Fever in human immunodeficiency virus-infected children
- Susan L Gillespie, MD, PhD
Susan L Gillespie, MD, PhD
- Associate Professor of Pediatrics
- Baylor College of Medicine
Febrile children with human immunodeficiency virus (HIV) infection are diverse in their clinical presentations, necessitating a thoughtful and varied diagnostic approach. Acutely febrile HIV-infected children who are well controlled by combination antiretroviral therapy often have illness that is mild and self-limited. Not all of these patients require diagnostic testing or antibiotic therapy. However, a few of these children have more serious infectious diseases. Differentiating these seriously ill patients from the larger group of mildly ill children can be difficult. HIV-infected children with prolonged fever often have complicating medical conditions, and the diagnostic evaluation can be complex.
An approach to the evaluation of fever in HIV-infected children is reviewed here. The epidemiology, classification, clinical manifestations, and outcome of pediatric HIV are discussed separately. (See "Pediatric HIV infection: Classification, clinical manifestations, and outcome" and "Epidemiology of pediatric HIV infection".)
The following terms are used throughout this discussion:
●Focal infection — A focal infection is associated with localizing signs or symptoms that suggest a source (eg, pneumonia, cellulitis, osteomyelitis, otitis media, herpes simplex virus stomatitis).
●Fever without a source (FWS) — Acute fever lasting one week or less with no source identified through the history and physical examination is referred to as fever without a source (FWS). Alternative terms are fever without localizing signs (FWLS) or fever without a focus. (See "Fever without a source in children 3 to 36 months of age".)
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- ETIOLOGY OF FEVER
- DIAGNOSTIC EVALUATION
- Asymptomatic/mildly symptomatic HIV disease
- Advanced HIV disease
- - Focal infection
- - FWS
- - FUO
- Empiric antibiotic therapy
- - Aims of empiric therapy
- - Asymptomatic/mildly symptomatic HIV disease
- - Advanced HIV disease
- - Fever of unknown origin
- - Neutropenia
- - Nosocomial infection
- Specific therapy
- Duration of treatment
- Response to therapy
- SUMMARY AND RECOMMENDATIONS