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Children's Health

High fever and elevated WBC`s

11/17/2008

Question:

My child has had a fever for four days ranging from 102-104.5. When I took him to the doctor his WBC`s were 20.3 and the granulocytes were elevated. They did a strep test, chest xray, and urine culture. Everything was negative. They sent me home saying it is viral. How do they know it is not bacterial in origin?

Answer:

I know it is scary to have a sick child with a high fever. You were also very correct in seeking medical evaluation for a fever of 102 degrees F and higher. The fact that the white blood cell count was elevated and especially the number of granulocytes suggested that the problem was likely to be an infection which might be bacterial in nature. However, these values can be seen in an early viral infection as well.

So the next step was to use additional tests that would help identify the common locations of infections in children. This includes urinary tract infections for which a urine culture was done and which did not grow bacteria. The chest X-ray, presuming it was done correctly and read by a qualified individual did not indicate pneumonia. A rapid strep test, hopefully followed up by a throat culture if it was negative, would rule out a strep throat infection.

So I think the conclusion that the source of the fever was viral and therefore would not respond to antibiotics was an appropriate conclusion to reach. Not knowing your child's age or history, it makes it difficult to judge how likely this conclusion was to be correct.

Watchful waiting is also not a bad thing. Early in an illness it may be quite difficult to determine the cause. Watchful waiting by a caring parent allows the illness to source to become clearer and avoids the excessive use of antibiotics for viral illness, for which they are completely ineffective, while also destroying common bacteria and allowing more deadly types of bacteria to increase in number. The less deadly form of bacteria actually hold the more deadly forms in check. 

So, I would say that if you see worsening of your child's condition with the fever staying high, poor fluid intake (don't worry about eating, just drinking) that increases the risk for dehydration, vomiting and diarrhea, any problems with chest pain or difficulty breathing, or unusual drowsiness and lethargy, it is time to go back to the doctor. Be sure to keep cool fluids abundantly available, give the proper dose of acetaminophen or ibuprofen for your child's age and weight regularly around the clock, and observe for the symptoms above. If any one of the symptoms occurs, don't hesitate to ask for re-evaluation.

I hope all is well soon and that this information is helpful.

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Response by:

Mary M Gottesman, PhD, RN, CPNP, FAAN Mary M Gottesman, PhD, RN, CPNP, FAAN
Professor of Clinical Nursing
College of Nursing
The Ohio State University