eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Fever Without a Focus: Follow-up

Author: Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Contributor Information and Disclosures

Updated: Jan 22, 2009

Follow-up

Further Inpatient Care

  • Patients with fever without a focus who appear toxic or who fail to improve with outpatient treatment require hospital admission for further evaluation and treatment.

Further Outpatient Care

  • All children and infants with a febrile illness without a focus of bacterial infection require close follow-up care and instructions to return if the patient's condition deteriorates.
  • Follow-up visits should be arranged within 24-48 hours after the initial visit.

Inpatient & Outpatient Medications

  • Tailor medication choice to the source of infection, if known. Administer empiric treatment based on the most likely organisms.
  • A second dose of long-acting parenteral antibiotic may be given at the follow-up visit pending culture results.

Complications

  • When an occult infection is not suspected and diagnosed in a timely manner, a small but very real possibility that the infection may progress to bacteremia, meningitis, or other life-threatening illness is present.

Prognosis

  • Prognosis for an appropriately treated patient is excellent.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • The biggest pitfall in treating patients with fever without a focus is failing to consider the possibility of a life-threatening illness. Physicians who approach their patients as if this is a possibility and who provide appropriate evaluation and treatment have done their best to avoid a poor outcome.
  • Stress to parents the criticality of their child returning for follow-up care and stress that they must seek immediate medical attention if their child's condition worsens.
  • Failure to evaluate and/or treat an ill-appearing infant or child because of a CBC count within the reference range considered normal is a serious pitfall.

Special Concerns

  • Even low-risk infants who meet criteria for discharge require close follow-up care. Instruct parents or caregivers to return before the next scheduled appointment if the infant's condition should worsen.
  • Admit to the hospital all 2-month to 36-month-old febrile patients who have sickle cell anemia.
 


More on Fever Without a Focus

Overview: Fever Without a Focus
Differential Diagnoses & Workup: Fever Without a Focus
Treatment & Medication: Fever Without a Focus
Follow-up: Fever Without a Focus
References
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References

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Further Reading

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Keywords

fever without a focus, bronchiolitis, childhood fever, croup, cyanosis, end-stage renal disease, Escherichia coli, fever without a source, fever without localizing signs, gingivostomatitis, Haemophilus influenzae type b, hand-foot-and-mouth disease, hyperventilation, hypoventilation, Listeria monocytogenes, meningitis, Neisseria meningitidis, occult bacteremia, otitis media, pediatric fever, pharyngitis, pneumonia, pyelonephritis, renal failure, renal scarring, sinusitis, Streptococcus agalactiae, Streptococcus pneumoniae, urinary tract infection, UTI, varicella, viral gastroenteritis

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Contributor Information and Disclosures

Author

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Consulting; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching; sanofi pasteur Grant/research funds Unrestricted research grant; sanofi pasteur  Consulting; sanofi pasteur Honoraria Speaking and teaching; Tap Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching

Medical Editor

Ashir Kumar, MBBS, MD, FAAP, Professor, Department of Pediatrics and Human Development, College of Human Medicine, Michigan State University; Consulting Staff, Department of Pediatrics, EW Sparrow Hospital
Ashir Kumar, MBBS, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, American Association of Physicians of Indian Origin, American Federation for Clinical Research, American Society for Microbiology, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Mark R Schleiss, MD, American Legion Chair of Pediatrics, Professor of Pediatrics, Division Director, Division of Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota School of Medicine
Mark R Schleiss, MD is a member of the following medical societies: American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Society for Pediatric Research
Disclosure: Nothing to disclose.

CME Editor

Daniel Rauch, MD, FAAP, Director, Pediatric Hospitalist Program, Associate Professor, Department of Pediatrics, New York University School of Medicine
Daniel Rauch, MD, FAAP is a member of the following medical societies: Ambulatory Pediatric Association, American Academy of Pediatrics, and Society of Hospital Medicine
Disclosure: Baxter Honoraria Consulting; Pfizer Honoraria Consulting

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
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