Fever and infectious diseases in children Flashcards
How do you work up fever in an infant < 21 days old?
- admit for fever
- CBC with diff
- blood cultures
- UA and Urine culture
- LP for CSF studies and culture
- CXR if resp sxs
- Stool studies if diarrhea present
What are the IV antibiotic regimens you could use in infant < 21 days with fever?
Which IV Abx should you avoid?
- Amp + gent
- Amp + cefotaxime
+/- acyclovir
AVOID rocephin if < 1 mo –> kernicterus risk
How do you work up infant 21-90 days old who have fever and are ill appearing?
- treat them the same as a < 21 day old if poor appearance, breathing, or circulation
What is the step by step approach for working up a 21-90 day old who has fever but appears up
UA for leukocytes
If negative get procalcitonin
if negative et CRP and CBC –> if CRP < 20 or ANC < 10K then there is low risk for invasive bacterial infection
What workup do you do for first simple febrile seizure in kids?
No workup
What is the most common serious bacterial infection in children?
UTI –> look for it when no other obvious sources
Antibiotic regimen to treat UTI in kids
Treat when > 50K CFU
- Abx: Cephalosporin or bactrim for 7-14 days
When a child has a UTI, when is imaging warranted and which study should you get?
Renal US - if first febrile UTI < 2 yo OR - recurrent UTIs (more than 1) Follow with voiding cystourethrogram (VCUG) if... - US reveals hydronephrosis/scarring OR - recurrent febrile UTIs (more than 1)
What do you do for the following scores on the Centor criteria for group A strep pharyngitis?
0-1
2-3
4-5
0-1 –> no testing or treatment
2-3 –> test with rapid antigen detection. Culture if negative in kids. Treat if positive
4-5 –> no testing, just treat
Treatment for strep pharyngitis
PCN/amoxicillin for 10 days
macrolide or clinda if PCN allergic
Prevents rheumatic fever but not glomerular nephritis
Should I test kids of all ages for Group A beta hemolytic strep?
No
IDSA 2012 guidelines indicate that GABHS infection is uncommon in children < 3 yo and recommend AGAINST testing them
Treatment for Epiglottitis
- Airway management
- Abx: Cephalosporin +/- clinda
- steroids and recemic epi are NOT used
Treatment of viral URIs
- Buckwheat honey ***
- Umcka coldcare
- Nasal saline irrigation
- zinc
- Vaporub –> don’t use < 2 yo –> airway inflammation
OTC cough/cold meds NOT recommended, particularly under age of 4
Management of lymphadenopathy in children
- watchful waiting up to 4 weeks (in absence of red flags)
- oral Abx can be considered if infalmmation evident
- If persistent or red flag sxs –> CBC/smear, ESR, CXR
- imaging: US if < 24 mo, CT if > 14 yo
Treatment of herpetic gingivostomatitis
oral acyclovir
Treatment of herpes labialis
oral/topical acyclovir
What causes herpangina and how do you treat it?
Ulcers in the back of the mouth caused by coxsackie virus
Treatment is symptomatic
Treatment of apthous ulcers (canker sores)
Symptomatic/topical steroids
How will croup be described on boards and how do you treat it?
- URI sx, “barky cough”, worse at night
- Dexamethasone IM or oral single dose for croup of ALL severity
- Nebulized racemic epi for mod to severe croup (stridors and retractions) –> then at least 4 hours observation
How will boards describe bronchiolitis and how do you treat it?
- URI, cough, wheezing, CXR normal. Fever and WBC inconsistent
- Supportive treatment –> O2, fluid, nep saline
- NO evidence for bronchodilators, steroids, abx
Treatment of pertussis in children
- inpt vs outpt?
- meds
- contacts?
- admission for most children < 6 months
- antibiotics decrease spread but don’t hasten recovery
- -> macrolides, bactrim
- close contacts should be given azithromycin
- Adults should get Tdap as single booster dose
How do you treat bacterial pneumonia in preschool age children up to 5 years
most common cause is strep pneumoniae and H flu
- Amoxicillin
- second choice is azithromycin or clarithromycin
How do you treat bacterial pneumonia in school age children (5-18 yo)
most common cause is mycoplasma pneumoniae and chlamydia pneumoniae
- treat with azithromycin
When should you obtain stool studies in children?
when symptoms last > 14 days or stools are bloody
A child presents with rash on cheeks that appeared after he had a fever. he no longer appears ill.
- what does he have and when can he return to school?
Fifth disease (erythema infectiosum) - parvovirus B19 The rash is immune-mediated and occurs after acute infection Children may return to school or day care with this rash
What will measles look like?
Conjunctivitis, cough, coryza, Koplik spots
rash that starts on face and spreads down
What will mumps look like
prodrome of malaise, myalgia, anorexia, fever, HA
Parotitis is most common manifestation
may cause orchitis
What will roseola infantum look like?
Caused by HHV-6 and HHV-7
usually age 6 mo to 4 years
- Day 1-4: abrupt onset of high fever, otherwise mild sxs
- day 4: rash begins as fever abates
- rash: pink almond shape blanchable macules begining on trunk and spreading peripherally
- fades in hours to days
What will Henoch Schonlein Purpura look like?
- do you need any labs?
- how do you treat?
- URI followed by triad of purpura, abdominal pain, and arthritis
- palpable purpura on buttocks and legs
- renal disease most serious complication (40-50% of pts) –> get UA
- treat with oral prednisone for 2 weeks
What will hand, foot, mouth disease look like?
prodrome of fever, sore throat, anorexia followed by rash
- small vesicles with erythematous base
- hands (nail borders), feet (heel margins), buttocks
Diagnostic criteria of kawaski disease
Fever > 5 days and 4/5 of the following
- bilateral conjunctival injection
- oropharyngeal erythema, strawberry tongue, fissuring and crusting of lips
- induration of hands and feet, erythema of palms and soles +/- desquamation at fingertips and toes
- erythematous rash
- enlarged lymph nodes
How do you treat kawasaki disease?
- IVIG
- high dose aspirin
- echo at onset and at 6-8 weeks
- if aneurysm then aspirin + warfarin
What is the compression to breath ratio in neonatal resuscitation?
3:1
