HomeAnswersInternal MedicinefeverMy 1 year kid has continuous fever and abscess in neck. Kindly guide.

My 1 year kid has continuous fever and abscess in neck. Kindly guide.

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My 1 year kid has continuous fever and abscess in neck. Kindly guide.

The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Medically reviewed by

iCliniq medical review team

Published At May 29, 2018
Reviewed AtJanuary 5, 2024

Patient's Query

Hello doctor,

My daughter is one-year-old. Since ten days she has a fever. From the very first day, we have consult pediatrician and he started a tablet containing Nimesulide and Acetaminophen for fever four times a day. We completed the course for five days and returned to doctor for follow up. He again suggested for a tablet containing Nimesulide and Acetaminophen twice a day and started antibiotic syrup. After five days, her fever was still there so we again consulted the doctor and he advised to do the blood test. The WBC count was 16000 per microliter of blood, platelet count 7.90 x10^3 per microliter of blood. So, the doctor advised to admit her and started antibiotics Ceftriaxone and Tazobactam 500 mg injection, Amikacin 100 mg, and Ranitidine. After three days the same situation, fever was still there so we insisted on a blood test, urine test as well as X-ray. The result was WBC 17100 per microliter of blood, platelet 7.27 x 10^3 per microliter of blood, urine report showed pus cells 2.3/H.P.F, and X-ray report was normal. So the doctor revised the treatment plan immediately after having all reports as, Meropenem 250 mg injection, Alpha Beta Arteether injection, and syrup containing Mefenamic acid and Paracetamol. But on the same night, we observed my baby's neck was swollen. So we asked the doctor and he diagnosed that it is kind of abscess. He explained that it appeared due to our antibiotic. It is the source of infection and due to that, her fever was present. There will be two options either revise the medication plan or by surgically remove the abscess. The doctor again revised the treatment plan as Meropenem 250 mg, Ceftriaxone 500 mg, a combination of Piperacillin and Tazobactam1.125 mg, Azithromycin 100 mg, and Electrolyte injection containing Sodium, Potassium, and Chloride. Kindly provide your insight.

Hello,

Welcome back to icliniq.com.

I read your query and understood your concern. I have gone through reports and history (attachment removed to protect patient identity). From the picture, it appears to be abscess only. Also, the doctor confirms it on examination. The next line of action should be an ultrasound of the abscess to look for extent. Also, drainage of abscess is necessary. She has enough antibiotics and, fever, TLC (total leucocyte count) not responding as antibiotics must not be reaching there adequately due to pus collection. So the abscess should be drained in my opinion while antibiotics should be continued. After draining, the pus should be sent for investigations, which includes gram staining, AFB (acid-fast bacilli) staining, GeneXpert (a cartridge-based nucleic acid amplification test) of the pus, bacterial culture and sensitivity. So if the facility is available there then you may keep or else should be shifted to higher center. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Patient's Query

Hello doctor, We have conducted further investigation with USG. I have attached the result of the report. Kindly provide your insight.

Hello,

Welcome back to icliniq.com.

I read your query and understood your concern.

I have reviewed the reports you attached (attachments removed to protect the patient’s identity), the features observed strongly suggest the presence of a large abscess with extensions. It is imperative that this abscess is promptly drained. Additionally, as I suggested earlier, the pus from the drainage needs to be thoroughly investigated using the tests I mentioned previously. There is a substantial likelihood of tuberculosis being involved in this case. A CT (computed tomography) scan should also be performed to provide detailed insights and determine the exact extent for thorough drainage. I suggest you consult a specialist for discuss these matters in detail. I hope this has helped you. Kindly follow up if you have more doubts. Thank you.

Patient's Query

Hello doctor, We got CT of neck done with contrast and I have attached the report also. Referring to the CT scan report, the doctor did perform the drainage, but solid nodes are still present. As per your and our treating doctor's suggestions, we have sent samples for further investigation. The doctor has prescribed antibiotics to prevent infection. However, my main concern is the existing solid mass. Can it be treated effectively with medication, or is surgical removal necessary? If surgery is indeed the last option, are there any associated risks, especially considering that there are multiple solid nodes? Kindly help.

Hello,

Welcome back to icliniq.com.

I read your query and understood your concern.

I have reviewed the reports you attached (attachments removed to protect the patient’s identity). I would like to inform you that only the abscess needs to be drained. Enlarged lymph nodes should respond to medication, and surgery is not required for them. Considering the overall situation, the leading possibility is tuberculosis, and there is no harm in initiating antitubercular therapy at this point. I suggest discussing the commencement of antitubercular treatment with your doctor. It is unlikely to be a bacterial infection at this stage. Additionally, also try to obtain the cartridge-based nucleic acid amplification test report, which is typically available within a day and can confirm tuberculosis if positive. Keep in mind that a negative test does not rule out tuberculosis. Furthermore, the FNAC (Fine Needle Aspiration Cytology) results should have been sent; please make an effort to collect those reports and any other relevant documents. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Patient's Query

Hello doctor,

All the tests you suggested are done and I have attached all the reports. Currently, our treating surgeon has indicated that no medication is necessary. Subsequently, we consulted with a physician who has initiated a multivitamin regimen. Does this medication plan is enough or should I discuss with our doctor regarding starting antitubercular therapy? Kindly suggest.

Hello,

Welcome back to icliniq.com.

I read your query and understood your concern.

I have reviewed the reports you attached (attachments removed to protect the patient’s identity). Is he currently afebrile, or is the fever persisting? If his fever has subsided, I suggest you adopt a watchful waiting approach to monitor for any recurrence. Although his cartridge-based nucleic acid amplification test and AFB (acid-fast bacteria) tests have returned negative results, these tests do not definitively rule out tuberculosis. In cases of tuberculosis abscess, these tests can yield positive results in only 50 to 60 percent of cases. Furthermore, his histopathology report indicates the presence of granuloma, which leans toward tuberculosis, although it can also be observed in bacterial infections. Thus, while there is no direct laboratory evidence confirming tuberculosis, it cannot be entirely ruled out either. If his fever has abated, we can closely monitor his response. However, if the fever persists, it may be prudent to consider initiating anti-tuberculosis therapy. Additionally, if a sample has been sent for AFB culture, this report may provide further valuable insights. I hope this has helped you. Kindly follow up if you have more doubts.

Thank you.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Sagar Ramesh Makode
Dr. Sagar Ramesh Makode

Cardiology

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