IAP President’s Action Plan 2018 – All about Fever

IAP President’s Action Plan 2018 – All about Fever

Chairperson: Dr. Santosh Soans
Coordinator: Dr. Jaydeep Choudhury
Convener: Dr. Ritabrata Kundu
Secretary: Dr. Bakul Parekh

Introduction
Fever is an enigma and it continues to perplex the treating physician. Though it is well known that fever alone doesn’t cause any injury to the child except perhaps in cases of heatstroke and febrile status epilepticus but still it is a cause of parental worry. In fact, fever is an evolutionary weapon of host defense against invading microorganisms. However, it serves as an important sign in alerting the physician that there may be an infection or other reason to cause elevation of body temperature.

A vast majority of children with fever have a trivial self-limiting viral infection that needs neither any investigation nor treatment and as such is going to settle in time. Unfortunately, most of these incidences are either treated with unnecessary antibiotics or put to the unwarranted investigation. Hence it is extremely important to distinguish between febrile illness of significance from those of minor importance.

Basics of fever will help us to understand what mechanism in our body changes the biological thermostat in our brain and the various ways to regulate body temperature. Types of fever give us a rough insight about the different causes that produce fever.

The most daunting causes are the fever of unknown origin which persists beyond a reasonable time in which most viral infections settle. Though serious infections manifest themselves with the passage of time and with routine studies but it is the young children particularly infants who may not produce enough signs and symptoms. Protocols are laid down to detect the high-risk infants both on clinical examination and simple laboratory parameters. Documentation of fever, individualized medical history and focused clinical examination with appropriate sequential laboratory investigations clinch the diagnosis in most cases.

Those children with fever showing a definite focus are approached in a set clinical pattern with emphasis on potentially serious manifestations that should not be missed.

Fevers in non-infectious subjects are also challenging. Immune deficient patients have an infection as the most common cause of fever though documentation is not possible in many of them. They have site predilection of infection particularly lungs, IV lines, skin, and perianal parts. There are well-laid protocols for their management.

Rheumatological diseases may present only with fever initially with inconclusive laboratory parameters. Here prolonged observation may help to achieve the definitive diagnosis. Periodic fevers are another group of recurrent episodes of illness in which fever is the cardinal manifestation and is associated with similar sets of symptoms at intervals.

This workshop will give an insight into the causes of febrile episodes to distinguish between the serious from trivial ones. A rational approach is needed in both clinical examination and laboratory tests to come to a conclusion. It would be prudent if one has a uniform rational protocol-based approach for febrile children.

Program outline
(Total 5 hours. Each lecture 20 + 5 min X 12 lectures = 300 min)

  1. Basics of fever
  2. Fever without focus
    1. i. Fever without focus in infants
    2. ii. Fever without focus in children
  3. Fever with focus
    1. i. Skin rash
    2. ii. Joint pain
    3. iii.Respiratory symptoms
    4. iv.CNS symptoms
  4. Fever with other features
    1. i. Fever in infections
    2. ii. Fever in connective tissue disease
    3. iii. Fever in malignancy and immunocompromised
    4. iv. Periodic fever and allied syndromes
  5. Antipyretics and fever management
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