Feverish Child, Kawasaki

Question 1

How do you measure fever in child?

Answer 1

<4 weeks - thermometer in axilla

>4 weeks - electronic or chemical dot thermometer in axilla or tympanic membrane

Question 2

Feverish children < 3 months info:

Answer 2

• Usually due to bacteria infection as they get immunity from mother for viral infections - but as If levels decrease they become more susceptible.
• Usually URTI or otitis media.

Question 3

What is in a septic screen?

Answer 3

1) FBC + Blood culture
2) Acute phase reactant (CRP)
3) Rapid antigen screening
4) Urine sample
5) Lumbar puncture
6) Meningococcal and pneumococcal PCR in blood and CSF
7) Viral PCR in CSF
8) Consider X-ray

Question 4

What are the red flags for a feverish child?

Answer 4

1) Fever (>38 in <3months, >39 in 3-6months)
2) Colour - pale, blue, mottled
3) ALOC, stiff neck, bulging fontanelle, status epilepticus, focal neuro signs
4) Significant respiratory distress
5) Bile stained vomitting
6) Severe dehydration/shock

QUESTION - RASH? FOCUS FOR INFECTION O/E?

Question 5

Management of feverish child?

Answer 5

Mild: Inform parents of features for urgent referral

Severe:

1) Hospital admissions + septic screen
2) DO NOT UNDRESS CHILD
3) IV Antibiotics - Cephalosporins: Cefotaxime in septicaemia and meningitis (1-3m), Ampicillin in Listeria (1-3m), Ceftriaxone (>3m)
4) Antiviral - Aciclovir (HSV)
5) Antipyretics

Question 6

What is Kawasaki disease?

Answer 6

• Assess for Kawasaki if PROLONGED fever
• Systemic vasculitis, can cause aneurysms of coronary arteries (complication)
• 6 months - 4 years (peak end of 1st year)
• Common in japanese
• Polymorphism in ITPKC gene in chromosome 19
• Atypical/incomplete cases can occur in infants

Question 7

Presentation of Kawasaki disease?

Answer 7

1) Fever > 5 days + (4 of following Sx)
2) Non-purulent conjunctivitis
3) Red mucuous membranes (lips + tongue)
4) Rash
5) Red and oedematous palms and soles/ peeling fingers and toes
6) Cervical lymphadenopathy

Question 8

Investigations for Kawasaki?

Answer 8

1) High inflammatory markers (ESR, CRP, WBC)
2) Platelet count increases in second week of illness
3) Echo to see aneurysms - CV signs include gallop rhythm, myocarditis and pericarditis (after 2nd week)

Question 9

Management for Kawasaki?

Answer 9

1) IV Ig (within 10 days) + aspirin for thrombosis (high to low dose)
2) Antiplatelet if platelet count is high
3) Warfarin in kids with giant coronary artery aneurysms
4) 2nd line: If fever recurs after treatment give 2nd round of IV Ig, and infliximab, steroid, ciclosporin.