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Infectious Disease > Paediatric febrile illness > Flashcards

Paediatric febrile illness Flashcards

1
Q

List common causes of fever in children

A
  1. Self-limiting viral illness
  2. Teething (not above 38.5 deg)
  3. Post-immunisation (begins <24h post jab and lasts 2-3days)
  4. SBI - UTI, CAP, bacteraemia, meningitis
  5. Kawasaki’s disease
  6. Arthritis or connective tissue disorders
  7. Malignancies
  8. Drug fever
  9. IBD
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2
Q

What is the definition of PUO?

A

Fever of 10-21days duration without an identifiable cause on history, exam or basic investigations.

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3
Q

List the common causes of SBI in neonates <2mths old.

What is the empiric therapy for these patients?

A
  • E.Coli
  • Listeria (usually pre-d/c from hospital)
  • GBS
  • Cefotaxime 50mg/kg + Ampicillin 50mg/kg
  • If meningitis excluded (???) - Gentamicin 7.5mg/kg + Ampicillin 50mg/kg

Remember aciclovir if H. Simplex suspected:

  • Aciclovir 10mg/kg
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4
Q

List the common pathogens in septic kids 2mths and upwards.

What is the empiric therapy for these patients?

A
  • Neisseria meningitides
  • Strep pneumo
  • Staph aureus
  • GAS
  • MRSA
  • E.Coli
  • Salmonella

As per eTG - >2/12 sepsis, source not apparent:

  • Ceftriaxone 50mg/kg
  • +/- Vancomycin 30mg/kg (up to 1.5g) to cover MRSA
  • If critically ill, add Gentamicin 7.5mg/kg
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5
Q

Outline the traffic light system for the assessment of a febrile child.

A
  • NICE guideline
  • Uses the following categories to look for Low Risk, Intermediate Risk and High Risk factors:
    • Colour
    • Activity
    • Respiratory
    • Circulation
    • Other
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6
Q

Outline the approach to the febrile child with a petechial rash.

A
  • Is the child unwell?
    • Yes -> treat empirically w/ fluids + abs
    • No -> Does the child have purpura >2mm?
      • Is the presentation consistent w/ HSP?
        • Yes - D/c with early r/v as per HSV
        • No - Is there hx of mechanical cause - coughing, vomiting, trauma?
          • Yes - D/c after observation (4h) with early r/v
          • No - FBC, CRP Culture
            • Normal bloods - D/c after observation (4h) with early r/v
            • Abnormal bloods - Admit and treat
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7
Q

List common causes of a petechial rash in children.

A
  • Infective causes:
    • Viral illnesses - many, inc parvovirus B19, influenza, measels
    • SBI - Neisseria, strep, H. flu,
    • Riccketsia - QLD tick typhus
  • Mechanical
    • Coughing or vomiting
    • Tourniquet application
    • Strangulation
  • Haematological
    • Thrombocytopeania
      • ITP
      • Leukaemia
      • Hypersplenism
    • Platelet dysfunction
      • Drugs
      • Congenital
  • Vasculidites
    • HSP
    • Malnutrition - scurvy
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8
Q

Discuss the options for obtaining clean urine for analysis.

A
  • SPA - lowest contamination rate, high failure rate, invasive, utilised in <6/12 or anatmoical abnormality
  • In/out catheter - Invasive, high sens and spec, first line in >6/12, non-toilet trained kids
  • Clean catch - time and labor intensive, perineum should be cleaned, not suitable for toxic children
  • Mid-stream urine - in toilet-trained kids only
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9
Q

What are the indications for CXR as part of the septic screen in febrile paediatric patients?

A
  • IWOB
  • Cough
  • Tachypnoea
  • SaO2 <=93% on RA
  • T >39 + WCCs > 20 (occult pneumonia)
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10
Q

What are the indications for LP in the febrile child?

A
  • Suspected meningitis or encephalitis
    • Febrile neonates <3/12
    • Infants <3/12 with suspiscion of CNS infection
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11
Q

What are the contraindications for LP?

A
  • Sick child
    • Reduced LOC
    • Signs of raised ICP
    • Cardiovascular compromise
    • Respiratory compromise
    • Focal neuro signs
    • Seizures now or <30mins ago
  • Coagulopathy
  • Local infection overlying the site
  • Fever + purpura in likley meningitis
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12
Q

What is the Paediatric Assessment Triangle?

A

The Tool assesses 3 aspects of a child’s presentation to determine whether it is “well looking” or “sick”.

  • Appearnce
  • Work of breathing
  • Circulation
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13
Q

What is the treatment of paediatric hypoglycaemia?

A

The rule of 50.

  • Adult - 1ml/gk of 50% dextrose (1x50=50)
  • School age - 2ml/kg of 25% dextrose (2x25 = 50)
  • Infants - 5ml/kg of 10% dextrose (5x10 = 50)
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14
Q

What are the Rochester Criteria?

A

The Rochester Criteria are used to predict infants 0-60days that are low risk for SBI.

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15
Q

What are the Step By Step criteria?

A

The Step-by-Step Criteria for the febrile infant assesses the risk of SBI in infants 21-90days old.

  • Well looking? Paediatric Assessment Triad
  • Urine WCCs?
  • Procalcitonin? >0.5ng/ml
  • CRP >20 or Neutrophils > 10

If all are negative:

  • Sensitivity of 92%
  • NPV (Rule-out) 99.3%
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Infectious Disease (2 decks)

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