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Suggest Treatment For Severe And Persistent Fever
Question: A 1.10 years old female baby experienced a high fever (103 F) with lethargy on 06-Sep-2016. She was treated with paracetamol drops every 4 hrs. The body temperature was recorded every four hours and was fluctuating with an average result of 101.0F. Since the pyrexia with fatigue didn’t resolve the next day, the baby was started with antibiotic (oflaxicin 5ml, 50mg, BID) and paracetamol (2.5 ml, 125 mg, BID) for next two days. The symptoms of fever and lethargy resolved on 09-Sep-2016 and the treatment with the medications were discontinued.
On 14-Sep-2016, at night the baby again experienced high fever with lethargy. The next day, blood tests were performed and results are as follows:
Widal test: S.Typhi O - 1:80 (Normal range: 1:20), S. Typhi H -1:80 (Normal range: 1:20), S. Parattphi AH 1:20 (Normal range: 1:20).
CBC: WBC: 11,500 (Normal: 4000 to 11500)
Differential count: Lymphocytes: 7.2% (normal 20 to 45%), Mid 12.1% (normal 2 to 15%), Neutrophils 80.7 % (40 to 75 %), Haemoglobin 11.4 gm/dl (13 to 18mg/dl), RBC 4.05 mill/cumm (4.5to 6.5 mill/cumm), HCT 34.7% (40 to 54%), MCV- 81.7 fl (Normal range: 78-94 fl), MCH- 28.1 pg (normal range: 27-32 pg), MCHC- 34.5 gm/dL (Normal range: 32-38 gm/dL), RDW-CV 13.8 % (11.5- 14.5%), RDW-SD 44.1 fl (37-54 fl), Platelet count 3.25 lakhs/cmm (1.5 to 4.5 lakhs/cmm), MPV 8.4 fl (7.4-10.4 fl), PDW 14.4 % (10-17%), PCT 0.273% (0.108-0.282%)
Chemical examination: Albumin: Nil, Sugar: Nil, Bile pigment: Negative, Bile salt: Negative
Urine analysis: Color: Pale yellow, Reaction: Acidic, Specific gravity: 1.017
Microscopic examination: Pus cells: 2 to 3 /hpf, Epithelical cells: 1 to 2, RBCs: Nil, Crystals: Nil, Casts: Nil, Bacteria: Nil, Parasite: Nil.
C-reactive protein: 4.9 mg/L (normal range: 0-6 mg/L)
Based on the laboratory reports the baby was diagnosed with viral infection/fever. From 15-Sep-2016 to 17-Sep-2016, the baby was treated with the Mefkid P (Mefenamic) TID 2.5 ml, Taxim O CV (cefixime) BID 5 ml, and Calpol (paracetamol) QID 3 ml. Viral infection was resolved on 17-Sep-2016. On 17-Sep-2016, at night suddenly the baby experienced running nose and was treated with Sinerest (acetaminophen, chlorpheniramine, and pseudoephedrine) 5ml TID.
On 18-Sep-16, at 4:00 PM, again the baby started to have fever.
Again a repeat blood test is suggested.
please let me know whether the give treatment is correct or should i consult the second doctor for my baby treatment.
On 14-Sep-2016, at night the baby again experienced high fever with lethargy. The next day, blood tests were performed and results are as follows:
Widal test: S.Typhi O - 1:80 (Normal range: 1:20), S. Typhi H -1:80 (Normal range: 1:20), S. Parattphi AH 1:20 (Normal range: 1:20).
CBC: WBC: 11,500 (Normal: 4000 to 11500)
Differential count: Lymphocytes: 7.2% (normal 20 to 45%), Mid 12.1% (normal 2 to 15%), Neutrophils 80.7 % (40 to 75 %), Haemoglobin 11.4 gm/dl (13 to 18mg/dl), RBC 4.05 mill/cumm (4.5to 6.5 mill/cumm), HCT 34.7% (40 to 54%), MCV- 81.7 fl (Normal range: 78-94 fl), MCH- 28.1 pg (normal range: 27-32 pg), MCHC- 34.5 gm/dL (Normal range: 32-38 gm/dL), RDW-CV 13.8 % (11.5- 14.5%), RDW-SD 44.1 fl (37-54 fl), Platelet count 3.25 lakhs/cmm (1.5 to 4.5 lakhs/cmm), MPV 8.4 fl (7.4-10.4 fl), PDW 14.4 % (10-17%), PCT 0.273% (0.108-0.282%)
Chemical examination: Albumin: Nil, Sugar: Nil, Bile pigment: Negative, Bile salt: Negative
Urine analysis: Color: Pale yellow, Reaction: Acidic, Specific gravity: 1.017
Microscopic examination: Pus cells: 2 to 3 /hpf, Epithelical cells: 1 to 2, RBCs: Nil, Crystals: Nil, Casts: Nil, Bacteria: Nil, Parasite: Nil.
C-reactive protein: 4.9 mg/L (normal range: 0-6 mg/L)
Based on the laboratory reports the baby was diagnosed with viral infection/fever. From 15-Sep-2016 to 17-Sep-2016, the baby was treated with the Mefkid P (Mefenamic) TID 2.5 ml, Taxim O CV (cefixime) BID 5 ml, and Calpol (paracetamol) QID 3 ml. Viral infection was resolved on 17-Sep-2016. On 17-Sep-2016, at night suddenly the baby experienced running nose and was treated with Sinerest (acetaminophen, chlorpheniramine, and pseudoephedrine) 5ml TID.
On 18-Sep-16, at 4:00 PM, again the baby started to have fever.
Again a repeat blood test is suggested.
please let me know whether the give treatment is correct or should i consult the second doctor for my baby treatment.
Brief Answer:
Child needs to be evaluated if fever persists...
Detailed Answer:
Hi,
I went through the details provided with diligence and I understand your concern. It seems like the child has recurring infection. Though the common source of infection in children is viral, her blood report (complete blood count) done few days ago showed high normal total counts with neurtrophil predominance. This type of blood report is typically seen in bacterial infection. Moreover she was treated with antibiotic which is how a bacterial infection should be treated.
That being said, the latest symptoms could be recurrence of previous infection or a new onset infection which may or may not be viral. It is too early to predict the nature of infection again without evaluation. In this circumstance, I will suggest you record the child's temperature regularly every 2-4 hours. Use paracetamol (calpol) syrup round the clock - every 4-6 hours. use mefkid P sparingly only if temperature reaches 103 deg F and above. Watch how symptoms progress. If she has new symptoms or if fever persists beyond couple of days, visit a pediatrician for more investigations.
I hope this helps.
Regards
Child needs to be evaluated if fever persists...
Detailed Answer:
Hi,
I went through the details provided with diligence and I understand your concern. It seems like the child has recurring infection. Though the common source of infection in children is viral, her blood report (complete blood count) done few days ago showed high normal total counts with neurtrophil predominance. This type of blood report is typically seen in bacterial infection. Moreover she was treated with antibiotic which is how a bacterial infection should be treated.
That being said, the latest symptoms could be recurrence of previous infection or a new onset infection which may or may not be viral. It is too early to predict the nature of infection again without evaluation. In this circumstance, I will suggest you record the child's temperature regularly every 2-4 hours. Use paracetamol (calpol) syrup round the clock - every 4-6 hours. use mefkid P sparingly only if temperature reaches 103 deg F and above. Watch how symptoms progress. If she has new symptoms or if fever persists beyond couple of days, visit a pediatrician for more investigations.
I hope this helps.
Regards
Above answer was peer-reviewed by :
Dr. Prasad
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