Fever Flashcards
Fever is especially common in _______ Most is caused by ____________ serious bacterial infections are more common in____________ highest risk age group is __________
under 2s
mild viral infections
under 2s as immune system is not mature enough
under 3 months
3 things that make fever more worrying?
- Fever that is more worrying = fever persisting fore more than five days, not feedy or drowsy
Why is it important to test for peripheral shutdown?
gives you an idea on whether this is a severe infection/ sepsis
should measure cap refill and feel temperature of the hands and feet
BP is not as helpful as this does not drop in children until very late
Fevers over what are more worrying?
- More worried about fevers over 39.5 C
- Except in children up to 3 months where fevers over 38C should be considered significant
should note the higher the temperature the more likely it is a serious cause but also this is all relative because some children are more prone to high temperatures
Describe the role of antipyretics when assessing fever?
- Fever itself can raise the HR and RR so giving an antipyretic allows you to remove fever’s influence on HR and RR and see if it is still abnormal
- Temperature dropping in response to an antipyretic is not a sign that infection is less serious, most fevers will drop
- When giving an antipyretic you are looking for an up and down pattern – does the child perk up and is their RR and HR more normal
- If RR and HR still abnormal and child is still drowsy or irritable when temperature is down this is much more worrying
- How has child behaved when temperature brought down it anti-pyretic? An up and down pattern is reassuring. If give these medications they usually perk up
- Children who are persistently drowsy or irritable even when temperature down is much more worrying
What is kawasaki disease?
- This is an idiopathic self-limiting vasculitis that most often affects under 2s
- The vasculitis affects small and medium sized arteries in multiple organs and tissues
- Heart involvement is the most worrying as this can cause complications later on in life, can get myocarditis, coronary artery aneurysms, pericarditis and valvular disease
Who tends to get Kawasaki disease?
- Cause unknown, potentially a reaction to a virus or autoimmune process
- More common in children of Asian origin
Presentation of kawasaki disease?
- CRASH and BURN
- Conjunctivitis, rash (maculopapular then rash fades and get peeling of fingers and toes), adenopathy (particularly cervical), strawberry tongue, hand/ feet problems and burn = fever
Investigations for kawasaki disease?
- No diagnostic test
- Urinalysis may show sterile pyuria +- proteinuria
- FBC in acute phase may show leukocytosis and neutrophilia
- Raised ESR and CRP
- Thrombocythemia may develop through weeks 2-3
- LFTs may show elevated transaminases and bilirubin
- Abdo ultrasound can show gallbladder distension
- ECG can shown conduction abnormalities
- Echo is essential as can reveal if there are cardiac complications e.g. aneurysms of coronary arteries
Management of kawasaki disease?
- high dose Aspirin and intravenous immunoglobulin
- Early treatment with IvIg reduces risk of cardiac complications
- Generally, aspirin is not used in febrile children due to risk of Reye’s syndrome (rare syndrome that causes increased ICP and damage to liver) but in Kawasaki disease it is decided risk is worth benefit as it has antiplatelet and antipyretic effect
Most UTIs in children are caused by?
E. coli
In children under 3 months UTIs are more common in _____ over 3 months more common in ______
under 3 months more common in boys, after this more common in girls
Presentation of UTIs?
- Often doesn’t present with typical UTI symptoms
- If history and exam is not showing a focus for an infection you should start considering a UTI
- In babies: vomiting, fever, lethargy, poor feeding, failure to thrive
- In older children may complain of increased frequency and dysuria, may also have changes in continence, abdo or loin tenderness
- 3-minute examination
Investigations for UTIs?
- All infants with unexplained temperature of 38 or more should have their urine sent for microscopy and culture
- Clean catch urine is recommended – can be difficult in those in nappies but essentially clean skin and remove nappy and wait and try and catch urine
- When not possible may need catheter samples or suprapubic aspiration
- Should also do a urine dipstick
- Depending on child age, symptoms and if recurrent UTIs may want to do additional investigations to see if underlying cause e.g. Ultrasound
Management for UTIs?
- Antibiotics – usually trimethoprim or nitrofurantoin
