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Febrile Child & Infections Flashcards

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1
Q

What are the red, amber and green categories in assessing the acutely unwell child?

A

GREEN = LOW RISK:

  • Colour: normal colour
  • Activity: responding normally, content, stays awake
  • Resp: no resp signs
  • Circulation: normal skin, moist mucous membranes
  • Other: nil

AMBER= INTERMEDIATE RISK

  • Colour: pallor
  • Activity: decreased activity, reduced responses
  • Resp: nasal flaring, RR> 50 in 6-12 months, RR>40 in >12months , SpO2 <95% on air
  • Circulation: dry, poor feeding, CRT> 3s, tachycardia (>160bpm in <12 months, >150bpm in 1-2 yr, >140bpm in 2-5 yr)
  • Other: 3-6 mths fever=T >39C , rigors

RED = HIGH RISK:

  • Colour: pale, mottled or blue
  • Activity: no response to cues, unable to rouse, weak crying
  • Resp: grunting, tachypnoea (RR>60bpm), chest indrawing, recessions
  • Circulation: reduced skin turgor
  • Other: 0-3 mths fever= T>38C, non-blanching rash, bulging fontanelle, focal seizures
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2
Q

Life threatening emergencies to always consider in the febrile child…

A
  • Meningitis
  • Sepsis
  • Encephalitis
  • Toxic shock syndrome
  • Necrotising fasciitis
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3
Q

What is the basic management of a febrile child under 3 months?

A
  • Septic screen: FBC, CRP, urine and blood cultures +/- stool culture, CXR and LP (depending on clinical signs)
  • Start IV antibiotics
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4
Q

What procedure should all febrile children under 1 month have?

A

Lumbar puncture

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5
Q

Name some common causes of fever with rash…

A

Maculopapular rash (flat red lesions, surrounded by raised bumps):

  • Viral = Parvovirus, enterovirus
  • Bacterial = Scarlet fever, rheumatic fever
  • Other = Kawasaki disease

Vesicular, bullous rash:

  • Viral = HSV, VZV (blistering rash)
  • Bacterial = impetigo, SSSS

Petechial/ purpuric rash:

  • Bacterial = meningococcal sepsis
  • Other = vasculitis
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6
Q

What is Kawasaki disease?

A

Type of vasculitis that predominantly affecrs children.

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7
Q

How is Kawasaki diagnosed?

A

Diagnosis requires:
3 essential criteria: high fever, persistent and unresponsive to antipyretics
AND
4 out of 5 essential criteria:
1. Conjunctival injection
2. Oral mucositis - development of oral ulcers
3. Cervical lymphadenopathy
4. Erythema and swelling of hands and feet - begin to peel
5. Maculopapular rash

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8
Q

What is the main complication of Kawasaki disease?

A

Coronary artery anuerysm

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9
Q

Management of Kawasaki disease…

A
  • High dose aspirin (not normally given to children) to prevent aneurysm and thrombosis
  • IV Ig - to combat autoimmune process
  • Echocardiogram and ECG - screen for coronary artery aneurysm
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10
Q

Why is aspirin normally contraindicated in young children?

A

Salicylates in aspirin may cause mitochondrial injury which can lead to metabolic non-inflammatory encephalopathy known as Reye’s Syndrome.

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11
Q

What is erythema infectiosum?

A

Common childhood infection causing slapped cheek appearance and rash.

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12
Q

Causes of erythema infectiosum…

A

Viral infection: EVB19 or Parvovirus B19

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13
Q

How does erythema infectiosum present?

A

Initially: viral illness prodrome: mild fever and headache
Few days later: slapped cheek appearance - firm red cheeks which are burning hot (can last for few weeks)
Followed by pink rash of the limbs/ trunk

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14
Q

Management of erythema infectiosum…

A

Self limiting - no specific treatment

Affected children can stay at school as infectious period is 3-5 days before the rash appears.

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15
Q

What is toxic shock syndrome?

A

Severe systemic reaction to the exotoxins released by Staph A / Strep pyogenes infections.

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16
Q

What is the diagnostic criteria for toxic shock syndrome?

A
  1. Body temp > 38.9C
  2. Systolic BP <90 mmHg
  3. Diffuse macular rash
  4. Desquamation - peeling of palms and soles about 1-2 weeks after onset
  5. Involvement of at least 3 organ systems:
    - GI = diarrhoea, vomiting
    - MSK= myalgia
    - Renal failure
    - Hepatitis
    etc. ..
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17
Q

What is the treatment for toxic shock syndrome?

