Fever in Children

Question 1

In a febrile child with no discernible focus of infection, what might a septic screen involve?

Answer 1

• FBE
• CRP
• MSU
• Blood culture
• CXR
• LP
• (Procalcitonin - bacterial infection)

Question 2

In children with UTI, who should receive US imaging?

Answer 2

• Younger than 2
• Recurrent febrile UTIs
• FHx renal disease
• Inappropriate response to antibiotic therapy
• Progression to voiding cystourethrogram if abnormalities found or multiple UTIs

Question 3

If a child less than 1 month old presents with a fever, what might be your investigation/management?

Answer 3

• Screening tools are poorly sensitive in this age group, so admission for septic work-up if the safest course
• Investigation
  
  • Exclude serious causes
  • FBE, UEC, blood cultures, urine MCS, CSF culture and microscopy
  • CXR with any pulmonary signs, stool MCS with GI signs
• Management
  
  • Admit
  • Empiric antibiotics (ampicillin and cefotaxime)

Question 4

What is a general septic screen for a febrile infant?

Answer 4

• FBE, UEC, blood cultures, urine MCS, CSF culture and microscopy
  
  • CXR with any pulmonary signs, stool MCS with GI signs

Question 5

What are the features of orbital cellulitis? What is the management?

Answer 5

• Features - fever, lid oedema, conjunctival injection, chemosis, proptosis, pain on eye movement, visual acuity decreased +/- diplopia
  
  • Associated with skin lesions, sinusitis, dental abscess
• Management
  
  • Admit, IVAB, blood cultures, CT orbit +/- surgical drainage

Question 6

What are the features of septic arthritis in a child? What investigations are appropriate?

Answer 6

• Features
  
  • Hot, red, swollen, tender joint. Reduced ROM. In young children, may just be associated with irritability
  • Commonly hip joint is the first affected in children
  • Associated with swinging pyrexia
• Investigations
  
  • FBE, blood cultures, ESR/CRP, aspiration of joint fluid, ?ASOT

Question 7

What is the appropriate management for a child presenting with septic arthritis?

Answer 7

• Admit
  
  • IVAB (flucloxacillin) to be modified with joint aspirate culture results. Several weeks
  • Surgical drainage if aspiration required > 3 times per day or if no response to aspiration and IVAB

Question 8

When does the incidence of acute otitis media peak? What are the risk factors?

Answer 8

• 6-15 months
• Youth, FHx, prematurity, orofacial abnormalities, immunodeficiency, Down’s syndrome

Question 9

What are some features of acute otitis media on presentation?

Answer 9

• Hx: otalgia, otorrhoea, hearing loss, irritability, fever, URT symptoms, poor sleeping, anorexia, N/V, diarrhoea
• Ex: febrile, middle ear effusion +/- signs of inflammation on otoscopy

Question 10

What should be the managment for acute otitis media?

Answer 10

• Exclude other sources of fever if present (consider septic workup/observation)
  
  • Most cases resolve in 24 hours
  • Mild: analgesia, withhold antibiotics if >12/12
  • Unwell OR prolonged OR <2, bilateral OR, otorrhoea OR recurrent
    
    • Analgesia, antibiotics (amoxicillin)
• Follow-up
  
  • For success of antibiotics (days)
  • For resolution of effusion (months or earlier if hearing loss present)
• Recurrent infection
  
  • Limit exposure to URTIs (e.g. daycare), cigarette smoke
  • Consider grommets especially if hearing developing

Question 11

What are flags that a child with acute otitis media should be given antibiotics?

Answer 11

Unwell OR prolonged OR <2, bilateral OR, otorrhoea OR recurrent OR ATSI

Question 12

How long can an effusion persist in children post-acute otitis media?

Answer 12

Up to 4 months in 10%

Question 13

What is the main concern with otitis media with effusion? What’s the appropriate management?

Answer 13

• Hearing loss
• Investigations
  
  • Confirm hearing loss - audiogram/tympanogram
• Management
  
  • Supportive
  • Referral for tympanostomy surgery at 3/12 if not resolved AND significant symptoms

Question 14

Which groups of people should have antibiotics for tonsillitis? Which should not?

Answer 14

• Should have (high GAS risk): ATSI, PHx rheumatic heart disease
• Should not: <4 (GAS rare here)

Question 15

What are the indications for a tonsillectomy in the setting of recurrent tonsillitis?

Answer 15

• > 7 in one year OR
• > 5 in each of two preceding years OR
• > 3 in each of three preceding years