fever Flashcards
meningitis causes in neonatal - 3 months?
GBS
e coli
listeria
meningitis causes 1 month- 6 yrs
neisseria meningitidis
strep pneumoniae
h influenzae
meningitis causes >6 yrs
neisseria meningitidis
strep pneumo
Meningitis signs
positive Kernig’s sign (hip flexed knee bent -> pain felt on attempting to straighten leg)
headache
photophobia
neck stiffness
younger- non specific symptoms like crying, irritability, lethargy, bulging fontanelle (late sign)
most common viral encephalitis
HSV type I
meningitis complications
long term neuro impairment hearing loss (all should have audiological assessment promptly) local vasculitis local cerebral infarction hydrocephalus cerebral abscess
Meningitis Ix
FBC, WCC, CRP Blood glucose Blood gas (for acidosis) coagulation screen U+Es LFTs Full septic screen. LP for CSF
Encephalitis symptoms
fever
altered consciousness
seizures
Encephalitis Mx
IV aciclovir
Encephalitis
LP (PCR of CSF)
EEG and MRI/CT head - may show focal changes
encephalitis complications/ prognosis
mortality rate is high 70%
most survivors have severe neurological sequelae
impetigo
‘cornflakes’ stuck to skin
usually on face
can be vesicular/ pustular/ bullous
most common cause of impetigo
staph aureus
in hot climates- strep pyogenes
impetigo mx
oral fluclox if sever
topical abx sometimes effective in mild cases
avoid school until lesions dry
eradicate nasal carriage w nasal cream containing mupirocin
impetigo ix
skin swab for MCS
Impetigo complicatoins
post strep glomerulonephritis
staphylococcal scalded skin syndrome
Staphylococcal scalded skin syndrome presentation
exotoxin-mediated epidermolysis secondary to staph aureus infection
Fever + malaise scalded appearance (widespread tender erythema and flaccid superficial blisters) Nikolsky sign (epidermis separates on gentle pressure)
Staphylococcal scalded skin syndrome Mx
IV Anti staph Abx
analgesia
monitoring of fluid balance
Emollient ointments
ADMIT
in chickpox hx always check
pregnant/ immunocompromised contacts
Chickenpox rash?
vesicular.
Chicken pox diagnosis
clinical based on characteristic rash, distribution and progression
Serology (VZV IgM)
Chickenpox mx
school exclusion for 5 days after start of rash
symptomatic tx of fever and itching
calamine lotion
gloves to prevent scratching
if immunocomp or severe,
iV aciclovir
If contacted chickenpox-> VZIG
chicken pox complications
bacterial superinfection with staph, group a strep -> may lead to toxic shock syndrome, necrotizing fasciitis
encephalitis
purpura fulminans -> can lead large areas of skin necrosis
Severe progressive disseminated disease in immunocomp patients -> haemorrhagic, pneumonitis, DIC
roseola infantum which virus
HHV6
exanthem subitum which virus?
HHV6
Primary HHV6 infection complication
febrile convulsions
also
aseptic meningitis
encephalitis
hepatitis
Erythema infectiosum which virus?
Parvovirus B19
Slapped cheek syndrome
Parvovirus B19
Parvovirus B19 infects?
erythroblastoid red cell precursors in the BM
Parvovirus B19 complication?
Aplastic crisis
in children with SCA/ thalassaemia and in immunodeficient (malignancy) unable to produce antibody response to infection
Erythema infectiosum presentation
fever
malaise
headache
myalgia
slapped cheek rash
progressing to maculopapular lace-like rash on trunk and limbs
Maternal Parvovirus B19 infection may lead to?
fetal hydrops and death due to severe anaemia
Erythema infectiosum Ix
Must have FBC to exclude pancytopenia
Hand foot mouth disease which virus?
