Lecture 19: Febrile Illness/ID Flashcards
Rise in hypothalamic set-point due to endogenously produced pyrogens explains the etiology of a…
Fever
MC cytokines that function as endogenous pyrogens
IL-1 and IL-6
Core temperature is specifically defined as the temperature of blood within the () artery
Pulmonary artery
Fever () the amount of iron available to invading bacteria
Decreases
Generally, we prefer a rectal temp (most accurate) from birth to () years
Birth to 3 years
Same period as when fevers are MC
Tympanic temperatures are unreliable in children () months
Under 6 months of age
T/F: A well-appearing, well-hydrated child with evidence of a routine viral infection can be safely sent home with symptomatic treatment and careful return precautions
True
Most febrile illnesses are (viral/bacterial)
Viral
The MC reason to treat fever is if a child is…
Uncomfortable
NSAIDs should generally not be used in child younger than () months and Tylenol should not be used in children younger than () months
- NSAIDs should be avoided in 6 months and younger.
- Tylenol should be avoided in 3 months and younger.
NO ASA DUE TO REYE’S SYNDROME
You should see a child immediately if any of these are present.
- Child is less than () months of age
- Fever is greater than () celsius
- Child is crying ()
- Child cries when ()
- Child is difficult to ()
- () spots or dots are present on the skin
- Less than 3 months of age
- Greater than 40.6C
- Crying INconsolably/whimpering
- Crying when moved or even touched
- Difficult to awaken
- Stiff neck
- Purple spots
You should a see a child within 24 hours if:
- Child is () to () months old (unless fever occurred within 48h of dtap with no other symptoms)
- Fever exceeds () C
- Burning or pain with ()
- Fever subsided for 24h but then ()
- Fever has persisted longer than ()
- 3-6 months old
- Exceeds 40C/104F
- Urination
- Returning fever
- Longer than 72h
On average, a (viral/bacterial) infection usually disseminates faster in a younger child
Bacterial infection
Fever is MC between the ages of…
Birth to 3 years
() account for most bacterial infections in infants under 90 days
UTIs
They can’t clean down there themselves
You should be especially concerned for a serious viral infection in an infant if they lack () vaccine or ()
- HiB
- Pneumococcal
T/F: Presence of petechiae/purpura in a viral illness is very sus
True
T/F: As long as child is 90 days old, their ill appearance does not require a full eval.
False
The mainstay diagnostics for any child under 21 days old with a fever >= 38C are (3)
- UA
- Blood cultures
- LP
Inflammatory markers are optional.
In order for a 21 day or younger neonate to be D/C’d off of IV abx and discharged, they must meet all of this criteria:
- Culture results are negative for ()
- Infant appears ()
- ()
- Negative culture results for 24-36h
- Infant appears well or is improving
- No other reason to hospitalize.
For a 22-28 day old or a 29-60 day old, feverish, but well-appearing infant, the 3 diagnostics you must order initially are:
- UA
- Blood culture
- Inflammatory markers
Generally, you want to order a procalcitonin alongside an ANC or CRP. If you CANNOT order procalcitonin, then you should obtain both ()
CRP and ANC
T/F: You can treat a urine only infection in a 29-60 day old via oral abx.
True
A 61-90 day old infant needs a full septic work-up if:
- They appear ()
- Signs of a () infection AND Abnormal (), (), or ()
- They appear toxic/ill
- They have signs of a focal infection.
- Abnormal WBC, inflammatory markers, or UA
One of the most important history things in a child with a fever of unknown source is…
Immunization status
T/F: In an infant aged 3 months to 36 months, full-workup is indicated if incompletely immunized.
True
Febrile seizures are highest risk between the ages of () months and () years
6 months to 5 years
A generalized tonic/tonic-clonic seizure of less than 15 minutes and occurring within 24 hours of fever onset is most commonly known as a () and is most commonly caused by ()
Simple febrile seizures, MCC: Viral illness
Complex is focal or b2b or > 15 mins
T/F: Prophylactic anticonvulsants are recommended for children with febrile seizures.
False
Simple ones have no long-term adverse consequences
A Fever of Unknown Origin (FUO) is defined as a daily temp greater than () for 8 days with no apparent diagnosis.
38.3C or 101F
The top 3 MCC of FUOs, in order of frequency, are:
- Infectious diseases
- CT/Rheumatologic disrders
- Neoplasms
The MC autoimmune disease in children that can result in a FUO is…
Systemic JIA (juvenile idiopathic arthritis)
The MC malignancies in children that result in FUOs are (2)
- Leukemias
- Lymphomas
T/F: Most evaluations of FUOs begin inpatient.