A
  • Admission and IV antibiotics

- May need ICU for organ support

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18
Q

Characteristic features of measles…

A

Prodrome = conjuctivitis, coryza, cough, fever, Koplik spots (small white spots on buccal mucosa)
Rash begins behind ears, then spreads across face and trunk - red-brown blotches

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19
Q

How long do measles patients remain infective?

A

Infective throughout incubation period (10-14 days) and 4 days from when rash appears.

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20
Q

What is the management of measles?

A

Mainly supportive - normally self limiting and will resolve within 7-10 days.
Notifiable disease as it is highly infective.

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21
Q

What are the main complications from measles?

A
  • Otitis media = most common
  • Pneumonia = most common cause of death
  • Febrile convulsions
  • Encephalitis - including very rare ‘subacute sclerosing panencephalitis’
  • Myocarditis
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22
Q

What is the cause of rubella infection?

A

Togavirus

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23
Q

How does rubella present?

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A

Prodrome: low-grade fever, suboccipital and post-auricular lymphadenopathy
Rash: pink maculopapular rash which starts on the face and then spreads to whole body

24
Q

What is the main risk of rubella infection?

Study These Flashcards
A

If pregnant woman contracts it during first trimester, it can cause congenital rubella syndrome.
This can lead to complications: sensorineural deafness, cataracts, congenital heart disease, cerebral palsy

