Expert Opinion :
This child has presented with fever with chills. Fever with chills is commonly seen with malaria, pneumonia, infective endocarditis, urine infection and deep seated abscesses. This child does have a right lower zone pneumonitis with neutrophilia. However there is no response to antibiotics. Thus, the infection does not appear to be a bacterial pneumonia. Also urine test is normal ruling out a urine infection. This child’s peripheral smear did not show any malarial parasite, however it still does not exclude malaria especially with a palpable spleen. Also the child should be investigated for abscesses. Infective endocarditis is unlikely in a child without an underlying heart disease and is unusual to present as fever for one day. Thus the child may need more tests to rule out malaria and abscesses. Blood tests in form of Rapid malaria tests and ultrasound of abdomen may be needed along with blood culture. In this child, rapid malaria test was positive for P.vivax and child responded to chloroquine. In malaria, lower zone pneumonitis is common and it is not unusual for a child with malaria to present with cough.