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My 7 Y/o Has Had A Low Grade Fever For

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Posted on Wed, 10 Feb 2021
Question: My 7 y/o has had a low grade fever for 3.5 weeks. Day 2 was tested for covid (neg). We had a follow up a week and a half later (drew labs), ALP 323, hemocrit 39.7, mch 26.2, wbc 6.39, platelets 307,rbc 5.15,rdw 11.8. Chest xray on day 15 (came back suggestive of Covid19 pneumonia, or RAD, thickening of airways and cloudiness in bottom right lung), another covid test on day18 (negative), started on 5 day zpak. First two days of zpak fever disappeared only to come back on day 3. Today is day 23 and I brought her for her follow up Chest xray ( results hopefully monday). I don't want something potentially major to get lost in the assumption of a past Covid infection, Dr does not want to do an antibody test citing they are highly inaccurate. If this chest xray does not show improvement what else would we be looking for? This child has zero other symptoms other than the low grade fever and slightly swollen lymph nodes. I am very concerned and anxious. Next step I have been told will be pulmonologist. We are very rural and it's not that I don't trust my doctor, I do but I am so afraid of something being over looked. Would an antibody test be a good idea and what else should I be advocating for tests?
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Follow up: Dr. Muhammed Aslam TK (0 minute later)
My 7 y/o has had a low grade fever for 3.5 weeks. Day 2 was tested for covid (neg). We had a follow up a week and a half later (drew labs), ALP 323, hemocrit 39.7, mch 26.2, wbc 6.39, platelets 307,rbc 5.15,rdw 11.8. Chest xray on day 15 (came back suggestive of Covid19 pneumonia, or RAD, thickening of airways and cloudiness in bottom right lung), another covid test on day18 (negative), started on 5 day zpak. First two days of zpak fever disappeared only to come back on day 3. Today is day 23 and I brought her for her follow up Chest xray ( results hopefully monday). I don't want something potentially major to get lost in the assumption of a past Covid infection, Dr does not want to do an antibody test citing they are highly inaccurate. If this chest xray does not show improvement what else would we be looking for? This child has zero other symptoms other than the low grade fever and slightly swollen lymph nodes. I am very concerned and anxious. Next step I have been told will be pulmonologist. We are very rural and it's not that I don't trust my doctor, I do but I am so afraid of something being over looked. Would an antibody test be a good idea and what else should I be advocating for tests?
doctor
Answered by Dr. Muhammed Aslam TK (2 hours later)
Brief Answer:
No need to worry much now

Detailed Answer:
Hi dear,
Welcome to Ask A Doctor service
I have gone through your query and understand your concern well.

I have gone through the entire medical record and reports- everything seems fine so far.
Before commenting on alternate possibilities and further course of action, I would like to get few more details:

1. Do you keep a temperature record? When does the fever comes usually- any time/evening/night? What was the maximum temperature recorded and site of recording(oral/axilla)?

2. How is her appetite- eating well or not?

3. Any significant weight loss during this 1 month?

4. Is she otherwise active and playful, or feeling dull/lethargic?

5. The details of lymph nodes- what all lymph nodes are enlarged(neck/axilla/inguinal), their approximate size if available/possible, and any tenderness over there?

6. Even-though you said zero other symptoms, just want to confirm: Does she has any cough/chest pain/throat pain/excess sweating/pain over legs or bones/any bladder or bowel disturbances/rash/joint pains?


Kindly get back with details, so that I can guide you better
Regards, Dr Aslam
Above answer was peer-reviewed by : Dr. Kampana
doctor
doctor
Answered by Dr. Muhammed Aslam TK (0 minute later)
Brief Answer:
No need to worry much now

Detailed Answer:
Hi dear,
Welcome to Ask A Doctor service
I have gone through your query and understand your concern well.

I have gone through the entire medical record and reports- everything seems fine so far.
Before commenting on alternate possibilities and further course of action, I would like to get few more details:

1. Do you keep a temperature record? When does the fever comes usually- any time/evening/night? What was the maximum temperature recorded and site of recording(oral/axilla)?

