Every child experiences episodes of fever as they get older. In the overwhelming majority of cases, the reason for this is infectious diseases, 80 - 90% of which are of a viral nature. But it should also be borne in mind that a fever can be caused by diseases or situations not associated with the infection (autoimmune diseases, sun or heat stroke, Kawasaki syndrome). If a child has a temperature of 38 without cold symptoms, then what kind of illness is it?
Common symptoms of ARVI
Usually, falling ill with ARVI, the child experiences the following symptoms:
- temperature rise;
- pain in the nasal, oropharynx;
- mucous or purulent discharge from the nose;
- swelling of the nose and difficulty breathing;
- cough with / without phlegm;
- hoarseness of voice;
- drowsiness, headache, weakness, body aches, loss of appetite.
These symptoms may not necessarily all be present; they may be present in different combinations.
But what if there is none of the above other than a fever? What else should you look for, and what questions should you answer to establish the root cause of the rise in temperature?
- what is the duration of the fever at the moment. If this is the first - the second day from the onset of the disease, and the general condition of the child does not cause concern for you and the doctor, then you can apply expectant tactics, since the symptoms may still manifest themselves. If the child has a fever for much longer without vivid symptoms, then it's time to expand diagnostic measures;
- whether you have recently had direct contact with a febrile patient;
- the age of the child. Since there are peculiarities for different age groups. For example, a teenager is unlikely to be bothered by a teething fever;
- how high the temperature is, and how it behaves during the day. At long-term temperatures of 37.5 C and 39 C, a different diagnostic search is carried out;
- what background diseases the child has and what chronic diseases the next of kin have. How often did he get sick in recent months, and whether there were complications after previous illnesses. Have any operations and / or blood transfusions been performed on the baby;
- Does the temperature go astray with drugs in an age-specific dosage (Ibuprofen, Paracetamol, Nimesulide);
- date of last vaccination. Fever is a normal response to a number of vaccines.
What other symptoms can a child develop?
- Rash on the skin and mucous membranes. It is advisable to examine the child in daylight and, when elements of a rash appear, track them several times a day. The rash can be very diverse: redness, blisters, hemorrhages or bruises, nodules, and so on. It is also necessary to take into account the color of the skin: red, pale, earthy or with a gray-blue tint. There may be a local change in skin color, for example, redness around a joint, or with general redness of the skin, the area between the nose and the upper lip remains pale.
- Pain or cramps when urinating. Also, this should include external changes in the properties of urine.
- Vomiting and nausea can be a sign of not only damage to the gastrointestinal tract, but also be a neurological symptom. Pay attention to its frequency, whether there is an endowment of the general well-being after vomiting.
- Abdominal pain, bloating, changes in the nature and frequency of stools, both upward and downward, the sound of bubbling, complete lack of appetite, changes in the properties of feces.
- Pain and limitation of mobility in the joint, the child spares the limb, there is a swelling over this place, is injury excluded.
- Shortness of breath, noisy breathing.
- Neurological symptoms: blurred consciousness, hallucinations, impaired coordination of movements, convulsions, lack of sensitivity and movement in the limb. In infants who still have an open fontanelle, it is retracted or bulging. Severe photophobia or headache.
What tests and diagnostic procedures should be done first?
- general blood analysis;
- general urine analysis and according to Nechiporenko;
- chest x-ray;
- consultation of additional specialists (ENT doctor, neurologist, surgeon).
The exact set of procedures will be dictated by the attending physician at his discretion, because, for example, when receiving a sharply altered urine test and in the absence of any changes when listening to the lungs with a stethoscope, it is unlikely that a chest X-ray is needed, since the focus of infection has already been found.
In addition to the above, they can be assigned depending on the situation:
- analysis of blood, urine, saliva for the presence of a specific pathogen or protective antibodies to it;
- culture of blood, urine, cerebrospinal fluid, feces, antibioticogram;
- lumbar puncture with microscopic examination, biochemical analysis, culture of cerebrospinal fluid;
- Ultrasound of the kidneys, abdomen, joints, neurosonogram for infants with an open fontanel;
- biochemical blood test (including inflammation markers - C-reactive protein, ASLO) + procalcitonin;
- a blood test for autoimmune antibodies.
The set of analyzes and studies in each case is strictly individual, depending on the current state of the patient.
Most common cases of fever without additional symptoms
Urinary tract infection / pyelonephritis
It accounts for approximately 20% of all hospitalizations for asymptomatic fever. This diagnosis is confirmed by altered urine tests and the presence of inflammatory changes in the calyx-pelvic system of the kidneys on ultrasound (for pyelonephritis).
It is often found in all age groups, but there are certain peculiarities: the younger the child, the "poorer" the clinical picture.
- up to 2 - 3 years, fever, refusal to eat, vomiting occur. The frequency of urination is usually unchanged and the urination itself is not painful;
- after 3 years, the child may complain of abdominal pain;
- after 5 - 6 years, the picture of the disease becomes clearer and more definite - the child may complain of lower back pain, cramps during urination.
