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Fever and tachypnoea in a child

BMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l1288 (Published 10 May 2019) Cite this as: BMJ 2019;365:l1288
  1. Dylon Christie, foundation year 2 doctor1,
  2. Neil Chanchlani, gastroenterology research fellow2,
  3. Sormeh Salehian, specialist registrar in respiratory paediatrics3
  1. 1Kings College Hospital NHS Foundation Trust, London, UK
  2. 2Royal Devon and Exeter Hospital, Exeter, UK
  3. 3Addenbrooke’s, Cambridge University Hospital, Cambridge, UK
  1. Correspondence to: S Salehian ssalehian{at}nhs.net

A 10 year old girl presented to her local hospital with a one week history of fever of up to 40°C, lethargy, and decreased oral intake. Her parents reported an occasional dry, non-productive cough.

She was otherwise well, born at term, and up to date with vaccinations, including Bacille Calmette Guerin. She had no unwell close contacts. She had returned from holiday in Nigeria two months previously and had taken malaria prophylaxis.

She seemed tired, but responsive. She was tachypnoeic, but not in respiratory distress. On auscultation of her chest, she had bronchial breath sounds on the left side with reduced air entry from mid to lower zone, and percussion note was dull. An examination of her ears, nose, and throat was unremarkable, and no skin rashes were seen on inspection.

Observations at presentation were temperature 40°C (normal range 36.0-37.5), heart rate 140 beats/min (normal range 60-100), and respiratory rate 38 breaths/min (normal range 12-20) with pulse oximeter saturations 97% in room air (normal range >97).

Blood results were: haemoglobin 104 g/L (normal range 112-165), white cell count 15.7×109/L (normal range 3.5-10.8), neutrophils 11.3×109/L (normal range 1.5-8.0), platelets …

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