Fever in HIV-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".)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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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
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- SUMMARY AND RECOMMENDATIONS