The Febrile Child with Unknown Origin Flashcards
What are the possible bacterial causes of pyrexia with unknown origin?
- UTI
- Pneumonia
- Endocarditis
- Occult abscesses
- TB
- Osteomyelitis
What are the possible viral causes of pyrexia with unknown origin?
- Infectious mononucleosis
- Hepatitis
- HIV
What are the other causes of pyrexia with unknown origin?
- Collagen vascular disease
- Inflammatory bowel disease
- Neoplastic disease
- Factitious fever
What would elevated WCC in FBC indicate?
- Bacterial infection
- Very high WCC in leukaemia
In which scenarios would ESR be elevated?
- Bacterial infection
- Highly elevated in collagen vascular disease
- Highly elevated in malignancy
When should blood cultures be taken?
- When bacterial infection is suspected
- Repeated samples in endocarditis, osteomyelitis and occult abscesses
When would a bone marrow aspirate be performed?
- Leukaemia
- Metastatic neoplasms
- Rare infections
When would echocardiography be performed?
In endocarditis, vegitations can be seen on the leaflets of heart valves
When would ultrasonography be performed?
Identification of intra-abdominal abscesses
When would total body CT or MRI scanning be indicated?
In detection of neoplasms or abscesses
What should not be given when a child presents with PUO?
Antipyretics as they obscure the pattern of fever
What should be suspected if the child has recurrent serious infections?
- Defective white cell function
- Immunoglobulin deficiency (congenital, HIV)
- Splenectomy
- Chest (foreign bodies, cystic fibrosis)
- Urinary tract (reflux)
- Meningitis (congenital dermal sinus)
What are the characteristics of tonsillitis?
- Pharyngitis
- Fever
- Malaise
- Lymphadenopathy
What is the most common causative organism of tonsillitis?
Streptococcus pyogenes (over 50% of cases)
What are the complications of tonsillitis?
- Otitis media
- Recurrent tonsillitis
- Quinsy - peritonsillar abscess
- Rheumatic fever and glomerulonephritis (rare, post-strep allergic disorders)
When should surgery be considered in tonsillitis?
If the patient meets the following criteria:
- Sore throats due to tonsillitis
- > 7 episodes per year, 5 per year for 2 years or 3 per year for 3 years
- Symptoms occurring for at least a year
- Episodes of sore throat are disabling and prevent normal functioning
What are the complications of a tonsillectomy?
Primary (<24 hours):
- Haemorrhage (2-3%), commonly due to inadequate haemostasis
- Pain
Secondary (24 hours-10 days):
- Haemorrhage, commonly due to infection
- Pain
What are the criteria for diagnosing tonsillitis?
FeverPAIN:
- Fever (during previous 24 hours)
- Purulence
- Attend rapidly (withthin 3 days of symptoms)
- Inflamed tonsils
- No cough or coryza
Each is worth 1 point, higher score suggests more severe symptoms and likely bacterial cause
Centor criteria:
- Tonsillar exudate
- Tender anterior cervical lymphadenopathy or lymphadenitis
- History of fever
- Absence of cough
What is the difference in presentation between viral and bacterial tonsillitis?
Bacterial:
- More commonly associated with cervical lymphadenopathy
Viral:
- More likely to present with headache, apathy, abdominal pain
What is the management of group A beta-haemolytic strep induced tonsillitis (eg. strep pyogenes)?
- Analgesics (paracetamol: 10-15 mg/kg orally every 4-6 hours)
- Antibiotics once group A strep confirmed by throat swabs (phenoxymethylpenicillin <=27kg give 250mg orally 2-3x PD for 10 days, >27kg 500mg 2-3x PD for 10 days)
- If symptoms are severe consider corticosteroids (dexamethosone sodium phosphate)
When should antibiotics not be considered in acute sinusitis?
Children over the age of 4, unless they are systemically unwell or have complications
When would the FeverPAIN and Centor criteria warrant antibiotic prescription?
FeverPAIN:
- 2-3 consider abx
- >= 3 prescribe abx
Centor:
- >= 3 prescribe abx
When should children with otitis media be offered antibiotics?
- Otorrhea, this indicates tympanic membrane perforation
- <2 years old with bilateral acute otitis media (regardless of temperature)
- Presence of a high temperature >38
How long does acute otitis media tend to last?
4 days