Fever in children Flashcards
Where should temp be measured in children?
Neonates - axilla
> 4 weeks - tympanic
What are causes of acute fever in children?
Brain - meningitis, encephalitis
Ears - acute otitis media
Throat - tonsilitis, infectious mononucleosis, epiglottitis, croup
Respiratory tract - URTI, chest infection, influenza, scarlet fever
Heart - endocarditis
Gastro - gastroenteritis
Urinary - UTI
Ortho/rheum - septic arthritis, osteomyelitis
Others: foreign infections (malaria), Kawasakis
What are the typical features of a febrile convulsion?
Child aged 6 months to five years with a high temp (e.g. roseala infantum HHV-6).
Generalised tonic-clonic seizure involving all limbs and usually lasting less than 5 mins and complete recovery within 1 hour.
How is a febrile seizure managed?
ABCDE
Cushion head, don’t restrain
Start timing
Buccal midazolam or rectal diazepam if not stopped within 5 mins
What is the risk of epilepsy following febrile convulsion?
Risk factors for epilepsy after febrile convulsion
- abnormal development
- complex seizure (lasting more than 15 mins, more than 1 in 24 hours and only one half of body affected)
- first degree relative with seizures
None of the above -> no increased risk of epilepsy (background is 1.8%)
1 risk factor -> 2.5%
2/3 risk factors -> 5-10%
What are the clinical features of meningitis and meningococcal septicaemia?
Meningitis
Symptoms:
fever, headache, neck stiffness, photophobia, fits, drowsiness/confusion
Signs:
Kernigs
Brudzinskis
Signs of raised ICP: papilloedema, dilated unequal pupils, full/bulging fontanelle, focal neurology
Meningococcoal septicaemia
- non-blanching rapidly spreading purpuric or petechial RASH
- shock
- fever, rigors
What are the community management for suspected meningococcal septicaemia?
ABCDE
call 999
IM/IV benzylpenicillin
What are the community management of suspected meningitis with NO RASH?
ABCDE
call 999
Withold abx until delay to hospital likely and then give parenteral cefotaxime/ceftriaxone
What is in hospital management of meningococcal septicaemia and meningitis?
ABCDE
Airway
Breathing - oxygen
Cicrulation
- cannulate
- take bloods (incl Mg P04 glucose, crossmatch and coag), cultures and PCR for Neiserria antigen
- fluid challenge (20ml/kg over 5-10 mins) over 5-10 seconds
- IV abx (under 3 months, IV cefotaxime + IV amoxicillin/ampicillin; 3 months of over, IV ceftriaxone)
D
- correct any hypoglycaemia
For bacterial meningitis may need to give parenteral dexamethasone
Arrange LP providing no contraindications
What are contraindications to LP?
Coagulation abnormalities
Infection at site
Shock
Resp distress
Signs of raised ICP
- focal neuro signs
- GCS <9
- unequal pupils
- papilloedema
What CSF results would you expect in a normal patient?
Appearance of CSF - colourless
White cells - 0-5/mm3
Protein - 0.15-0.4
Glucose - >2/3 serum or 2.2-4.7
What CSF results would you expect in a patient with bacterial meningitis?
Appearance of CSF - turbid
White cells - polymorphs
Protein - high
Glucose - low
What CSF results would you expect in a patient with tuberculous meningitis?
Appearance of CSF - variable
White cells - mainly lymphocytes with some polymorphs
Protein - very high
Glucose - very low
What CSF results would you expect in a patient with viral meningitis?
Appearance of CSF - clear
White cells - mainly lymphocytes
Protein - normal
Glucose - normal
What are the causes of meningitis?
Infection
- bacterial, viral, others
Non-infective
- drugs, autoimmune, cancer
