Infection: Fever Flashcards
What does most febrile children have?
A brief, self limiting viral infection e.g otitis media or tonsillitis - may be diagnosed clinically
When assessing a febrile child, what should be considered?
How the fever is identified How old is the child Are the risk factors for infection How ill is the child Is there a rash Is there a focus for infection
In hospital, how is a fever measured if less than 4 weeks old?
By an electronic thermometer in the axilla
How is a fever measured if child is 4 weeks to 5 years?
Electronic or chemical dot thermometer in axilla or infrared tympanic thermometer
What temperature is classified as a fever in a child?
Over 37.5 degrees
In general axillary measurements over or under estimate body temperatures and by how much?
Under by 0.5 degrees
Can febrile infants less than 3 months old present with non specific features and have a bacterial infection?
Yes - may not be able to identify reliably on clinical examination alone
Why during the first few months of life are infants relatively protected against common viral infections?
Due to passive immunity acquired by trans placental transfer of antibodies from mother
Unless a clear cause for the fever is identified, what is required?
A sepsis screen
What risk factors for infection are there?
Illness of other family members
Specific illness prevalent in community
Lack of immunisations
Recent travel abroad - malaria, viral hep, typhoid
Animal contact - brucellosis, Q fever, haemolytic uraemic syndrome caused by e.coli O157
Immunodeficiency- usually secondary e.g splenectomy (increased susceptibility to encapsulated bacteria)
What red flag features suggest urgent investigation and treatment?
Fever over 38 if less than 3 months or over 39 if 3 months to 6 months Colour - pale, mottled, cyanosis Level of consciousness reduced Bulging fontanelles Neck stiffness Status epilepticus Focal neurological signs or symptoms Significant respiratory distress Bile stained vomit Severe dehydration or shock
What often accompany febrile illness?
Rash
If no focus of infection is identified, what does this indicate?
Prodromal phase of viral infection
May indicate potentially serious bacterial infection especially UTI or sepsis
Parental antibiotics should be given to seriously unwell child - what type?
Third generation cephalosporin e.g cefotaxime or ceftriaxone
If child is less than 1 month old ampicillin added to cover listeria infection
When should antipyretics be considered?
Children with fever who appear distressed or unwell
What antipyretics can be used?
Paracetamol or ibuprofen
Do antipyretics prevent febrile seizures?
No
Can antipyretics be given sequentially?
Only if limited response by one
Is feverish illness common in children?
Yes - probably commonest reason for child to be taken to doctor
Is tepid sponging recommended for treatment of fever?
No
Should children with fever be undressed or over wrapped?
No
Describe what is involved in the septic screen in infants less than 3 months
Blood culture
FBC
CRP
Urine sample
Consider if indicated:
CXR
LP - unless contraindicated
Rapid antigen screen on blood/CSF/ urine
Meningococcal and pneumococcal PCR on blood/CSF sample
PCR for viruses in CSF - especially HSV and enteroviruses