Coxsackie A6 Virus
Hand foot mouth symptoms?
fever
sore throat
oral ulcers
painful vesicular lesions on hands, feet, mouth and tongue
Kopliks spots
Measles
measles
fever cough, coryza, conjunctivitis maculopapular rash spreads behind ears downwards onto trunk generalised lymphadenopathy anorexia diarrhoea
measles ix
clinical diagnosis (kopliks spots)
blood film- leucopenia and lymphopenia
LFTs- raised transaminases
Serology- Measles IgM, measles RNA on PCR
Measles MX
public health notification!!
supportive - hydration and pain relief
immunocomp - give ribavarin
Vit A supplement may be given
Measles Complications
Encephalitis Pneumonia Acute otitis media Subacute sclerosing panencephalitis Myocarditis, corneal ulceration, hepatitis
Swollen parotid glands
Mumps
Mumps
myalgia anorexia headache low grade fever chills ear pain due to parotitis - or pain on eating/ drinking trismus (spasm of muscles of chewing)
Mumps Ix
examination of parotid duct - redness and swelling
Salivary PCR or Serology (mumps IgM)
FBC, WCC: increased amylase
Mumps complications
viral meningitis encephalitis orchitis + epididymitis- may lead to infertility but rare pancreatitis myocarditis arthritis
Rubella presentation
maculopap rash starting on face then spreading to whole body
*suboccipital and post-auricular lymphadenopathy
suboccipital and post-auricular lymphadenopathy
rubella
rubella hx check…?
pregnant women!
Kawasakis
CRASH and burn
Kawasakis Ix
Cardiac echo - visualize any aneurysms (coronary arteries most affected)
FBC, WCC, Pl, CRP, ESR
(high neutrophils, Pl, CRP/ ESR)
Kawasakis complications
myocarditis pericarditis aneurysms MI sudden death
Kawasakis Mx
IVIG one dose
High dose aspirin to reduce risk of aneurysms/ thrombosis
HIV in children Mx
Start ART
Prophylaxis for PCP and co-trimoxazole
Immunisations (avoid live vaccines)
MDT
Malaria
cyclical fever jaundice anaemia thrombocytopenia diarrhoea vomiting Cerebral malaria**
Typhoid fever presentation
worsening fever headaches, cough, abdo pain GI symptoms rose spots on trunk splenomegaly
Typhoid fever diagnosis
Stool culture*, blood culture
Serology
Typhoid fever tx
ceftriaxone
or azithromycin
Scarlet fever what organism?
Group A strep (usually strep pyogenes)
Scarlet fever presentation
strawberry tongue
rough sandpaper like rash that starts on torso
fever
tonsillitis
malaise
peeling of skin on palms/ soles
scarlet fever ix
throat swab
scarlet fever mx
abx (oral Penicillin for 10d)
can return to school 24 h after starting abx
scarlet fever complications
otitis media
rheumatic fever
acute glomerulonephritis
measuring temp in infants <4 wks
electronic thermometer in axilla
measuring temp in children 4 wks - 5yrs
electronic thermometer in axilla
infra red tympanic thermometer
Any child w fever ->
Use traffic light system
Fever Ix
Obs: temp, HR, RR, CRT
red light - high risk in fever <5
pale/ ashen/ blue skin no response to social cues, looks ill to healthcare professional weak, high pitched or continuous cry grunting RR>60 reduced skin turgor ***Age <3 months temp >38 non blanching rash bulging fontanelle status epilepticus focal neuro signs focal seizures
Feverish illness mx
Immediate IV fluid bolus 20ml/kg 0.9% Nacl
immediate parenteral abx if shocked, unrousable, signs of meningococcal disease
Perform septic screen
1st line abx in infants <3 months
third gen cephalosporin cefotaxime + abx against listeria (amoxicillin)
if meningitis suspected in neonate, Mx?
IV amoxicillin and cefotaxime
if +ve GBS + septic neonate, Mx?
IV Benzylpenicillin
OR
Gentamicin
If listeria in a septic neonate, Mx?
