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Q. A 12 years old previously well child admitted with 6 days h, o high fever - 39C to 40C. Fever was associated with chills. No other associated symptoms. He had no cold, no cough, no GI or urinary symptoms. His General physical examination and systemic examination was normal. ENT examination was normal. Fundus normal. Skin and joints no abnormality detected. No meneingeal signs.
His WBC count was 6600, Neutrophils-4800, Platelet count 122, Hb-11 g, dl.
ALT- borderline high- 109 IU, L. Rest of LFT was normal.
ESR was 50, C-reactive protien was 354 mg, L.
Uric acid, LDH- WNL. Peripheral smear- normal.
Blood and Urine clture later showed no bacterial growth.
Chest x-ray-Normal
U, S abdomen and KUB- normal
Nasal endoscopy - no abnormality
X-ray PNS- normal
No prior antibiotic treatment was given.

We treated him with Ceftriaxone for 7 days as presumed bacterial infection o the basis of high fever and high CRP. He became afebrile on Day 2 of antibiotic treatment.
His CRP repeated Day 3 of treatment showed a falling trend to 274.
My question is:
- What is the significance f high CRP in the absence of any focus of infection clinically and normal White cell count_?
- Could we have waited without antibiotic treatment_?
Aasma Rasul
General pediatrician
Muscat
Sultanate Of Oman

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