Clinical Case Database / Category: Patient Management

Look before you leap: viral infections

Publication details

Dr Nandhakumar Nagarajan, Dr S Subramania Krishnamoorthy
Foundation Years Journal, volume 8, issue 8, p.41 (123Doc Education, London, September 2014)


Viral infections are the most common paediatric illnesses that you will encounter when working as the front line medical staff in any medical facility. Respiratory viruses are the predominant agents in this category. Even though these infections dominate paediatric illnesses, the mortality associated with this group of organisms is very low.

It is also challenging to differentiate them from other serious medical conditions when children present with almost similar symptoms and signs. In this article we will look at a very common clinical presentation both in GP practice and in the acute paediatric service. Progressive disclosure of information is given in this case and so you are encouraged to select your answers as you go and not at the end of the case history.

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Dr Nandhakumar Nagarajan (Corresponding author)

Consultant Paediatrician, KK Hospital
Adj Asst Prof of Paediatrics
YLL and Duke-NUS Medical Schools
100 Bukit Timah Road
Singapore 229899

Dr S Subramania Krishnamoorthy

Consultant Paediatrician, KK Hospital
Adj Asst Prof of Paediatrics
YLL and Duke-NUS Medical Schools
100 Bukit Timah Road
Singapore 229899


1.  Feverish illness in children: Assessment and initial management in children younger than 5 years; NICE Guidelines (CG160) 2013

2.  Incidence of Rash After Amoxicillin Treatment in Children With Infectious Mononucleosis, ChovelSella, et al. Pediatrics 2013; 131:5 e1424-e1427

3.  Epstein-Barr virus infectious mononucleosis in children, II. Heterophil antibody and viral-specific responses. Sumaya, CV.Ench,Y. Pediatrics. 75(6):1011-9, 1985 Jun


Conflict Of Interest

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Patient Consent statement

All pictures and investigations shown in this article are shown with the patients’ consent. We require Authors to maintain patients’ anonymity and to obtain consent to report investigations and pictures involving human subjects when anonymity may be compromised. The Journal follows the Guidelines of the Uniform Requirements for Manuscripts ( The Journal requires in its Guidelines for Authors a statement from Authors that “the subject gave informed consent”.

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About the Clinical Cases Database

T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

The database is fully searchable, or can be browsed by medical specialty. Abstracts can be read free of charge, however a subscription is required in order to read the complete cases.