Amoxicillin + Gentamicin
Brudzinski’s sign (forced flexion of neck -> reflex flexion of the hip)
Meningitis
Non blanching rash
Meningococcal septicaemia
Fever + vomiting in infant DDx
Meningitis UTI Pneumonia Sepsis could be anything!
non blanching rash 1st line mx in GP
IM/ IV BenPen immediately
Send directly to hospital
non blanching rash / petechial rash 1st line mx in hospital
IV ceftriaxone
Meningococcal septicaemia Ix
FBC, WCC, CRP, coagulation screen Blood culture Whole blood PCR for N meningitides Blood Glucose Venous blood gas CT scan to detect alternative intracranial pathology if reduced/ fluctuating LOC, or focal neuro signs ***LP
Bacterial meningitis Mx (>3mths) in hosp
IV ceftriaxone
Suspected Bacterial Meningitis Mx (<3mths) in hosp
IV cefotaxime + amoxicillin
why not use ceftriaxone in <3 months?
biliary sludging -> may exacerbate hyperbilirubinaemia
if confirmed gram - bacterial meningitis in child <3 mths, mx?
IV cefotaxime for at least 21 days
Full Mx in bacterial meningitis
IV abx
dexamethasone
respiratory support - O2 15L rebreathing mask
IV fluids 0.9% saline with 5% dextrose
Monitor fluids and urine output
monitor electrolytes and glucose regularly
Correct any metabolic disturbances e.g. coagulopathy (FFP, cryoprecipitate)
Meningococcal septicaemia 1st link mx for shock
IV resuscitation fluid bolus of 20ml/kg 0.9% NaCl over 5-10 min
reassess and if persists, 2nd bolus
Following bacterial meningitis, what follow up is needed?
audiological assessment within 4 wks
off cochlear implants if severe deafness
discuss any morbidities w paediatrician at follow up
if recurrent- test for complement deficiency
recommended method for acquiring Urine sample
clean catch urine
under 3mths, UTI Ix?
Urine sample for urgent MCS
3 months - 3yrs. UTI ix?
Urine dip first and send urine for culture
3mths - 3yrs Leucocyte + Nitrites +?
UTI! start abx
3mths - 3yrs. Leucocyte - Nitrites +?
send for urine culture but start Abx in meantime!
3mths - 3yrs. Leucocyte + Nitrites -?
May not be UTI. send for urine culture.
don’t start abx unless good clinical evidence of UTI
3mths - 3yrs. Leucocytes - Nitrites -?
No UTI
Risk factors for UTI?
poor urine flow hx suggesting previous UTI recurrent fever of uncertain origin antenatally diagnosed renal abnormality FHx renal disease of VUR
> 3 months with upper UTI mx?
oral antibiotics for 7-10 days. (ceftriaxone or co-amoxiclav)
or IV ceftriaxone for 2-4 days then oral for total 10d
> 3 months with lower UTI mx?
trimethoprim, nitrofurantoin
oral abx for 3 days
<6 months with UTI further IX?
all should have renal USS.
if simple-> outpatient USS in 6 weeks.
if abnormal-> MCUG
if recurrent UTI/ atypical UTI further Ix?
Renal USS - to identify structural abnormalities
DMSA scan - to detect renal parenchymal defects
Assessed by paediatric specialist
advice to prevent UTI recurrence?
drink adequate math
ready access to clean toilets
should not delay voiding
address dysfunctional elimination syndromes and constipation
consider prophylactic abx in infants w recurrent UTI
If neonate in close contact with TB person? Mx?
Assess for active TB.
Start isoniazid (with pyridoxine)
refer to TB specialist
child w latent TB Mx?
involve TB specialist
3 months of Isoniazid (with B6) and rifampicin
OR
6 months of isoniazid (with B6) alone
offer testing for HIV, Hep B, Hep C before starting treatment for latent TB
child with active TB Mx?
TB specialist referral
2 months of RIPE
then 4 mths of Isoniazid (+B6) + Rifampicin
child w active TB of the CNS Mx?
