Fever in children: diagnosis and management by nurses, medical students, doctors and parents.

Thirty-six nurses, 18 final year medical students, 24 doctors and 36 parents were questioned about their understanding and management of the symptom "fever". There was an obvious tendency to over-diagnose fever by the nursing and medical staff. Antipyretics and sponging were unnecessarily prescribed. Most parents do not have a thermometer and have minimal understanding of fever and its management, and 37% regard fever as a cause of brain damage. Their main sources of information on the subject derive from relatives and friends: only 9% mentioned nurses or doctors as their source of information. Medical students receive little teaching on fever. It is recommended that more time should be devoted to teaching nurses, medical students and junior doctors about fever and they in turn should educate parents on the subject.

Osteoarticular brucellosis in children.

The findings in 40 children (24 female, 16 male) with osteoarticular complications of brucellosis are presented. Raw milk was the main source of infection. Most patients had acute onset of fever, arthralgia, and myalgia. Arthritis was the presenting symptom in all patients, of whom two also had osteomyelitis. Arthritis was monoarticular in 28 (70%) of 40 cases with predilection for large weight-bearing joints. Spine and small joints were spared. Brucella melitensis was detected in 23/31 (74%) cases. Mild anaemia, leucopenia, increased liver enzymes, positive acute phase reactants, and low titres of autoantibodies were prominent non-specific laboratory findings. Bone scintigraphy was more helpful than conventional radiography in detecting hip and sacroiliac joint disease. Treatment with a combination of antibiotics for six weeks or more resulted in a cure rate of 92.5%. Early recognition of infection, prolonged treatment, and long term follow up should improve the outcome of patients.