A 5-year-old male (Weight: 18 kg; Height: 105 cm) presented with fever of four days duration. The child was apparently well prior to fever onset. Initially, the fever was mild to moderate and responded to paracetamol, although it recurred every 4-6 hours. By day 4, the fever was high and the child appeared sicker. There was no history of cold or cough or any other significant symptoms. There was no history of any major illness or disease in the family.
On physical examination, the child’s temperature was 104oF, pulse was 130/min, and the respiratory rate was 28 per min. The child looked sick, was irritable and exhibited a cold periphery. Examination of the abdomen revealed mild gaseous distension. The liver was 2F+, soft, not tender, and the spleen was not palpable. There was no lymphadenopathy, skin rash, or icterus and ENT was normal.