Child Health- Fever

Question 1

define a fever

Answer 1

more than 38deg celsius
due to physiological changes

Question 2

define hyperthermia

Answer 2

increase in body temperature due to decrease in ability to regulate heat

Question 3

which interleukins are involved in the febrile response

Answer 3

IL1 and IL6

Question 4

what do IL1 and IL6 do?

Answer 4

cause the release of prostaglandin E2

Question 5

how does paracetamol reduce fever

Answer 5

inhibits COX enzymes, reducing the conversion of IL1 and IL6 to Prostaglandin e2

Question 6

how does fever work as a defence mechanism?

Answer 6

Increases lymphocyte mobility and bacterial acidity
increases interferon gamma, which activates macrophages and inhibits viral replication
disrupts replication of pathogens and survival proteins

Question 7

what are the primary causes of fever

Answer 7

infection
VURTI
Gastro
UTI, otitis media, bacterial pneumonia
CNS infection! Sepsis

Question 8

what does the mnemonic TORCH stand for?

Answer 8

toxoplasmosis
other (syphilis, heb B)
rubella
cytomegalovirus
herpes simplex virus

Question 8

which age groups are the TORCH conditions more common in?

Answer 8

1 month old

Question 8

define a fever with out source

Answer 8

no clear source of acute fever
self limiting

Question 9

define fever of unknown origin

Answer 9

38deg most days for more than 3weeks
no clear cause after at least one week of investigations
most likely infection, inflammatory disease or malignancy

Question 10

what are non specific symptoms of fever

Answer 10

irritability
poor appetite
lethargy
rash (viral exanthema)
-rash can also indicate meningitis or Kawasaki disease

Question 11

upper respiratory tract infection symptoms

Answer 11

cough, rhinorrea, congestion

Question 12

GI infection symptoms

Answer 12

abdominal pain (not specific can also be linked to pneumonia)
d+/V+

Question 13

UTI symptoms

Answer 13

dysuria, increased frequency

Question 14

otitis media symptoms

Answer 14

ear pain, discharge, poor sleep

Question 15

sinusitis symptoms

Answer 15

headache, congestion

Question 16

CNS symptoms

Answer 16

headache, neck stiffness, photophobia, vomiting, non blanching rash

Question 17

what indicates a chronic cause of infection

Answer 17

repeated infections
poor weight gain or growth
cyclical pattern indicates inflammatory or rheumatoid cause

Question 18

what is the name of the nice guidelines for children with fever

Answer 18

the unwell child- traffic light system, for under 5 year olds

Question 19

does fever severity indicate the severity of the underlying illness?

Answer 19

NO!

Question 20

what would determine the diagnosis?

Answer 20

history
- exposure (family, nursery, foreign travel)
- duration and severity of the fever (bacterial = short lived and high severity, viral = long lasting and low grade)
-vaccinations
-birth history (premature?)

Question 21

what further investigations can be done for a child under 36 months presenting with fever?

Answer 21

children under 36 months may not have all signs at a physical exam
- WBC, CRP, Culture, Serology (HIV, CMV, EBV)
- LP/CSF
-urinalysis
-imaging
-blood smear

Question 22

treatment for fever in children

Answer 22

fever is NOT a disease
- treat underlying cause
–specific ABX (empirical IV if severe)
– antivirals (acyclovir, oseltamivir(Influenza))

-supportive
–encourage hydration, if severely dehydrated IV fluid
–antipyrexials (paracetamol and ibuprofen NOT aspirin)

Question 23

why is aspirin not used as an antipyrexial in children?

Answer 23

link to Reye syndrome
- encephalopathy
- features hepatic dysfunction due to mitochondrial injury