False.
Ideally, a physical exam of a febrile infant is done when the infant is currently ()
Febrile
What might bilateral red eyes in a pediatric patient suggest in terms of underlying disease?
Kawasaki’s disease
T/F: It is reasonable to order serological testing for FUOs.
True.
If an infant is ill with persistent fever and NO diagnosis, you could order ()
IgG, IgA, IgM
Generally, empiric antimicrobial therapy (is/is not) indicated in FUO.
Is NOT (unless life-threatening)
If () occurs more than 24h prior to delivery, Bacterial sepsis in newborns increases 10x.
Normal rate is 1-2 in 1000
PROM (1 in 100 births)
PROM + Chorioamnionitis = 1 in 10 live births!
The MCC of bacterial sepsis in a newborn are (4)
- GBS
- E. coli
- Listeria
- S. Aureus
Generally, bacterial sepsis of the newborn appears on day () of life
Day 1
T/F: An intrapartum maternal temperature of 100.4F or higher is a risk factor for Bacterial sepsis of the newborn.
True.
The MC presenting sign of bacterial sepsis in a newborn is…
Respiratory distress d/t PNA
The Dx of PNA in bacterial sepsis is via…
Pleural fluid from effusion
Tx of early bacterial sepsis in newborns is…
- Ampicillin
- Gentamicin/cefotaxime
Q12 hrs
Tx of late bacterial sepsis in a newborn is…
- Ampicillin
- Gentamicin/Cefotaxime
- Add on Vancomycin for staph
Late bacterial sepsis is MC due to staph aureus
10-14 days IV for proven sepsis.
Late onset bacterial sepsis of the newborn occurs after () days of life.
7 days of life.
Most likely due to staph.
Prevention of neonatal GBS infection is usually achieved via intrapartum delivery of () more than () hours prior to delivery.
Penicillin, 4 hours prior to delivery.
GBS cultures are obtained from both () and () at ()-() weeks.
- Vaginal and rectal GBS cultures
- 35-37 weeks
Prophylaxis with pencillin is indicated for women who are () or who have () GBS status at delivery.
- GBS positive
- Unknown GBS status at delivery
The MCC of aseptic/viral meningitis is…
Non-polio enteroviruses
MC before the age of 1
A full anterior fontanelle in the sitting position, a maculopapular rash, marked fever, irritability, and lethargy with an acute onset is suggestive of…
Viral meningitis
T/F: Meningeal signs are typically seen in pediatric patients.
False, generally only seen in older patients.
In both older and younger children, certain strains of () can cause flaccid paralysis in viral meningitis
Enteroviruses
Similar to polio
The most useful diagnostic lab for viral meningitis is…
PCR of enteroviruses
In 95% of cases, protein should be less than () mg/dl and glucose more than () of serum values in viral meningitis.
- Protein less than 80 mg/dl
- Glucose MORE than 60% of serum values
The general tx for an infant with viral meningitis is…
- Admit
- Isolate
- Fluids
- Antipyretics
In an infant younger than 1 month, you should consider () in your differential alongside viral meningitis and start () until you have a diagnosis.
- You should consider herpes virus encephalitis
- Start empiric acyclovir until diagnosis is made.
The MOST important sign in very young infants when it comes to bacterial meningitis is…
A tense, bulging fontanelle
CSF of bacterial meningitis should show () WBCs, () glucose, () protein
- Elevated WBCs
- Decreased glucose
- Increased protein
One might see G() diplococci on smears of CSF sediment for bacterial meningitis
G+ diplococci
Empiric abx for bacterial meningitis in newborns is…
- IV Vanco
- IV Cefotaxime/Rocephin
- Steroids prior to abx to reduce cerebral edema and lower likelihood of hearing loss per viv / I wrote IF no hx of HiB vaccine, maybe its both?
The two MC time periods to contract neisseria meningitidis are…
- First year of life
- Teen years
In order to qualify for chemoprophylaxis for neisseria meningitis, you must have () exposure
Direct exposure to respiratory secretions
Household members are high risk
MC agent for chemoprophylaxis for neisseria meningitis is…
Rifampin
A purpuric/petechieal rash in association with bacterial meningitis means it is most likely…
Meningococcemia w/ similar symptoms
T/F: You should treat meningococcemia in a newborn/kid as shock.
True
Im guessing this is for meningococcemia
T/F: Pneumococcal meningitis and meningococcemia (meningitis due to N. meningitidis) are treated the same.
True.
MC bacteria for bacterial conjunctivitis
- Strep Pneumo
- H flu
- M cat
Same as AOM top 3
Pseudomonas if contact lens wearer