Clinical Pathways
Clinical Pathways
>5 days fever
>5 days fever

>5 days fever

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Action

  • Consider Kawasaki disease, bacterial infections, MIS-C (Class II)
  • If fever has persisted longer > 7 days, perform workup for fever of unknown origin (Class II)

Background

Children With Fever for More Than 5 days

When fever has been present for more than 5 days, additional diagnostic testing must be considered. The vasculitis Kawasaki disease or similar multisystem inflammatory syndrome in children (MIS-C) related to recent SARS-CoV-2 infection must be considered. Other diseases that mimic this appearance include scarlet fever, measles, adenovirus infection, Stevens-Johnson syndrome, and toxic shock syndrome. In some cases, incomplete Kawasaki disease presents with fever, but instead of 4 of the 5 classic findings, the patient may have only 2 or 3, no alternative explanation, and elevated inflammatory markers (high CRP or ESR). It is important to identify Kawasaki disease, as it can lead to coronary aneurysms and other coronary disease. If identified, it should be treated with aspirin and IV immunoglobulin under specialist care. Fever that is present for more than 7 days requires further investigation as described in reviews on fever of unknown origin, but is outside of the scope of this review.

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References

Evidence-based medicine requires a critical appraisal of the literature based upon study methodology and number of subjects. Not all references are equally robust. The findings of a large, prospective, randomized, and blinded trial should carry more weight than a case report.

To help the reader judge the strength of each reference, pertinent information about the study, such as the type of study and the number of patients in the study is included in bold type following the references, where available. The most informative references cited in this paper, as determined by the authors, are noted by an asterisk (*) next to the number of the reference.

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