Nelson - Ch. 177 Fever Without a Focus Flashcards
Fever without a focus refers to
Rectal temp of 38C or higher as sole presenting feature
MC serious bacterial infection in 1-3 month infants
UTI/pyelonephritis
MC pathogen in infants 1-3 months old
E. coli
Hyperpyrexia is defined by a temp of
> 40C
Patients with sickle cell disease are at high risk for developing sepsis, pneumonia, and meningitis caused by what organism
S. pneumoniae
Patients with complement or properdin deficiency are at high risk for sepsis caused by
N. meningitidis
Patients with AIDS are at high risk of infection from which organisms (3)
1) S. pneumoniae 2) H. influenza 3) Salmonella
Patients with central venous lines are at high risk for developing infection from what organisms (3)
S. aureus, coagulase-negative staphylococci, Candida
Patients with malignancy have high risk for developing bacteremia caused by what organisms (3)
G- enteric bacteria, S. aureus, coagulase-negative staphylococci
Patients with malignancy have high risk for developing fungemia caused by what organisms (2)
Candida, Aspergillus
In general, neonates who have a fever and do not appear ill have a ___% risk of having a serious bacterial infection
7
Neonates are mainly at high risk for late-onset neonatal bacterial disease caused by (3)
1) Group B strep 2) E. coli 3) Listeria monocytogenes
If excessive clothing and blankets encasing the infant are suspected of falsely elevating the body temperature, then the excessive coverings should be removed and the temp retaken in ___
15-30min
T/F All febrile neonates should be hospitalized
T, blood, urine, and CSF should be cultured and the child should receive empirical IV antibiotics
___ should be started as treatment in neonates if HSV infection is suspected
Acyclovir
Large majority of children with fever without localising signs in the 1-3 months age group likely have what illness
Viral syndrome
Pyelonephritis is the MC serious bacterial infection in 1-3 months age group and is more common in what subgroup
1) Uncircumcised boys 2) Infants with urinary tract abnormalities
MC pathogen identified in bacteremic infants
E. coli
Organisms most frequently identified in bacteremic infants 1-3 months after E. coli
Group B streptococcus and S. aureus
In 1-3 months, most significant blood cultures turn positive within
24 hrs
In 1-3 months, ___% of the most significant blood cultures turn positive within 48 hours
99
Recommended initial antimicrobial regimen for ill-appearing infants without focal findings to cover for the usual bacterial pathogens causing illness in very young infants
Ampicillin + either ceftriaxone or cefotaxime
Antimicrobial agent to be included in initial regimen for ill-appearing infants if meningitis us suspected because of CSF abnormalities
Vancomycin (to treat possible penicillin-resistant S. pneumoniae)
T/F Infants in whom a virus has been detected are at low or no risk of a serious bacterial infection
T
___ are the cause of the vast majority of fevers in 3-36 month old
Viral infections
Account for most cases of occult bacteremia in 3-36 month olds (3)
1) S. pneumoniae 2) N. meningitides 3) Salmonella
Risk factors indicating increased probability of occult bacteremia
1) Temp ≥39C 2) WBC ≥15,000/uL 3) Elevated ANC, ABC, ESR, or CRP
T/F Socioeconomic status appear to affect the risk for occult bacteremia
F
T/F Without therapy, occult bacteremia caused by pneumococcus can resolve spontaneously without sequelae
T, in 30-40%
T/F Hib bacteremia is characteristically associated with a higher risk for localized serious infection than is bacteremia caused by S. pneumoniae
T
FUO is defined as fever documented by a healthcare provider and for which the cause could not be identified after
3 weeks of evaluation as an outpatient OR 1 week of evaluation in the hospital
In cases of drug fever, discontinuation of the drug is associated with resolution of the fever generally within
72 hours to as long as 1 month
Connective tissue disease associated most commonly with FUO
JIA and SLE
FUO lasting >6 months is uncommon in children and suggest ___ diseases (3)
1) Granulomatous 2) Autoinflammatory 3) Autoimmune
T/F Immunization of dogs against specific disorders such as leptospirosis can prevent canine disease and prevents the animal from carrying and shedding leptospires and transmitting to household contacts
F, may still carry, shed, and transmit
A history of ingestion of rabbit or squirrel meat might provide a clue to the diagnosis of
Tularemia
Ingestion of ___ is a particularly important clue to infection with Toxocara canis (visceral larva migrant or Toxoplasma gondii (Toxoplasmosis)
Dirt
___ conjunctivitis in a child with FUO suggests Kawasaki disease or leptospirosis
Bulbar
Chorioretinitis suggests what infectious illnesses
1) CMV 2) Toxoplasmosis 3) Syphilis
A clue to FUO caused by hypothalamic dysfunction is
Failure of pupillary constriction
Fever resulting from ___ may be suggested by lack of tears, an absent corneal reflex, or a smooth tongue with absence of fungiform papillae
Familial dysautonomia
Recurrent oral candidiasis may be a clue to various disorders of the immune system especially involving the ___
T lymphocytes
Hyperactive DTRs can suggest ___ as the cause of FUO
Thyrotoxicosis
Tenderness over this muscle may be a clue to sub diaphragmatic abscess
Trapezius
An ANC of ___ is evidence AGAINST indolent bacterial infection other than typhoid fever
Less than 5000/uL
T/F A low ESR eliminates the possibility of infection or JIA
F
T/F CRP returns to normal more rapidly than ESR
T
Polymicrobial bacteremia suggest (2)
1) Factitious self-induced infection 2) GI pathology
Tuberculin skin testing should be performed with ID placement of how many units purified protein derivative?
5
___ is useful for detecting osteomyelitis before plain roentgenograms
Techenetium-99m phosphate
T/F Children with FUO have a better prognosis than do adults
T
