Information

[Guest guest]

Group here is a worksheet we received from our ID doc at Childrens

Hospital here in Colorado, please feel free to use it as a guideline

to show your doctors if you like.

Information about Periodic or Recurrent Fever

Children with periodic or recurrent fever are routinely seen in the

Infectious Diseases Clinic. Most have had fevers for some time and

many have had extensive work-up at their doctor's office. If that is

the case, we ask for those results to be sent to us for review

before we see your child.

Terminology:

ľ Recurrent fever, periodic fever, episodic fever, fever of

unknown origin, fever without source. These terms are not

necessarily synonymous but they are often used as if interchangeable.

ľ ESR = Erythrocyte (red blood cell) Sedimentation Rate, also

called the Sed rate, is a measure of inflammation anywhere in the

body.

ľ CRP = C Reactive Protein is another measure of inflammation

anywhere in the body. CRP tends to increase earlier in an illness

and go away faster then the Sed rate.

ľ CBC = Complete Blood Count where all types of cells in a

small sample of blood are counted. There are normal ranges for each

type of cell. Abnormal values can give us clues about various types

of infection.

ľ WBC = White Blood Cells are one part of the CBC (see above).

White blood cells respond to infection of inflammation in the body.

ľ RBC = Red Blood Cells are also part of the CBC.

ľ Ig = Immunoglobulins are substances that are part of the

immune system. They respond to infection in predictable patterns

that may allow us to determine whether your child is having a new

infection, recurrence of an old infection or no current infection.

There are many different types of Ig including IgG, IgM, IgA, IgD or

IgE.

„« Pharyngitis = red/sore/swollen throat

„« Tonsillitis = red/sore/swollen tonsils

„« Adenitis = red/sore/swollen glands

„« Apthous Stomatitis = canker sores in the mouth

„« EBV = Epstein-Barr Virus; EBV can cause ¡§Mono¡¨

„« Gingivitis = red/sore/swollen gums

Some possible causes of your child¡¦s recurrent fever:

1. Periodic viral illnesses

„X All children get viral illnesses such as colds, sore

throats, the flu and diarrhea and many times those illnesses include

fever. The fevers your child is having may simply be viral illnesses

than came in a pattern (once/month), just by chance.

2. = Periodic Fever, Adenitis, Pharyngitis, Apthous Stomatitis

„X Usual onset in early childhood (average 2.8 years)

„X Episodes occur around once a month on average

„X Fevers begin abruptly and last 5 days on average

„X Antibiotics have not effect on the fever episode

„X Parents can accurately predict when the next fever will occur

„X Children remain in general good health and have normal

growth and development in spite of routine fevers

„X Lab findings; elevated WBC and ESR

3. Cyclic Neutropenia

„X Severely decreased numbers of WBCs (specifically a type of

WBC called a neutrophil) in a predictable pattern that occurs every

3 weeks, just before the fever begins.

„X A CBC done during the fever episode (which is when they are

usually done) will have a normal neutrophil count.

4. Familial Mediterranean Fever (FMF)

„X Found almost exclusively in people of Jewish, Turkish,

Armenian and Arabic ancestry

„X Fever plus abdominal pain, chest pain, joint pain, and/or

rash

„X Onset usually in childhood

5. Hyper-IgD Syndrome (HIDS)

„X Recurrent fevers usually begin in infancy /very early

childhood

„X Fever lasts 3-7 days/episode

„X High fever accompanied by chills, headache, abdominal pain,

joint pain, swollen glands and rash

„X Fevers tend to become less frequent and less severe with age

„X Laboratory findings; elevated IgD and ESR

6. Behcet¡¦s

„X Fever plus mouth ulcers, genital ulcers and inflammation of

the iris (colored portion) of the eye (this can only be seen with a

special lamp in the eye doctor¡¦s office)

„X Rare in US, common in Japan and Far East

„X Rare in childhood