2. How is her appetite- eating well or not?

3. Any significant weight loss during this 1 month?

4. Is she otherwise active and playful, or feeling dull/lethargic?

5. The details of lymph nodes- what all lymph nodes are enlarged(neck/axilla/inguinal), their approximate size if available/possible, and any tenderness over there?

6. Even-though you said zero other symptoms, just want to confirm: Does she has any cough/chest pain/throat pain/excess sweating/pain over legs or bones/any bladder or bowel disturbances/rash/joint pains?


Kindly get back with details, so that I can guide you better
Regards, Dr Aslam
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Muhammed Aslam TK (50 minutes later)
1. Yes I do. 97.1 - 98.2 in am. Afternoon and evenings 99.8 is average at those times. 100.9 XXXXXXX temp. Her normal is 97.1.
2.No appetite loss. She is in fact eating like a lion.
3. None
4. Other than the day before her first Covid test and the day of her Covid test and possibly the day after a little no. On those days only the only other thing she experienced was fatigue. Perfectly normal otherwise.
5. Neck. Unsure of size, that was not relayed to me. I can't feel them at this point.
6. None of these symptoms

Thank you for responding so quickly!
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Follow up: Dr. Muhammed Aslam TK (0 minute later)
1. Yes I do. 97.1 - 98.2 in am. Afternoon and evenings 99.8 is average at those times. 100.9 XXXXXXX temp. Her normal is 97.1.
2.No appetite loss. She is in fact eating like a lion.
3. None
4. Other than the day before her first Covid test and the day of her Covid test and possibly the day after a little no. On those days only the only other thing she experienced was fatigue. Perfectly normal otherwise.
5. Neck. Unsure of size, that was not relayed to me. I can't feel them at this point.
6. None of these symptoms

Thank you for responding so quickly!
doctor
Answered by Dr. Muhammed Aslam TK (2 hours later)
Brief Answer:
Stay relaxed

Detailed Answer:
Hi dear,
Thank you for the details given. Now I will explain the possibilities and ways ahead.

1. The possibilities:

Firstly, to take this as significant, temperature should be above 99.7 consistently.
3 main possibilities we doctors keep in mind in such scenarios are: 1. An ongoing active infection 2. A post-infectious inflammatory state(inflammation following infections like COVID/mononucleosis/non specific viral illness; occasionally this takes few weeks to settle). 3. Connective tissue disorders 4. Malignancies.

With the back ground history, normal blood count, sedimentation rate and CRP(all being normal), an active infection and malignancy is out at the first look itself. These are almost definitely excluded.

In this case, I will keep a post infectious inflammatory state(although not sure of the triggering infection) as a possibility. Connective tissue diseases like lupus can also present like this, but here we expect some abnormalities like elevated sedimentation rate or blood count and few additional symptoms like rash/joint pains. So, for the time being, we can keep this possibility also out.

2. What ahead?

Since all investigations so far is normal(I expect the repeat X ray also to be normal), she is active/playful, eating well and gaining weight, I would prefer to just keep her monitoring for another 4-6 weeks. Most probably fever will disappear by then as the inflammation settles down and we can forget everything. If not settling, or if she develops additional symptoms as mentioned, we can evaluate further.

Until then, absolutely no reason to worry. Antibody testing, as your doctor rightly said, is very non-specific, and would not help us much in our decision ahead. If at all an additional testing is needed, I would recommend a peripheral blood smear to assess the morphology of white cells. You can discuss this with your doctor.

Once again I remind you- In an active child with normal blood count and sedimentation rate, passive monitoring is the rule rather than active invasive tests and absolutely no reason to worry, as dangerous/worrisome things are already out in the list.

I hope this answer will help
If you need further clarification, I will be happy to help
Wishing you good health
Dr Aslam
Above answer was peer-reviewed by : Dr. Kampana
doctor
doctor
Answered by Dr. Muhammed Aslam TK (0 minute later)
Brief Answer:
Stay relaxed

Detailed Answer:
Hi dear,
Thank you for the details given. Now I will explain the possibilities and ways ahead.

