraclavicular spaces. On auscultation, stridor is heard. Questions 1. What does this information tell you about the cause of her problem? 2. What is the most likely diagnosis? Why? 3. Does this patient require referral to a medical practitioner or a hospital? How urgent is the situation? 4. List the possible causes of fever in an infant or child. Case 6.2 A 9-year-old girl presents with a fever and upper abdominal discomfort, which is worse on the right side. The pain has been present for 2 days. One week ago, she started to complain of nausea and anorexia. There was some transient vomiting and diarrhoea. She was taken to her general practitioner after the first 2 days of illness, who reassured her mother that her symptoms were probably due to ‘something that she ate’, or ‘an infection of some kind’. Relevant history includes a recent family trip to Vietnam 4 weeks ago. Questions 1. Do you think that the doctor’s initial assessment was reasonable? 2. If she went back to her doctor now, do you think that the differential diagnosis may alter? What are the possibilities? 3. For each disorder you named in question 2, state the other clinical features that may be present — or likely to occur — that would support your diagnosis. Case 6.3 Jade is a 1-year-old who presents with ‘sores’ and swelling in and around the oral cavity. They have been present for 2 days, and seem to be getting worse. Jade’s mother states that her child has had a fever for a ‘few’ days. Since the sores have developed, she has been reluctant to eat and drink, and is very irritable. She is starting to become very concerned, and wonders if she should go to see her local doctor. On examination, there is significant swelling and hyperaemia of the lips, gums and tongue, as well as a number of papular and vesicular lesions. There are no other areas of her body with similar pathology. Questions 1. What is meant by the terms ‘papular’ and ‘vesicular’ lesions? 2. What is your differential diagnosis? 3. What question(s) might you ask to differentiate between your differential diagnosis? 4. Assuming that Jade’s mother has recently had a ‘blister-like’ lesion on her lip, what is the most likely diagnosis? 5. What is the causative agent? 6. Approximately how long will Jade’s symptoms last, assuming no complications or secondary infection? 7. Can Jade expect further episodes of this problem? Case 6.4 You have been contacted by a friend who asks you for urgent advice. Her 5-month-old daughter Jane has had a cold for a few days, but overnight has become more distressed. A hacking type of cough has developed, and she seems to be breathing quite rapidly. Jane also has a fever and does not want to feed. Your friend can also hear some wheezing sounds, and has observed that the parts of her chest wall between her ribs seems to be intermittently drawn inwards. She asks you if you think that Jane has asthma. Questions 1. Do you think that this is asthma? Why or why not? 2. What do you tell your friend to do? Why? 3. Two days later your friend informs you that Jane is now stable, but was hospitalised requiring oxygen and hydration. She had been informed that her condition was due to a viral infection. What is the most likely diagnosis? 4. What type of virus causes this disorder? 5. What is the common age distribution of this disorder? How common is it? Case 6.5 While travelling on a bus, you observe a pre-pubescent schoolboy who has significant erythema of his cheeks. You also notice that a similar confluent rash is present on his upper limbs. It has a slightly elevated appearance. Questions 1. What disorder is classically described by this clinical presentation? 2. Name the causative agent. 3. Is it contagious? 4. What are the possible consequences if it occurs in a pregnant woman? Case 6.6 The child of your friend has been diagnosed with herpangina. She is concerned that her daughter now has ‘herpes’. Questions 1. Is your friend correct about the diagnosis of herpes? 2. Name the most likely causative agent of this disorder. 3. Describe the typical clinical presentation of this condition. 4. How does it differ clinically from ‘hand, foot and mouth disease’? Case 6.7 A 1-year-old child presents with a high fever, which has been present for the last 24 hours. He is alert, active, and does not seem to be in any distress. His mother is puzzled, as she is concerned about the fever, but his behaviour is normal. He is eating and drinking normally, has not vomited or had any bowel changes. There has been the usual number of wet nappies. On examination, you can find no localising signs. Temperature is 39.9°. Questions 1. What precautions do you need to ensure in this situation? 2. Assuming serious causes have been ruled out by the medical practitioner, what disorder is typical of this presentation? 3. What is the causative agent? 4. How many days does the fever typically last in this disorder? 5. What sign may appear once the body temperature returns to normal? Case 6.8 Ivan is a 9-year-old who presents to your office with his mother, complaining of a sore throat, fever, and headache that has been present for the last 2–3 days. Yesterday, an itchy rash on his chest developed, which commenced as spots of redness, then changed over a few hours to become elevated and then blister-like. Some even appear to have crusted over. More ‘spots’ are now developing on his abdomen and on his back. Medical history is otherwise unremarkable. Ivan has not had any of the usual childhood diseases, nor has he had all of his childhood vaccinations. Three weeks ago he returned from a recreational spring camp. Questions 1. What is your differential diagnosis? Which is the most likely? Why? 2. Is it possible that Ivan was infected by someone at the camp? 3. In what other areas of the body can you often find the blisters? Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: Eating disorders, substance abuse and behavioural disturbances in adolescence Miscellaneous cases in infancy and childhood Sports injuries Acute joint pain Acute back pain Upper limb pain Stay updated, free articles. 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