Table 5.10.

Differential diagnosis of fever without focal signs and duration <14 days in HIV infected children

Differential diagnosis	Diagnostic clues
Malaria	• Living or a history of visiting malaria area • Blood film/dipstick positive • The presence of anaemia, low platelets
Typhoid fever	• Seriously ill without apparent cause • Abdominal tenderness • Relative bradycardia in relation to body temperature • Maculopapular rash, often sparing palms
Urinary tract infection	• Dysuria, frequency, pyuria, tenderness in renal angles • Positive nitrate and WBC dipstick
Dengue	• Patient from areas at risk • Sudden onset of high fever with headache, pain behind eyes, joint and muscle pain • Macular rash in 50% (centrifugal, itching) (In dengue haemorrhagic fever, there is in addition bleeding tendency, e.g. from the nose, bowel, fingers)
Septicaemia	• Seriously ill with no apparent cause
Immune reconstitution inflammatory syndrome	• Recent start of HAART • CD4% < 10% at start of HAART • Rise in CD4+ lymphocyte count
Drug-induced fever	• Nevirapine, cotrimoxazole, dapsone, ß-lactams, isoniazid, anticonvulsants, abacavir, efavirenz

HAART highly active antiretroviral treatment