Infection, Inflammation and Fever Flashcards
What are the vascular causes for fever in children?
Kawasacki Syndrome, Systemic Erythematous Lupus and Juvenile Idiopathic Arthritis
What are the inflammatory/infection causes for fever in children?
Everything! Chest infections, meningitis/encephalitis, skin infections (cellutitis and impetigo), gastroenteritis, UTIs
Inflammatory Bowel Disease, Coeliac Disease
What are the autoimmune causes for fever in children?
Systemic Erythematous Lupus and Juvenile Idiopathic Arthritis
What are the iatrogenic or idiopathic causes for fever in children?
Drug reactions
Questions to ask to localise a fever for Central Nervous System disease?
Any visual changes?
Any bright lights, or not being able to handle the light?
Do any positions make head pain worse?
Questions to ask to localise a fever for ENT?
Is the child pulling their ear?
Is the ear looking inflamed?
Have they experienced difficulty swallowing or denying food?
Questions to ask to localise a fever for respiratory disease
Cough? Productive?
Stridor?
Breathlessness?
Recession and increased work of breathing?
Cyanosis?
Questions to ask to localise a fever for abdominal disease?
Change in bowel habits (diarrhoea)?
Vomiting?
Abdominal pain?
Jaundice or icterus?
Distension?
Changes to stool colour, consistency etc?
Questions to ask to localise a fever urinary disease?
Dysuria, frequency, urgency?
Changes to colour of urine?
Changes to smell of urine?
Questions to ask to localise a fever to joint disease?
Swellings in the joints?
Red, painful joints?
Struggling to move in that region?
Physical signs of dehydration in children?
Sunken fontanelle, tachycardia, dry mucous membranes, reduced skin turgor
What is Kernig’s Sign?
Signs of meningitis
An inability to straighten the leg when the hip s flexed at 90oC
What does IO stand for paediatric management?
Interosseous
What do the lumbar puncture results for normal children look like?
Low neutrophils
Low Lymphocytes
<1.0 Protein
> 0.6 Glucose
What do the lumbar puncture results for bacterial meningitis in children look like?
High neutrophils (but may be normal)
Low lymphocytes
High Protein (>1.0)
<0.4 Glucose
What do the lumbar puncture results for viral meningitis in children look like?
Low neutrophils
High lymphocytes (but may be normal)
Low to normal Protein (0.4-1.0)
Normal glucose
What do the lumbar puncture results for TB meningitis in children look like?
Low Neutrophils
High lymphocytes
High protein
Low to normal Glucose
Common causes of bacterial meningitis ages 0-3 months?
Group b Streptococcus
E.coli
Listeria monocytogenes
Common causes of bacterial meningitis ages 3 months - 5 years?
Niesseria Meningitides
Streptococcus penumoniae
Haemophilus Influenza B (same thing that causes epiglottitis)
Common causes of bacterial meningitis ages over 5 years?
Niesseria Meningitides
Streptococcus penumoniae
What are the common causes for viral meningitis?
Enteroviruses
But it can be caused by many other viruses
Which steroid is used in bacterial meningitis for some serious cases?
Dexamethasone
What are the indications for the use of dexamethasone in bacterial meningitis?
Frank purulent pus
CSF white cell count >1000/mcL (very high)
Above result, with >1g Protein
Bacteria on gram stain
What are some reasons not to do a lumbar puncture?
Evidence of raised intracranial pressure
Child is too unstable
Extensive or spreading purpuric rash
Bleeding disorder
Infection at site of proposed LP
What is the go to antibiotic for bacterial meningitis over 3 months old?
Ceftriaxone
What is Kawasaki’s Disease?
Vasculitis of unknown aetiology. It causes multi-system involvement and inflammation of the small to medium sized arteries which results in aneurysms.
Which ages does Kawasaki’s Disease mainly affect?
Less than 5 years old
(Peak incidence between 2 and 3 years old)
How many phases are there for Kawasaki’s Disease and what are these phases called?
