Child with a fever Flashcards
presentation of bacterial meningitis symptoms in <3 months
presentation of bacterial meningitis symptoms in 3months - 3years
presentation of meningitis symptoms in >3 years
microscopy and culture of CSF should be performed in all cases except
coma or decerebrate/decorticate posturing
absent or non purposeful responses to pain
focal neurological signs or seizures
abnormal pupil size or reactions
irregular breathing
papilloedema
cardiovascular instability, bradycardia, hypertension
treatment of bacterial meningitis
antibiotics and supportive care
- 3rd gen cephalosporin
- vancomycin if pneumococcal disease is likely
- penicillin/amoxicillin (<1m or immunosuppressed)
corticosteroids - give early if at all
cautious use of IV fluids
observation and treatment of complications - convulsions, haemodynamic compromise, cerebral oedema
signs of bactrial meningitis <3 months
signs of bacterial meningitis 3months - 3 years
signs of bacterial meningitis >3 years
pathogens causing bacterial meningitis <3 months
pathogens causing bacteral meningitis 3months - 3 years
pathogens causing bacterial meningitis >3 years
complications of bacterial meningitis
death 2-5%
intellectual disability, spasticity, seizures, hydrocephalus, deafness 10-15%
learning and behavioural disorder 25-45%
important investigations for pneumonia
plasma glucose
blood cultures
CXR
NP swabs/aspirate for respiratory virus
others that may be useful: sodium, creatinine, bicarbonate, WCC, neutrophils, CRP and/or procalcitonin
bacteria causing lower resp tract infection
viruses causing lower resp tract infection
other agents causing lower resp tract infection
broncholitis
most common viral LRTI in infants - a clinical diagnosis
pathophysiology is characterised by airway oedema, mucous production
usually secondary to RSV and hMPV
self resolving after 7-10 days
preterm and babies with underlying lung disease at greatest risk
broncholitis severrity
pneumonia presents with
cough and tachypnoea
can be due to viral or bacterial infection, viral is most common
clinical features and diagnostic tests are unreliable at distinguishing viral from bacterial
amoxycillin is appropriate treatment
bacterial pneumonia is most frequently due to
S. pneumoniae in young children
M. pneumoniae in older children
empyema
defined as the presence of pus in the pleural space (compared with parapneumonic effusion)
drainage is both diagnostic and therapeutic
suggestive features of empyema
pneumonia wth pleural effusion
failure of pneumonia to improve within 48 hours with Rx
US or CT may be helpful to identify effusion
empyema is most frequently due to
S. pneumoniae (or staphylococcus aureus)
kawasaki’s disease
fever and 4 of 5 clinical features:
- bilateral non-purulent conjunctivitis
- oral mucosa changes: erythema, pharyngitis, strawberry tongue, dry cracked lips
- cervical lymphadenopathy (unilateral > bilateral)
- changes in extremitis: swelling of hands/feet, erythema of palms/soles, desquamation
- a generalised variable rash
incomplete presentation of kawasaki disease
15-20% of children have an incomplete presentation - this is more common at the extremes of age
community acquired sepsis pathogens
hospital acquired sepsis pathogens
other clinical features that may present with kawasaki’s disease
inflammation and crusting of BCG site
sterile pyuria
aseptic meningitis
hydrops of the gall bladder
kawasakis disease prognosis
without treatment, fever lasts median of 11 days (may be weeks)
what investigations are needed for kawasakis
WCC and platelet count
CRP and ESR
sodium, creatinine, albumin
echcardiography is required as complications include coronary aneurysms
what is kawasakis disease
uncommon but important non-infectious condition in young children
most common between ages 1-4
more common in children of asain descent
aneurysms develop in 20% if not treated
treatment for kawasakis disease
anti-inflammatory therapy: IV immunoglobulin +/- low-dose aspirin
10-20% will require a second dose
follow up: echocardiographic follow up
- low dose aspirin until echocardiogram normal
simple febrile convulsion
temp >38° C
no evidence of CNS infection
no evidence of metabolic derangement
no history of afebrile seizures or neurological problem
