[Fever of unknown origin in a young child: diagnosis and treatment]

Abstract

In children with fever without focus, evaluation should be aimed at recognition of children with an increased risk of bacteraemia or of major bacterial infections, while young children in particular will show few typical symptoms of bacterial infections. A child younger than 1 month with fever (> or = 38.0 degrees C) or hypothermia (< 36.0 degrees C) needs clinical evaluation and additional diagnostic investigations. In children aged from 1 to 36 months referral to hospital should be based on presence of age specific clinical characteristics, i.e. toxic appearance, high fever, diarrhoea, decreased urine production, tachypnoea, or bulging fontanelle. Presence of clinical characteristics as judged by a paediatrician or abnormal laboratory findings indicates hospitalisation and treatment with parenteral antibiotics. Absence of alarming clinical characteristics with normal laboratory values justifies outpatient follow-up without treatment or additional diagnostic procedures. Careful instructions to parents regarding observation, parents' ability to detect clinical changes and facilities for rapid medical re-evaluation are crucial.