25
How does mumps present?
- Fever - Malaise - Myalgia - Parotitis ( unilateral painful swelling of the parotid gland, then may become bilateral)
26
Management of mumps...
- Rest and simple analgesia for fever/pain | - Notifiable disease - need to inform PHE
27
Complications of mumps...
- Orchitis in young post-pubertal males - may lead to subfertility - Hearing loss - Meningoencephalitis - Pancreatitis
28
Presentation of diphtheria...
- URTI causing sore throat and low grade fever - Swollen tonsils may lead to "bull neck" appearance - Pseudomembrane formation: layer of dense, grey debris of necrotic mucosal cells in the posterior pharynx/ larynx
29
Complications of diphtheria...
Systemic distribution of infection may cause necrosis of other tissue: - Myocardial = myocarditis - Renal = renal disease - Neural = peripheral neuropathy
30
How does polio present?
- 70% of cases = asymptomatic - 25% of cases = mild sx e.g. fever, sore throat- back to normal within a few weeks - 0.5% of cases= muscle weakness leading to paralysis (infantile paralysis) , many people fully recover from this.
31
How does pertussis present?
2-3 days of coryza, followed by: - Paroxysmal coughing bouts - frequent, violent coughing usually occurring at night/ after feeding, leading to vomiting - Inspiratory whoop - forced inspiration against closed glottis - Spells of apnoea * symptoms can last 10-14 weeks
32
How is pertussis diagnosed?
- Nasal swab | - PCR/ serology is now increasingly used
33
Management of pertussis...
- Admission if <6 months - Oral antibiotics - macrolide e.g. clarithromycin indicated if onset of cough is within previous 21 days - Household contacts receive abx prophylaxis (macrolide)
34
What are the complications of pertussis?
- Persistent coughing can cause subconjunctival haemorrhage and anoxia leading to seizures - Bronchopneumonia
35
Clinical features of tetanus...
Tetanus = bacterial infection causing fever prodrome followed by prolonged contraction of skeletal muscle: - Lockjaw - Rictus (grin appearance caused by spasm of facial muscles) - Opsithotonus -backward arching of the back and neck - Spasms = dysphagia
36
Management of tetanus...
- IM human tetanus Ig | - Metronidazole = antibiotic of choice
37
What are the modes of transmission of HIV to infants?
- In-utero - During labour - Breastfeeding - Blood trasnfusion - Sexual abuse
38
Typical signs of AIDS seen in infants?
AIDS develops rapidly in children who don't receive treatment for HIV: - Hepatosplenomegaly - abdominal distension - Lymphadenopathy - Recurrent infections - Global developmental delay - Failure to thrive - Oral thrush - Fevers and night sweats
39
How is HIV diagnosed in infants?
- >18 months: Detection of HIV antibodies | - <18 months: Detection of HIV RNA
40
What measures can reduce vertical transmission of HIV?
1. Pregnant women receive antiretroviral therapy - aiming for undetectable viral load at time of delivery (<50 copies/ml) 2. If viral load is still detectable at delivery (>50 copies/ml) - C section is recommended. 3. Babies receive oral antiretroviral therapy e.g. AZT (zidovudine) as post exposure prophylaxis for 4-6 weeks 4. Infants should be exclusively bottle fed 5. Babies have checks at; birth, 6 weeks, 3 months, 18 months
41
What causes scarlet fever?
Erythrogenic toxins produced by group A streptococci e.g. strep pyogenes
42
How does scarlet fever present?
- Fever lasting 24-48 hrs - Malaise, headache, nausea and vomiting - Sore throat - Strawberry tongue - Fine punctate erythematous rash (sandpaper texture) appearing on torso first then spreading - Flushed appearance of face - with circumoral pallor
43
How is scarlet fever diagnosed?
Throat swab - but antibiotic treatment should begin immediately, not wait for the results.
44
Management of scarlet fever...
- Oral Pen V for 10 days - Penicillin allergy = azithromycin - Notifiable disease
45
Complications of scarlet fever...
- Otitis media = most common - Rheumatic fever - 20 days after infection - Post-streptococcal glomerulonephritis - 10 days after infection
46
What causes rheumatic fever?
Immunological reaction to strep pyogenes infection
47
How is rheumatic fever diagnosed?
Diagnosis is based on the Jone's criteria: Recent streptococcal infection along with 2 major criteria OR 1 major with 2 minor criteria... Major criteria: - Erythema marginatum = pink circles with clear centre (annular) found on trunk, upper arms and legs. Painless and may fade and reappear - Subcutaneous nodules = small lumps under the skin - Sydenam's chorea (rapid, uncoordinated jerky movements of limbs and trunk) - Polyarthritis - Carditis and valvulitis Minor criteria: - Raised ESR/ CRP - Fever - Arthralgia - Prolonged PR interval
48
What is the current UK immunisation schedule...
At birth = BCG (if risk factors for TB present) 2 months = 6 in 1 (diphtheria, tetanus, pertussis, polio, Hib and hep B), Rotavirus, Men B 3 months = 6 in 1 (diphtheria, tetanus, pertussis, polio, Hib and hep B), Rotavirus, PCV (pneumococcal) 4 months = 6 in 1 (diphtheria, tetanus, pertussis, polio, Hib and hep B), Men B 12-13 months = Hib/Men C, MMR , PCV, Men B 2-8 years = annual flu vaccine 3-4 years = 4 in 1 preschool booster (diphtheria, tetanus, pertussis, polio) , MMR 12-13 years = HPV vaccination 13-18 years = 3 in 1 teenage booster (tetanus, diphtheria and polio) , Men ACWY
49
What complications should parents be warned of with regards to vaccinations?
- Swelling/ discomfort at injection site - Mild fever/ malaise (if persisting >24hrs, seek medical advice) - Mild disease seen 7-10 days after measles/ rubella vaccination - Anaphylaxis - very rare - Pertussis can cause big swelling
50
General contraindications to immunisation...
- Confirmed anaphylactic reaction to a previous dose of a vaccine containing same antigens - Confirmed anaphylactic reaction to another component present in vaccine e.g. egg protein
51
Contraindications to live vaccines...
- Immunosuppression | - Pregnancy
52
Reasons to defer immunisation ...
- Acute febrile illness - Evolving neurological condition - specifically DTP (diphtheria, tetanus, polio) vaccine so new symptoms are not wrongly attributed to vaccine
53
What factors are NOT contraindications to immunisation?
- Asthma/ eczema - Afebrile minor illness - Febrile convulsions - give advice on antipyretics - Breastfeeding - Prematurity - no need to adjust immunisation schedule, should not be further delayed! - Neuro conditions e.g. cerebral palsy
54
Causes of meningitis in children..
0-3 months: - Group B strep - E. coli - Listeria monocytogenes 1 month -6 years: - N. meningitidis - Strep pneumoniae
55
Presentation of meningitis in children...
- Fever (absent in <3 months) - Severe headache - Bulging fontanelle - Non-blanching rash - Dislike of bright lights - Very sleepy - Confusion - Seizures
56
Investigations for meningitis...
- Lumbar puncture - contraindicated if raised ICP signs (papilloedema, bulging fontanelle) - Blood cultures - PCR
57
Management of meningitis...
1. <3 months = IV amoxicillin + IV cefotaxime >3 months= IV cefotaxime 2. Steroids (if >3 months) - dexamethsone if LP shows bacterial cause 3. Fluids to treat shock 4. Cerebral monitoring - mechanical ventilation if resp impairment 5. Abx prophylaxis of household contacts

Paediatrics (12 decks)

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