It has been my pleasure to serve as Guest Editor for this issue of Pediatric Annals in which we discuss some of what I consider to be the most interesting and challenging issues related to fever in children. Fever has long captivated the human imagination, from Hippocrates’ lifelong search for its cause, to the lyrics of popular music (“You Give Me Fever”), to the language of love.
However, there are probably few things that distress parents as much as a fever in their child. It is not surprising, therefore, that fever accounts for one of the most common reasons for a visit to the health care provider.
In this issue of Pediatric Annals, we present five articles on the following topics: fever without a localizing source in toddlers; fever of unknown origin; fever related to animal contact; fever in the returning international traveler; and periodic fever syndromes.
In “Fever without a Localizing Source” (see page 21), Dr. Trainor and I present current data regarding the incidence of occult bacteremia. We propose an approach to the febrile toddler, based on the fact that illnesses secondary to Haemophilus influenzae type b have basically been eradicated and the incidence of invasive pneumococcal disease has decreased tremendously since the widespread use of the pneumococcal conjugate vaccine. This article also discusses the issue of “fever phobia,” as well as the overuse of antipyretics.
Fever of unknown origin (FUO) continues to be extremely anxiety-provoking for parents and health care providers. In “Fever of Unknown Origin in Children” (see page 26), Drs. Seashore and Lohr discuss how to approach the child with FUO. They emphasize the importance of conducting a good history and physical examination, even in this modern era in which sophisticated technology has supplanted these items in making a diagnosis.
Febrile illness acquired from animals is also an important topic because so many people have pets, including those that used to be considered quite exotic. Drs. Arguello and Steele have organized their article “Febrile Illnesses Acquired from Animals” (see page 31) in a unique way. The text is divided into presenting symptoms and signs, matched with the possible animal contact and illness with which those features may be associated.
International travel is more prevalent than ever. Many of our patients are going to places in the world where they are exposed to pathogens, which we may rarely see in the United States. Dr. Crowell and I, in the article “Fever in the Returning International Traveler” (see page 39), emphasize the importance of pretravel preparations and discuss the more common diseases that the international traveler may encounter.
Finally, in the article “Periodic Fever Syndromes” (see page 48), Victoria Wurster and Drs. Carlucci and Edwards summarize the more important syndromes that present with periodic fevers. During the past decade, advancement in our knowledge of these diseases and the genetic tests that have become available allow the definitive diagnosis of many of these diseases. The authors nicely review the genetics and pathophysiology of the periodic fever syndromes, as well as the typical clinical manifestations with which these syndromes present.
There is no doubt that fever in children will always cause parental anxiety. As health care providers, we must be knowledgeable of the latest developments related to fever and its likely causes, take very careful histories, and perform thorough physical examinations to provide the most accurate assessments possible. We need to know when reassurance is the best advice, but we also need to know when we should evaluate for more exotic or serious illnesses and how to perform these evaluations. I am confident that the articles that follow will aid in accomplishing those goals.