Fever in children: complex issues of diagnosis and treatment

Fever in a child is one of the most common reasons for seeking medical care, while fever is an important symptom of the body’s defense reaction, signaling changes in the body that require attention from specialists in various specialties. A pediatrician should know the norms of temperature reactions depending on the child’s age and measurement methods, circadian rhythms, remember the physiological increase in body temperature, the differences in the thermometers used. The causes of febrile conditions can be extremely diverse, there are 2 main groups: infectious and non-infectious. Infectious – the most common causes of fever in children, but we must not forget about the rarer non-infectious causes. The article demonstrates 2 clinical cases of children with fever (a child with Marshall syndrome and with chronic granulomatous disease), shows the difficulties of diagnostic search and treatment of such patients. Marshall syndrome is a periodic syndrome that includes fever, aphthous stomatitis, pharyngitis and cervical lymphadenitis, the most common variant of periodic fever in our country, criteria for diagnosis and treatment methods are given. Chronic granulomatous disease is one of the common primary immunodeficiencies, the main manifestation of which is bacterial and fungal infections of the lungs, liver, lymph nodes and other organs, while the manifestation of symptoms occurs, as a rule, up to 5 years. Possible algorithms for diagnostic search in a child with prolonged fever are given, taking into account the anamnesis data, clinical examination, previously conducted laboratory and instrumental examination methods. Issues of safe and effective treatment of fever, including symptomatic treatment with ibuprofen and paracetamol, indications for prescribing antipyretics in real clinical practice are discussed.