Treatment is antibiotic therapy.
"Dumb" or "atypical" pneumonia
In the middle of the 20th century, the proportion of pneumonia, which was very difficult to diagnose, increased significantly. With them, there were practically no symptoms such as a strong cough, an abundance of sputum, and the pathogen was practically not detected when inoculating sputum on a nutrient medium.
Most often, of the signs, only fever and a sharp depression of the general condition remained, some time later a dry cough joined. However, the radiograph showed inflammatory changes.
Therefore, such pneumonia in the medical environment is called "a lot can be seen, nothing is heard." It means that listening to the lungs during auscultation also did not give a picture characteristic of pneumonia.
Now, with new diagnostic capabilities (detection of antigens or antibodies in the blood) and the awareness of doctors about the epidemiological data, such pneumonia is diagnosed much faster, which allows avoiding a huge number of complications.
Such atypical symptoms in the form of prolonged high temperature and intoxication are most often given by pathogens:
- Chlamydia pneumoniae, Chlamydia psittaci;
- Coxiella burnetii;
- Francisella tularensis;
- Legionella pneumophila;
- Mycoplasma pneumoniae;
- viruses: influenza / parainfluenza, measles, adenovirus, herpesvirus type V (cytomegalovirus), respiratory syncytial virus. The latter is a real problem for premature babies, causing bronchiolitis. The inflammation can then spread to the lung tissue, severe respiratory failure develops;
- coronavirus, which causes severe acute respiratory syndrome (SARS), claimed the lives of about a thousand people in the early 2000s;
- mushrooms;
- protozoa.
Treatment depends on the pathogen, but an antibacterial component is required to avoid bacterial infection.
Tuberculosis
Unfortunately, this phenomenon is not uncommon in pediatrics.
According to the Federal Monitoring Center for Counteracting the Spread of Tuberculosis, in the Russian Federation in 2016 the number of newly diagnosed patients was 3829 per 100,000 of the population among children 0-18 years old, which suggests that over the past 10 years there has been a slight decrease in the incidence it remains at a fairly high level.
The temperature can be very varied. For example, a subfebrile temperature (up to 38.0 degrees Celsius) can be kept for a long time. When complications join or when the disease progresses, rise higher.
Tuberculosis is divided into primary and secondary tuberculosis infection (which are divided into a number of sub-items), and it can also be of other organs and systems.
Common symptoms:
- prolonged temperature (weeks - months);
- loss of body weight;
- deterioration in general health;
- the child becomes more susceptible to ARVI.
The Mantoux test and the diaskin test should not be performed against the background of fever in an outpatient observation. A quantiferon test can be performed against a background of temperature, but it does not distinguish between an active infection and a simple infection of the body, therefore, in this situation it is useless. Therefore, from the diagnostic measures, X-ray and computed tomography remain.
Long-term treatment with special anti-tuberculosis antimicrobial drugs. It is imperative to examine the immediate environment of the child to identify the source of infection.
Herpetic infection
Its prevalence is very high, it is considered a real scourge of the XXI century and is being actively studied at the moment. The group of viruses itself is numerous, which causes very different manifestations of the disease:
- Type 1 - herpes simplex virus ("cold sore lips"). Most often it causes damage to the skin of the face, mucous membranes of the mouth and nose, in some cases it can affect any organs and systems. It is very easy to miss the redness in the early days of the fever, which then turn into herpetic blisters on the mucous membranes. Especially if the "cold" occurs in the nose.
- Type 2 - genital. Also causes meningoencephalitis in newborns and infants.
- Type 3 - chickenpox. It is accompanied by the appearance of a characteristic rash, so it practically does not apply to the topic under discussion.
- Type 4 - Epstein-Barr virus. High fever lasts an average of 5 to 7 days, in most cases there are concomitant symptoms in the form of enlargement of the lymph nodes, liver and spleen, overlaps on the tonsils, swelling of the nasal passages.
- Type 5 - cytomegalovirus, which is manifested by a prolonged increase in temperature. Other symptoms (see Epstein-Barr virus) are mild, so this type of herpes is often the cause of fever without signs of a cold. The main danger is congenital cytomegalovirus infection. Therefore, women of childbearing age, and especially during pregnancy, if there were episodes of high fever without other symptoms, should be examined for this pathogen in order to avoid intrauterine transmission of infection.
- Type 6 - "baby roseola", or "pseudo-rubella". It is characterized by prolonged high fever, against the background of a drop in temperature at the end of the disease (usually 4 - 5 - 6 days of the illness), a pink rash with tubercles appears. So this pathogen is a common cause of high fever without signs of a cold.
- Type 7 - "chronic fatigue syndrome". With this infection, the rise in temperature can be extremely prolonged, although it rarely exceeds 38 C.
- Type 8 is more likely to present with fever with symptoms of immunodeficiency.
