Problem 5

Question 1

What are the clinical clues to suspect a severe bacterial infection for a fever without source

Answer 1

• ill-appearing but lack of sensitivity
• grunting
• tachypnea
• tachycardia
• neck stiffness
• temperature of 39ºC or higher
• saturation of 94% or less

Question 2

What are the biological markers to suspect a severe bacterial infection

Answer 2

• Nombre de globules blancs above 15,000/mm3 but not reliable
• CRP
• procalcitonine

Question 3

What is the Lab-score

Answer 3

2 points were attributed to PCT and CRP if above the cutoff values (PCT: 0.5 µg/l and CRP: 40 mg/l)
4 points for values of PCT and CRP if above 2 µg/l and 100 mg/l, respectively
1 point was attributed for a positive urine dipstick

Question 4

Lab-score results

Answer 4

<3: pas d’antibiotiques, pas d’hemoculture, stix urinaire

>3: hemoculture, culture d’urine, Rx thorax, antibiotiques

Question 5

Quels sont les signes toxiques

Answer 5

• Léthargie : Niveau de conscience caractérisé par un contact visuel pauvre ou absent, difficulté à reconnaître
  ses parents ou à interagir avec des personnes ou
  des objets.
• Mauvaise perfusion périphérique
• signes de choc, tachypnée
• Cyanose

Question 6

Si <3 et nitrite +

Answer 6

culture d’urine et ttt ATB

Question 7

Si <3 nitrite- mais leuco +

Answer 7

culture d’urine, ttt ATB selon resultats