Diplomate, Board Certification of Emergency Medicine
Chairman, Department of Emergency Medicine Ma'ayenei Hayeshua
Hospital
We were discussing fever, with a spotlight on kids. Let's
look at some common causes of fever.
A not so uncommon cause of fever, and a dangerous one, was
epiglottis. This disease caused inflammation of the
epiglottis, the little cap that covers the breathing tube
when food is going down the other pipe. It caused difficulty
in breathing, a "hot potato" voice, drooling and high fever.
The disease often required putting the child on a
respirator.
However, most physicians will now never see this disease
because of the vaccination that was released in 1987 against
the main bacteria that causes this disease. True we see it
occasionally in adults, caused by other bacteria, but now it
is rare.
I mention this only because of the importance of making sure
you have not been remiss in vaccinating your child.
Pneumonia is usually a high fever with cough. Cough without
fever is probably viral and does not need antibiotics. I
think respiratory infections is another area of overuse of
antibiotics, and I think without X- ray confirmation, I would
not run to use antibiotics unless it is obvious on exam --
and I mean obvious.
Strep throat is a disease of the tonsils. We now use a score
to determine the likelihood of a sore throat being strep.
Take four elements: fever, white plaques on the tonsils,
lymph nodes in the neck, and the absence of cough. If one has
all four, strep is very likely. If two or three, strep is a
possibility, and a strep test should be taken. One element is
unlikely to be strep.
While in the USA they have many who do not treat this
disease, in Europe we do treat it as our strep is much more
virulent.
Tonsillectomy -- taking out the tonsils -- is reserved for
those with frequent cases of strep. However, since tonsils
often shrink as one gets older, and disappear, this is done a
lot less these days. On the other side, doing the operation
when one gets older is possible, but extremely painful. Let
your Ear, Nose and Throat physician help you make this
decision.
If you do not want this disease to spread through the family,
wash out cups carefully and do not share toothbrushes.
Penicillin remains the drug of choice for this disease.
Urinary tract infections can be occult and therefore all
children with fever should have a urine test done until the
child is old enough to tell us it doesn't hurt to pass urine.
In young children -- under the age of five - - this can be a
due to a disease called reflux, where urine occasionally goes
from the bladder in the wrong direction, up to the kidneys,
resulting in scarring of the kidney and possible kidney
failure. Therefore studies are usually done to determine that
this is not the cause. While in newborns this is more common
in males, after this period this is a disease of little
girls. Therefore, if a boy has a urine infection, we get very
aggressive as it is rarer in boys.
A major cause of fever in Israel, although less so in the
west is dysentery. We'll speak about that next week. Write me
in care of the Yated.
A message from Glaxo, sponsor of this column. Herpes
and chicken pox are nuisances and can be dangerous -- the
former in infants especially and the latter in adults.
Valtrex is a wonderful antiviral that is effective against
this family of viruses and is indeed the treatment of
choice.