Herpes viruses of types 7 and 8 have been recently discovered and are now being actively studied. But it has already been proven that they are directly related to severe immunodeficiencies, are almost always found in HIV at the AIDS stage and play a huge role in the development of oncology in such patients.
If we consider less severe disorders of immunity, then here herpes also play an important role. It is generally accepted that frequent relapses of type 1 herpes or the detection of antibodies or antigens of herpes types 4, 5, 6 indirectly indicate a decrease in immunity and play a large role in the formation of a group of frequently ill children (FD).
Infectious mononucleosis is a disease caused by herpes viruses (IV, V, VI types) and manifested by a number of symptoms: a long high fever (38-40 degrees Celsius, on average a week); enlargement of the liver, spleen and lymph nodes; whitish overlays on the tonsils (angina), the appearance of atypical mononuclear cells in the blood. If the child is not examined by a doctor, the mother may not notice other signs and may mistake it for a fever without symptoms.
Enterovirus infection
This genus of viruses includes the poliomyelitis virus (3 types), Coxsackie (30 types) and ECHO (31 types), hepatitis A, which determines the diversity of the patient's clinic. But, despite such a variety, usually the disease begins with a rise in temperature. Then, other symptoms gradually join, depending on what the virus has infected (tonsils, heart, nervous system, skin).
This virus causes the notorious hand, foot, mouth disease. It begins with a rise in temperature, and after 2 - 3 days a rash in the form of vesicles on the legs (more often on the soles), hands and oral mucosa joins.
Vesicles are cavitary elements with transparent content, around it there is a slight redness.
The disease most often proceeds favorably, and after 5 to 7 days the rash disappears.
Parvovirus infection ("fifth disease")
This virus is known for being dangerous for people with pathology of the erythroid (red) bone marrow sprout, provoking a crisis (sharp) development of anemia.
It starts with a temperature that lasts for several days. Then, against the background of its decrease, a rash of the most diverse nature appears. Already during the onset of the disease, there may be reddening of the cheeks ("splattered" cheeks), pain in the joints and head, loss of appetite and general malaise.
Latent bacteremia
It differs from septicemia in the absence of a specific focus of infection, multiple organ failure and shock.
This condition can be either transient and do not entail any consequences, or turn into sepsis, meningitis, encephalitis, pneumonia, osteomyelitis and other bacterial lesions can also join.
Latent bacteremia is especially often the cause of fever without signs of acute respiratory viral infections in children under 3 months of age (in a quarter of cases when the main causes have already been excluded); in older children, latent bacteremia is much less common.
Autoimmune diseases
Now we should talk about non-communicable diseases that can cause fever, which include autoimmune diseases. They are divided into organ-specific (when one organ is damaged), organ-specific (many organs and tissues are damaged) and mixed.
Often occur at puberty against a background of intense hormonal changes, often after exposure to an infectious agent or against a background of severe stress. The predisposition to autoimmune diseases is inherited. A rise in temperature without signs of a cold is a common factor for everyone. Consider the main pathologies characteristic of this age:
- Systemic lupus erythematosus is a lesion of the connective tissue. Since it is present in all organs, therefore, the whole organism suffers. The main targets are kidneys, nervous system, bone marrow, skin, joints.
- Juvenile rheumatoid arthritis is a disease of large joints. It is manifested by an increase in temperature, an increase in lymph nodes, pain and stiffness in the joints.
- Inflammatory bowel disease - Crohn's disease and ulcerative colitis.
- Kawasaki Syndrome. It manifests itself as a vascular lesion (especially of the heart) soon after ARVI. Prolonged fever (at least a week about 40 degrees Celsius) is one of the main criteria for making a diagnosis, along with others.
- Insulin-dependent diabetes mellitus - damage to the beta cells of the pancreas that produce insulin.
- Graves' disease, or thyrotoxicosis, is a lesion of the thyroid gland, as a result of which there is a decrease in body weight against a background of increased appetite, low-grade fever, arrhythmias, sleep disturbance, protruding eyes.
The most common childhood syndromes are listed here, but there are many more.
Other reasons
For reasons not associated with infectious agents and hereditary diseases, the following conditions can be listed:
- Sunstroke is a life-threatening condition resulting from prolonged and intense exposure to sunlight. The patient has an expansion of the vessels of the head, as a result of which vomiting, fever, convulsions, and clouding of consciousness develop.
- Heatstroke is a general overheating of the body. That is, it can happen due to a long stay in the bath, excessive wrapping of the baby, intense physical labor in an unventilated room with high humidity.
- Teething of molars in infants and young children of preschool age.
As it becomes clear from the above text, an increase in temperature can be associated with a huge number of diseases - both infectious and somatic.
The main thing for parents to remember is that lowering the temperature should not be an end in itself. And if the temperature is knocked down, this does not mean that the disease is eliminated. Temperature can serve as a marker of process activity. Therefore, the main goal should be to find the cause of the disease and eliminate it.
