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Body temperature of healthy people varies between 1-1.5 ° C. Normal body temperature is 37 ° C (ranging from 36.5 ° C to 37.5 ° C). Fever, which reaches its peak in the evening, changes during the day in most people. Normal body temperature is controlled by a center called the hypothalamus within the head through a complex system. In rectal measurements, temperatures higher than 38 ° C are generally considered abnormal.
The course of fever in children may vary depending on the nature and age of the disease. In newborns, although there is a marked infection, it may not respond with fever or may have low fever, whereas older infants and children under 5 years of age may respond to a serious bacterial infection or exaggerated fever up to 40.5 ° C in a reasonable viral picture. This level of fever in older children and adults is unusual and indicative of an important pathological event. Fever caused by bacteria, viruses, fungi or parasites, malignancy, autoimmune diseases or fever caused by drugs cannot be distinguished from the course of the fever with some exceptions.
Most of the febrile diseases in children can be classified as follows:
Short-term fever accompanied by clinical history and physical examination and guiding signs and symptoms.
Fever, which usually occurs in children under the age of 3 without directive symptoms, which cannot be determined by history and physical examination but can be diagnosed by laboratory studies.
Fever of unknown origin (NBA); Fever lasting more than 14 days with no history, physical examination and routine laboratory investigations. In older children and adults, fever that persists for more than 3 weeks and lasts for 7 days in the hospital, but is undiagnosed above 38 ° C, is usually defined as NBA.
FIRE IN SMALL BABIES FOR 3 MONTHS
In this age group, there is a higher risk of severe bacterial infections compared to fever in older infants. Young infants may not have a guiding symptom and may exhibit non-specific symptoms such as meningitis, urinary tract infection, or pneumonia that are not only well absorbed. Fever is often the only symptom of severe bacterial infection in early infancy. However, the most common febrile diseases in this age group are caused by viral pathogens. It is often difficult to distinguish between virus and bacterial infections. Therefore, infants appearing ill under 3 months and all infants younger than 1 month (especially those suspected during follow-up) are usually hospitalized. After culturing blood, urine and cerebrospinal fluid, most of these infants are given broad-spectrum antibiotics.
FIRE IN CHILDREN BETWEEN 3 MONTHS AND 2 YEARS
In children aged 3 months to 2 years, most febrile episodes include a significant source of infection (pharyngitis, otitis media, bronchitis, upper respiratory tract infection) that can be identified by physical examination or history. The evaluation of infants with febrile, good-looking but infectious foci is based on clinical research to find the focus of white blood cells (leukocytes), complete blood count, erythrocyte sedimentation rate, blood culture, full urine examination, urine culture and chest film and infection focus.
Fever of unknown origin is defined as a fever lasting more than 14 days and persisting above 37 ° C for more than three weeks and lasting above 38 ° C in older children and adults, although there is a comprehensive history, physical examination and routine laboratory tests. Infectious diseases, connective tissue diseases and malignancies are the three most common types of fever in children. It is a difficult problem in which many patients could not be diagnosed, although they had been investigated in the hospital for a week. The differential diagnosis between occult infections and malignancies often required invasive procedures. The development of diagnostic imaging techniques including ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), and radionuclide scanning with gallium or technicium significantly reduces the number of undiagnosed patients in this class, but in 10-20% of children presenting with fever of unknown origin Despite research, no diagnosis can be made.
Dr. Example: Levent AKGÜNGÖR
Bayındır Hospital Department of Pediatrics