Fever Flashcards
What defines fever in children
> 38 OR reported parental perception of fever
What are the causes of fever
Acute fever: URTI, tonsilitis, otitis media, viral infections, pneumonia, meningitis, septic arthritis, UTI
Fever + rash: measles, rubella, roseola, scarlet fever, hand/foot/mouth disease, varicella, meningococcus
Fever + neck swelling: cervical adenitis, infectious mononucleosis, mumps, thyroiditis, mastoiditis
Recurrent: immunodeficiency, HIV, hyposplenism/splenectomy
Pyrexia of unknown origin
What are the common causes of pyrexia of unknown origin
Infective endocarditis
Osteomyelitis
Inflammatory bowel disease
Neoplastic disease
Factitious fever
At what age is a fever worrying and what should be done for them
<8 weeks
All should be admitted
Describe how temperature-taking methods differ from eachother (age and use)
< 4 weeks: electronic thermometer in the axilla
>4 weeks-5 years: electronic thermometer OR chemical dot thermometer in the axilla OR infra-red tympanic thermometer
Axillary temperatures are 0.5oc lower than oral or rectal temperatures. Rectal temperatures can be used if the child is unconscious
Forehead thermometers/oral/rectal routes are not recommended
What investigations should be done for a fever in children
Bedside: throat swab for culture, urine dip + MC&S, stool culture
Bloods: Blood cultures, FBC, CRP
Other: LP, CXR
What supportive management can be done for a fever
Antipyretics: paracetamol/calpol or ibuprofen
Undress the child, discourage wrapping in blankets
Sponging/tepid baths (lukewarm water)
What are the most common causes of fever <1 month
GBS
E. Coli
Listeria
HSV
What is the management for fever <1 month
Always admit
Full septic screen (blood cultures, urine culture, LP, CXR ± NPA, stool)
Commence Abx without waiting - cefotaxime + amoxicillin IV
What are the most common causes of fever 1-3 months
GBS, E. coli, listeria
Meningococcal/strep/staph/Hib
RSV, enterovirus, adenovirus, HSV
What are the most common causes of fever >3 months
Meningococcal/sepsis
Viruses e.g. RSV
What is the aetiology of scarlet fever
Bacterium Streptococcus pyogenes - a group A streptococcus (GAS)
Highly contagious, transmitted through saliva/mucous or aerosol transmission → colonises the throat and skin
Incubation 2-3 days
Rash and fever due to exotoxin or superantigen release
What are the risk factors for scarlet fever
At extremes of the age range, such as the very young and old, or postpartum women.
Immunocompromised or immunosuppressed.
Comorbidities such as skin breakdown, diabetes mellitus, or underlying malignancy.
Concurrent chickenpox or influenza.
IVDU or alcohol dependent
What defines an outbreak of scarlet fever
a credible report of two or more probable or confirmed scarlet fever cases attending the same school or nursery or other childcare setting, notified within 10 days of each other (two maximum incubation periods), with an epidemiological link between cases, for example they are in the same class or year group
What are the symptoms and signs of scarlet fever
Prodrome: sore throat, fever (>38.3), headache, fatigue, N&V
Blanching rash
- starts on trunk, spreads to limbs
- Red, generalised, pinpoint (punctate)
- Rough ‘sandpaper’ texture
- Accentuated in the skin folds of the neck, axillae, groin etc. (Pastia’s lines)
- Palm and sole sparing
- Skin peeling after rash resolvement
Strawberry tongue (covered with a white coat through which red papillae may be seen → White coat disappears to leave a beefy red appearance
Cervical lymphadenopathy
Flushed face, circumoral pallor
Pharyngitis and petechiae on the hard and soft palate (‘Forchheimer spots’).