PEDS Fever Flashcards
Define fever
Fever: >100.4º F (>38ºC)
Define Hyperpyrexia
> 40C/104 F = hyperpyrexia
Lethal fever
Body temperatures rarely rise above lethal levels (107.6F) in a neurologically intact child
Exception: heat stroke
Pattern of fever
Pattern of fever : Diurnal
Lower AM
Higher PM (late afternoon)
4 MC cause of Fever
Most common: Infectious
Inflammatory
Neoplastic
Miscellaneous
How does fever effect the SZR threshold
Fever lowers seizure threshold
An inconsolable child
Think
Meningitis
MGMT of fever in >2 mo
HYDRATION!!
Define fever of short duration
Localized Signs and Symptoms
Can establish diagnosis by clinical history and exam
Define fever without a focus
Often in children <3yrs of age
H&P fails to establish cause
Define Fever of unknown origin
Fever >8* days without identified etiology despite history, physical exam, lab tests
Is Teething assoc with fever
Teething rarely associated w/ temp >100.4º F
If a less than 28 day old pt presents with fever
Think
Consider Herpes Simplex Virus in <28 days
Most common cuase of fever in 0-3 months olds
UTI- E.coli
Or bacteremia/. Meningitis- E. coli or Group B strep
Does petechia blanch
Nope
MGMT for fever without focus in less than 1 mo
Hospitalize!
CBC, blood culture, UA/culture
LP for CSF analysis
CXR (if respiratory concerns)
Stool cultures (if GI concerns)
Empiric antibiotics:
-ampicillin/gentamycin or other combo abx regimen
(go by the local hospital antibiogram or peds guidance)
Don’t waste time trying to differentiate viral vs bacterial!
MGMT for fever without focus in 1mo-3 years
Hospitalize
CBC, blood culture, UA/culture
Strongly consider LP (if 1-3 mos old)
LP in 3-36mos old usually only if neurologic/meningeal signs
If respiratory signs, or fever with elevated WBC (>20K) = CXR
Consider stool cultures for GI symptoms
Treatment: Empiric ceftriaxone or cefotaxime
What is the most common reason 3 year olds see medical care
Fever
W/u for fever over 3 yo
UA/culture for urinary symptoms
Stool studies for bloody/mucus diarrhea or >2 weeks
CXR, PCR testing if exam is not reliable or changes management
Common virus in the summer/ early fall
enteroviruses (coxsackieviruses)
Present as HFM, herpangina, aseptic (viral) meningitis
Common viruses in the winter
RSV, influenza, Norovirus, Rotavirus
Bronchiolitis (RSV, influenza), diarrheal illness (Norovirus, Rotavirus)
Common virus in the fall
Parainfluenza
->Croup
MC bacterial infections in peds
Most common: acute otitis media (AOM), streptococcus pharyngitis, PNA, UTI
Is step pharyngitis common in age under 3
NO
If no obvious source of inception in a kid with fever
Think
UTI
Postive blood culutre in a well appearing child with no source
Think
Bacteremia
MC agent of bacteremia
Pneumococcus
Define fever of unknown origin
Children w/temp >100.4 F documented with no known cause lasting longer than 8 days
Duration of fever is main difference between this and fever without a source—FWS can progress!
Peds pts presents with Headache, nausea, vomiting, anorexia, photophobia, restlessness, altered state of consciousness and irritability
+ Fever, neck pain and rigidity, focal neurologic deficits, seizures, obtundation and coma
Think
Meningitis or encephalitis
What two defects have an increased risk of meningitis
Complement defects (C5-8) Splenic dysfunction (sickle cell or asplenia)
What is the mc cause of bacterial meningitis
Sterp pneumo
What is the most common meningitis cause from daycares
Neisseria meningitis
What is the rash of neisseria
(meningococcemia)—petechial rash, evolves into ecchymotic and purpuric lesions
Clincal manifestations for meningitis
Fever
URI S/S
GI S/s
Lethargy/ irratiability
DIC, purpura, coma, death
HOTN, tachycardia
NUCHAL RIGIDITY
HA, emesis, bulging fontanels
SZR? AMS
What is the most important step to Dx meningitis
LP
C/I for LP
Evidence of increased ICP (other than bulging fontanelle)
Papilledema, focal neuro findings, coma, h/o hydrocephalus, h/o prior neurosurgical procedure to include CSF shunt placement
Severe cardiopulmonary compromise
Infection of skin overlying site of LP
Thrombocytopenia is a RELATIVE contraindication
If LP delayed, then antibiotic therapy should be initiated
What are the recommended ABX for meningitis
Vancomycin combined with 3rd generation cephalosporin !!(ceftriaxone)
- Ceftriaxone (50mg/kg/dose Q12h)
- Vancomycin (60mg/kg/day divided Q6-8h, follow troughs)
PCN or cephalosporin allergy?—can use meropenem
What is the sequalae of treating meningitis
deafness, seizures, learning disabilities, blindness, paresis, ataxia, or hydrocephalus
SIADH
MC viruses of encephalitis
Enteroviruses
Arboviruses
Herpesviruses
What is the MC arbovirus that causes encephalitis
West Nile
Presentation for encephalitis
Prodrome
Several days of nonspecific symptoms such as
-Sore throat, fever, headache, and abdominal complaints
Followed by the characteristic symptoms of progressive lethargy, behavioral changes, and neurologic deficits
Seizures are common at presentation
Maculopapular rash
LABS for encephalitis
Serologic studies
-Arboviruses (including West Nile virus, at risk by hx), Epstein-Barr virus (EBV), Mycoplasma pneumoniae, cat-scratch disease, and Lyme disease
Test for less common pathogens as indicated by the travel, social, or medical history
Polymerase chain reaction (PCR) tests for HSV, enteroviruses, West Nile virus, and other viruses
Viral stool cultures & nasopharyngeal swab
MGMT for encephalitis
Supportive care
ICU
Séqueles of Encephalitis
Motor incoordination, seizures, total or partial deafness, and behavioral disturbances
Visual disturbances from chorioretinopathy and perceptual amblyopia
