Case 10 Flashcards
What does an elevated leukocyte count with a left shift suggest?
Bacterial infection!
What is on the differential diagnosis for UTI?
Otitis media, Roseola, Bacterial meningitis, Viral meningitis, Urinary tract infection, Pneumonia.
What are key findings from testing for a UTI?
Elevated leukocyte count, leukocytes/nitrate in urine.
What is the definition of a fever?
Greater than 100.4 deg F (38.0 deg C)
What is the definition of bacteremia?
Presence of viable bacteria circulating in blood.
What is occult bacteremia?
Bacteremia in a child with high fever.
What is sepsis?
Severe systemic illness caused by overwhelming infection of the blood stream by toxin producing bacteria. A diagnosis of sepsis typically requires a positive blood culture.
What is fever without a source?
Fever with no apparent focus of infection after careful history and physical examination.
What is fever of unknown origin?
Temperature of greater than 38.3 deg C (101 deg F) for at least 2 weeks duration with failure to reach a diagnosis after one week of evaluation.
What are meningeal signs?
Neck stiffness (“nuchal rigidity”), Kerning’s sign, Brudzinski’s sign.
What is nuchal rigidity?
Involuntary resistance to neck flexion. Clinician flexes patient’s neck forward. In severe cases, increased extensor tone of neck and spine leads to hyperextension of entire spine or “opisthotonus”.
What is Kerning’s sign?
Flex patient’s hips and extend knees, and see if patient resists knee extension from this position. Kerning’s sign is positive when patient resits extension.
What is Brudzinski’s sign?
Flex supine patient’s neck to see if patient flexes hip and knee. Brudzinski’s sign is positive if patient retracts legs toward the chest.
How do the majority of infants younger than 12 mo of age present with bacterial meningitis?
They will not have a positive Kerning’s or Brudzinski’s sign, but can present with a variety of findings including fever, hypothermia, lethargy, respiratory distress, poor feeding, vomiting, diarrhea, seizures, restlessness, irritability, and/or bulging fontanelles. However, if a febrile infant demonstrates a positive Kerning’s or Brudzinski’s sign, you must assume that he or she may have meningitis and perform a lumbar puncture.
What are the most likely differential diagnosis for a UTI?
Meningitis, Pneumonia, Occult bacteremia, Roseola
What are less likely differential diagnosis for a UTI?
Primary herpes simplex virus (HSV) gingivostomatitis, Otitis media, Vaccine symptoms, Viral upper respiratory tract infections (URI).
UTI:
Consider in patients with unexplained fever with a non-focal history and physical examination. Consider degrees of toxicity, dehydration, and ability to retain oral intake. Fussiness and lack of appetite are common associated symptoms.