RIPE for 2 months
then 10 months of Isoniazid (B6) + rifampicin
TB specialist referral
+ adjunctive dexamethasone and prednisolone gradually withdrawn over 4-8 wks
Symptoms of clinical dehydration
unwell/ deteriorating
altered responsiveness (lethargic, irritable)
decreased UO
Symptoms of clinical shock
decreased LOC
pale / mottled skin
cold extremities
Signs of clinical shock:
weak peripheral pulses prolonged cap refill hypotension tachycardia tachypnoea
Signs of clinical dehydration
sunken eyes dry mucous membranes tachycardia tachypnoea reduced skin turgor normal peripheral pulses normal cap refill normal BP
Red flags to identify children at risk of progression to shock
unwell/ deteriorating lethargic/ irritable sunken eyes tachycardia tachypnoea reduced skin turgor
if child is clinically dehydrated, mx?
rehydration with 1st line oral rehydration solution
50ml/kg of rehydration + maintenance vol over 4h period
Continue breastfeeding as well
Clinical dehydration Ix?
U+Es (Na, K, Urea, Cr)
blood glucose
Venous blood gas - acid base status
Full clinical assessment for symptoms and signs of dehydration
suspect HyperNa dehydration if jittery movements, increased muscle tone, hyperreflexia, convulsions, drowsiness or coma
jittery movements, increased muscle tone, hyperreflexia, convulsions, drowsiness or coma
what type of dehydration?
HyperNa dehydration
high fever lasting a few days followed by (and resolving at the time) maculopapular rash starting on the trunk. Febrile convulsions seen in 10-15%.
roseola infantum
exanthem subitum
complications: aseptic meningitis, hepatitis
best initial ix for SUFE
AP and frog leg Xray
tx for kawasakis
infusion of IG on the day of diagnosis.
high dose aspirin at anti-inflammatory doses followed by low-dose aspirin at anti-thrombotic doses.
what are risk factors for development of coronary artery aneurysms in Kawasaki’s?
prolonged fever >16 days, male sex, age < 1 yr, cardiomegaly, raised inflammatory markers and raised platelets.
strep pneumo meningitis?
IV ceftriaxone and IV dexamethasone
ix for TB in child?
tuberculin skin test (IGRA), sputum collection for MCS, FBC, CRP, U+Es, LFTs.
CXR.
Mx for TB in child?
RIPE + pyridoxine to reduce risk of isoniazid causing peripheral neuropathy.
intense itching in a child? + burrows, papules, vesicles and pustules.
scabies
thread-like, linear burrows, typically in the finger webs and wrists are pathognomonic but often v difficult to see.
Dx of scabies
definitive diagnosis involves removal of the mite from the burrow and examination under the microscope. - difficult
tx of scabies
permethrin.
tx all household contacts.
+ topical abx may be needed for secondary bacterial infections.
oral antihistamines and topical steroids (1% hydrocortisone) may be needed to help tx the itching.
all clothing/ bed linen needs to be laundered at high temps to remove eggs and mites.
can take 4-6 wks for itching to resolve.
if lesions still present and persistent itching-> consider reinfection and repeating treatment.
fever followed by rash?
roseola infantum
when to refer for developmental skills?
can’t smile by 10 wks.
doesn’t sit unsupported by 12months.
can’t walk by 18 months.
A 3 month old boy is suspected of having hypospadias. At which of the following locations is the urethral opening most frequently located in boys suffering from the condition?
on the distal ventral surface of the penis
non motor problems of cerebral palsy include?
learning difficulties (60%) epilepsy (30%) squints (30%) hearing impairment (20%)
what does a prolonged jaundice screen involve?
conjugated and unconjugated bilirubin: the most important test as a raised conjugated bilirubin could indicate biliary atresia which requires urgent surgical intervention. direct antiglobulin test (Coombs' test). TFTs, FBC and blood film, urine for MC&S and reducing sugars, U&Es and LFTs
what disorders exhibit genetic anticipation?
Huntingtons disease
and myotonic dystrophy
major risk factors of sudden infant death syndrome
putting baby prone, parental smoking, prematurity, bed sharing, hyperthermia or head covering
other risk factors of sudden infant death syndrome
male sex, multiple births, social classes IV and V, maternal drug use, increased incidences in winter
protective factors for Sudden infant death syndrome
breastfeeding, room sharing, use of pacifiers