3
Acute
Subacute
Convalescent
How long does the acute phase of Kawasaki last?
1 - 2 weeks
What happens during the acute phase of Kawasaki Disease?
Hectic fever - really bad, unresolvable fever
Conjunctival erythema
Dry, cracked lips
Strawberry Tongue
What happens during the subacute phase of Kawasaki Disease?
Fever resolves
Desquamation of the skin (fingers and toes)
Platelet count increases
Coronary artery aneurysms
Hwo long is the subacute phase of Kawasaki?
2 weeks
What marks the beginning of the Convalescent phase of Kawasaki?
The disappearance of the symptoms seen in the first two phases
What are the main treatments for Kawasaki Disease?
Intravenous immunoglobulins (IVIG)
Aspirin
What are the clinical features of Toxic Shock Syndrome?
Fever, coryzal symptoms, including headache, exhaustion, aching body
How is Toxic Shock Syndrome (TSS) managed?
IV fluids
IV antibitoics
What bacteria is Scarlet Fever caused by?
Group B streptococcus
What are the symptoms of Scarlet Fever?
Fever
Sore throat
Strawberry tongue
Sandpaper rash
(malaise, headache, nausea and vomiting)
How is Scarlet Fever managed?
Penicillin [or Azithromycin is penicillin-allergic]
What is Henoch-Schonlein Purpura?
IgA Vasculitis
Inflammation of the small blood vessels that causes a petechial/purpuric rash
What is a common complication of Iga Vasculitis (Henoch-Schonlein Purpura)?
Kidney disease (glomerulonephritis) - IgA Nephritis
What are the clinical features of henoch-schonlein purpura?
Petechial/Purpuric rash
Swollen joints (Arthralgia)
Kidney problems
Abdominal/GI involvement
What is the most common preceeding illness to Henoch-Schonlein Purpura?
Upper respiratory infection (possibly triggering abnormal IgA activation)
How is HSP (henoch-schonlein purpura) managed?
Steroids [namely Prednisolone]
Azathioprine (5-ASA)
What is the organism that causes Measles?
Single stranded RNA Paromyxovirus
What happens in Measles
The organism infects the upper airway and the surrounding lymph nodes
What are the clinical features of Measles?
Fever, conjunctivitis, coryza, cough and Koplik Spots (on the back of the throat)
How many phases of Measles are there
AND
What are they called?
4
Incubation
Prodromal
Exanthematous
Recovery
How is Measles managed?
Routine support care
Fluids and antipyretics
What is in a full paediatric SEPSIS screen?
FBC
CRP (LP if this is greater than 10)
Blood cultures
ECG
Throat swab
What does a skin biopsy of Henoch-Schonlein Vasculitis show?
Leukocytoclastic vasculitis with IgA deposition
What is Immune Thrombocytopenic Purpura?
Purpura that is caused by destruction of criculating platelets in the body, by the body’s own immune system, leading to bleeding.
What are the clinical features of Immune Thrombocytopenic Purpura?
Purpuric rash
Epistaxis or other mucosal bleeding
(Intracranial bleeding, however this is not common)
What is the organism that causes Lyme Disease?
Borrelia burgdorferi (bacteria)
What is the classical sign of Lyme Disease?
Erythema Chronicum Migrans
What disease does Parvovirus characteristically cause?
Slapped Cheek Syndrome
What is the distinct Newborn test done of their 5th day of life?
Guthrie Heel Prick Test
This tests for many different conditions such as Cystic Fibrosis, PKU, SCID, Sickle Cell and Congential hypothroidism. some other disease are identified as well.
Which antibiotic is given to a child with bacterial tonsilitis?
Phenoxymethylpenicilin (if they aren’t allergic to penicillin)
Clarithyromycin (if they are allergic to penicillin)
What does a ToRCHS Screen look for?
Toxopalsmosis
Rubella
Cytomegalovirus
Herpes Simplex Virus
Syphillis
