Febrile Child Flashcards
Focus for infection?
CNS: bright lights cause distress? irritable? moving normally? pain?
ENT: pulling at ears? URT infection? difficulty / pain on swallowing? nasal discharge?
Respiratory?
Urinary?
Abdominal?
Joints / bone - swelling / redness/ pain / reduced ROM
Assessment
Normal temperature - 36.5 - 37.5
Infants < 3 months with temp > 38 = greater likelihood of bacterial sepsis
In older children height of fever bears little relationship to bacterial / viral infection
Kawaski Disease
Fever for > 5 days plus at least 4 of: Cervical lymphadenopathy Bilateral conjunctival infection Red, cracked lips and strawberry tongue Pleomorphic rash Red palms and soles of feet
Febrile child + purpuric rash
IM benzylpenicillin
Give immediately and admit to hospital
IV Abx
Give immediately to seriously unwell children
< 3 months = Cefotaxime + amoxicillin / ampicillin (listeria cover)
> 3 months = Ceftriaxone
Meningitis: signs on examination
Fever Purpuric rash Bulging fontanelle Signs of shock Positive Brudzinski / Kernig signs
- Brudzinski - flexion of the neck with the child supine causes flexion of the knees and hips
- Kernig - child supine with hips and knees flexed, back pain on extension of the knee
Investigations
Bloods - FBC, CRP, U&Es, LFTs, coag screen, blood glucose, blood gas, blood cultures
Throat swabs, urine MC&S, stool MC&S
Rapid antigen test for meningitis organisms (blood / CSF / urine)
Samples for viral PCR (throat and conjunctival swabs, stool sample)
LP - Microscopy and gram stain, culture and sensitivity, protein, glucose, virology, PCR virology
Dexamethasone
Adjunct to abx, reduced incidence of neurological and audiological complications in bacterial meningitis
Indications - frankly purulent CSF, CSF > 1000, raised CSF WCC with protein > 1, bacteria on gram stain
LP Contraindications
Cardiorespiratory instability Neurological signs Raised ICP Coagulopathy Thrombocytopaenia
Complications
Acute - seizure, raised ICP, metabolic disturbance, coagulopathy, anaemia, coma / death
Long term complications - hearing impairment, psychological problems, epilepsy, learning / developmental difficulties, neurological impairment
Herpes Simplex Virus Encephalitis
Inflammation of the brain substance
Typically affects temporal lobes - aphasia
Other viral causes of encephalitis - enterovirus, influenza, HIV…
Features: fever, headache, psychiatric symptoms, seizures / altered consciousness, focal features
Meningitis vs HSV encephalitis
Can initially be difficult to differentiate - give IV abx and IV aciclovir
Investigations for HSV Encephalitis:
LP: increased lymphocytes and protein
PCR: detects HSV
CT: temporal and inferior lobe changes
When proven HSV enceph - stop abx, continue aciclovir for 3 weeks
CENTOR
Tonsillar exudate present
Anterior cervical lymphadenopathy / lymphadenitis
History of fever
Absence of cough
3+ suggests bacterial infection - phenoxymethylpenicillin / erythromycin
ITP
Thrombocytopaenia is platelet count < 150 - ITP most common cause in children
Bruising, petechiae, purpura, mucosal bleeding
Most present at 2-10 years (onset 1-2 weeks following a viral infection)
Cause - IgG autoantibodies cause destruction of platelets
Dx of ITP
Diagnosis of exclusion - must exclude leukaemia
Disease is acute, benign and self limiting - usually spontaneously resolves in 6-8 weeks. Most children managed at home.
