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During the examination, concentrate on figuring out any of the next: п‚· Toxic appearance, which suggests potential signs of lethargy, poor perfusion, hypoventilation or hyperventilation, or cyanosis (ie, shock) п‚· A focus of infection that is the apparent cause of the fever п‚· Minor foci (eg, otitis media, pharyngitis, sinusitis, pores and skin or gentle tissue infection) п‚· Identifiable viral an infection (eg, bronchiolitis, croup, gingivostomatitis, viral gastroenteritis, varicella, hand-foot-and-mouth disease) п‚· Petechial or purpuric rashes, typically associated with bacteremia п‚· Purpura, which is related extra often with meningococcemia than is the presence of petechiae alone For all sufferers aged 2-36 months, management decisions are based mostly on the diploma of toxicity and the identification of great bacterial an infection. 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