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Infection Mimics

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Dr S Balasubramanian, Chennai    16 January 2018

  1. Infections constitute majority of indications for outpatient and inpatient treatment in children. Fever is the most common symptom causing anxiety Pyrexia of Unknown Origin (PUO) is caused in most cases by: a) Infections; b) Infl ammatory or autoimmune disorders; c) Malignancy.
  2. In children, majority of PUO is often due to infections in contrast to adults in whom malignancies are more common.
  3. Awareness of conditions mimicking infections is an essential prerequisite for early and appropriate differential diagnosis of PUO.
  4. With vaccinations and changes in lifestyle and affl uence, there is a defi nite shift from infections to autoimmunity and malignancy as important causes of PUO.
  5. The commonest infection mimics in pediatrics are vasculitis (Kawasaki disease, SLE, SOJIA, etc.) and malignancies, particularly lymphoreticular malignancies.
  6. The following are important rules of thumb regarding infection mimics: Repeated clinical assessment leads to clues; multisystem involvement is frequent in infection mimics particularly in older children; hypertension, renal impairment, visual disturbances in association with fever are clues to infection mimics; negative CRP with raised ESR may be a clue to SLE; bone marrow examination is essential before giving steroids in a febrile child particularly without a defi nitive diagnosis; antibiotic failure may not always mean serious infection – It may mean a noninfectious causefor fever; empirical anti-TB therapy these days is to be avoided since our facilities for confi rmation of infections such as TB are excellent in most places.

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