1. The possibilities:

Firstly, to take this as significant, temperature should be above 99.7 consistently.
3 main possibilities we doctors keep in mind in such scenarios are: 1. An ongoing active infection 2. A post-infectious inflammatory state(inflammation following infections like COVID/mononucleosis/non specific viral illness; occasionally this takes few weeks to settle). 3. Connective tissue disorders 4. Malignancies.

With the back ground history, normal blood count, sedimentation rate and CRP(all being normal), an active infection and malignancy is out at the first look itself. These are almost definitely excluded.

In this case, I will keep a post infectious inflammatory state(although not sure of the triggering infection) as a possibility. Connective tissue diseases like lupus can also present like this, but here we expect some abnormalities like elevated sedimentation rate or blood count and few additional symptoms like rash/joint pains. So, for the time being, we can keep this possibility also out.

2. What ahead?

Since all investigations so far is normal(I expect the repeat X ray also to be normal), she is active/playful, eating well and gaining weight, I would prefer to just keep her monitoring for another 4-6 weeks. Most probably fever will disappear by then as the inflammation settles down and we can forget everything. If not settling, or if she develops additional symptoms as mentioned, we can evaluate further.

Until then, absolutely no reason to worry. Antibody testing, as your doctor rightly said, is very non-specific, and would not help us much in our decision ahead. If at all an additional testing is needed, I would recommend a peripheral blood smear to assess the morphology of white cells. You can discuss this with your doctor.

Once again I remind you- In an active child with normal blood count and sedimentation rate, passive monitoring is the rule rather than active invasive tests and absolutely no reason to worry, as dangerous/worrisome things are already out in the list.

I hope this answer will help
If you need further clarification, I will be happy to help
Wishing you good health
Dr Aslam
Above answer was peer-reviewed by : Dr. Kampana
doctor
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Follow up: Dr. Muhammed Aslam TK (10 hours later)
Thank you very much for all of the information provided and thank you for easing my mind! I appreciate it more than words can say!
default
Follow up: Dr. Muhammed Aslam TK (0 minute later)
Thank you very much for all of the information provided and thank you for easing my mind! I appreciate it more than words can say!
doctor
Answered by Dr. Muhammed Aslam TK (7 hours later)
Brief Answer:
Thank you

Detailed Answer:
Hi XXXXXXX
Thank you for your kind words, and I am happy that you are relieved now.

Now, if you do not have further queries, you can close the discussion and kindly rate the answer.
Wishing you and family good health always ahead.
Dr Aslam
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
doctor
Answered by Dr. Muhammed Aslam TK (0 minute later)
Brief Answer:
Thank you

Detailed Answer:
Hi XXXXXXX
Thank you for your kind words, and I am happy that you are relieved now.

Now, if you do not have further queries, you can close the discussion and kindly rate the answer.
Wishing you and family good health always ahead.
Dr Aslam
Note: For further queries related to your child health, Talk to a Pediatrician. Click here to Book a Consultation.

Above answer was peer-reviewed by : Dr. Raju A.T
doctor
Answered by
Dr.
Dr. Muhammed Aslam TK

Pediatrician

Practicing since :2012

Answered : 2023 Questions

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My 7 Y/o Has Had A Low Grade Fever For

My 7 y/o has had a low grade fever for 3.5 weeks. Day 2 was tested for covid (neg). We had a follow up a week and a half later (drew labs), ALP 323, hemocrit 39.7, mch 26.2, wbc 6.39, platelets 307,rbc 5.15,rdw 11.8. Chest xray on day 15 (came back suggestive of Covid19 pneumonia, or RAD, thickening of airways and cloudiness in bottom right lung), another covid test on day18 (negative), started on 5 day zpak. First two days of zpak fever disappeared only to come back on day 3. Today is day 23 and I brought her for her follow up Chest xray ( results hopefully monday). I don't want something potentially major to get lost in the assumption of a past Covid infection, Dr does not want to do an antibody test citing they are highly inaccurate. If this chest xray does not show improvement what else would we be looking for? This child has zero other symptoms other than the low grade fever and slightly swollen lymph nodes. I am very concerned and anxious. Next step I have been told will be pulmonologist. We are very rural and it's not that I don't trust my doctor, I do but I am so afraid of something being over looked. Would an antibody test be a good idea and what else should I be advocating for tests?