Fever without a focus in 9-month-old boy (Page 1/1)
Prepared by...
Virat Sirisanthana, M.D.
Department of Pediatrics, Chiang Mai University
 
A 9-month-old infant was brought to the Emergency Room because of high fever and convulsion
2 hours prior to the admission. His birth history was uneventful. He has been healthy until a week
prior to the admission he developed low grade fever with URI symptom. He was admitted to the
hospital with the diagnosis of "febrile convulsion" on June 3, 1999.
 
PE: VS: Temp 39.5 C, PR 140/min, RR 40/mim
HEENT: mild injected pharynx
Chest + Abdomen : WNL
Nervous system: no stiff neck, no neurological deficit.
 
Laboratory investigations:
CBC: Hb 12.9 mg, Hct 42%, WBC 24,500 (N 72%, L 28%), platelet count 579,000
LP: CSF : clear, micro trama, RBC 4,200/cu.mm. WBC 22/cu.mm.
Latex agglutinin test negative for Hib, S. pneumoniae.
H/C: sent
Course in the hospital:
     He was given symptomatic and supportive care. Antibiotic was not started until day 3 of
admission when the H/C grew S. pneumoniae. The fever subsided on the third hospitalized day.
Repeated hemocultue on day 3 before starting antibiotic was no growth. Repeated lumbar
puncture on day 3 before starting antibiotic show normal CSF.
Diagnosis : Occult bacteremia
Ref: Powell KR. Fever without a focus. In Nelson WE, Behrman RE, Kliegman RM, Arvin AM. eds. Textbook of Pediatrics 15th ed. W.B. Saunders Company, 1996;698-704.



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