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78 Cards in this Set
- Front
- Back
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what is the def of a fever?
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rectal temp of 38C or 100.4 or higher
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what is good about a fever?
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the body's adaptive response to infectious and noninfectious inflammatory challenges
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__% of of children visit a physical for a febrile illness
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65
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Fever without a source accounts for as many as __ of the yearly office visits
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50
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a __ % of children with fever will have a SBI
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small
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what is FUO>
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fevers lasting > 10 days - 2 weeks with no identifiable cause
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what is the incidence of FUO>
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20% of febrile children
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what are the organisms responsible for SBI in infants < 3months old?
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GBS, e coli, Strep pneumo
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what are the organisms responsible for infection in older infants and children?
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strep pneumo, H flu, N meingitidis, klebsiella and staph, enterococcus, e coli, GAS and GBS, salmonella in sicklers and psuedomonas in sicklers
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What is FWLS?
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fever with no identifiable source of infection after thorough hx and physcial exam are obtaines
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what is the temperature that requires further evaluation if developed in children 3-36 months and previously healthy?
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102.2
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why are people so afraid of fever?
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could be a sign of serious infection, younger children at higher risk, absence of other s/s make dx difficult, abx resistance
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1 in ___ acutely ill, non toxic appearing children with have unidentifiable source of fever
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5
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about __ to __ % of kids < 36 months have occult bacteremia and SBI?
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1.6-1.8
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what are the uncovered myths about fevers?
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physiologic response of the body to infection; usually benign illness; SBI and occult bacteremia is rare due to effective immunizations; common occult SBI: UTIs, meningitis, pneumonia; symptoms are not a disease
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what is occult bacteremia?
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presence of pathogenic baceria in the blood of a febrile child without focus on infetion or signs of sepsis
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what is the general approach to tx fever without source if chld is < 3 months?
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screening labs, admission, empiric abx started
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what is the general tx for children 3-36 months with fever wihtout a cause>
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tep > 39; CBC, US, abx If wbc > 15,000
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for a baby under 18 months with temp of > 39.5, what are the tests to be done and the tx?
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CBC, bld cx, US and Ucx. Give Abx for wbc . 20000 (ceftriazone 50mg/kg)
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the addition of pneumococcal vaccine has decreased the infection of child < 5 by ___, < 2 years by ___ and for 24-35 month olds by ___
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59, 69, 44
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what is the currrent approach for any infant under 29 days old that appears toxic?
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complete sepsis workup and admitted for observation until the culture results are obtained and the source of fever is found
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what is the workup for an infant < 29 days old with fever?
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cbc, blood culture, urine cx, LP, chem, CXR
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what are the prerequisites for FWLS?
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temp >38, well appearing, no obvious focal infection, previously healthying (including birth hx), not on abx
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what are the key history questions for an infant with fever?
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vaccinations, sick contacts, recent symptoms, birth hx, maternal hx (GBS, herpes), how high was the fever and how was it recorded?
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what are the key things to look for in the PE for a baby with fever?
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vitals, PO2, weight, cyanosis, lethargy, toxic, poor feeding, hypoventilation, poor tone, perfusion, tachycardia
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what did the study show were the predictive facotrs of occult bacteremia or bacterial meningitis?
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toxic appearance in under 30 days old, and rectal temp of 103, 39.4
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ToF: a baby with fever and a smile can be thought to not have bacteremia
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FALSE
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what are the risk factors for OB/SBI?
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age of infant, height of the fever, petechiae, immune deficiency, WBC >15K or bands >1K, toxic appearing
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if a child has wbc > 15k and bands >1K, they have a __ fold increase risk for OB.
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5
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what is the rochester criteria for low risk OB/SBI patients?
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Temp > 38, term, well appearing, secure f/u; WBC bertween 5-15K; bands < 1500; UA with < 10wbc; no evidence of ear, soft tissue or bone infection
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what is the modified rochester criteria?
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has the added criteria of diarrhea, if present and has < 25 WBC on stool smear they are low risk.
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what is the CHOP low risk criteria for SBI?
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temp > 38.2, well appearing low IOS; WBC < 15K BNR < 0.2; US with < 10 WBC; CSF with < 8 WBC and -gram stain; neg CXR
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ToF: febrile neonates can be screened as low risk with The CHOP criteria with success
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false, febrile neonates are different (3-28 days old)
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what is the BCH low rist criteria?
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T > 38; presence of secure f/u; WBC < 20K; CSF WBC < 10; UA dip with - lueks; all pts were treated with cefriaxone
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what is the yale observation scale scoring?
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A: quality of cry; B: reaction to parents; C: state variation; D: Color; E: hydration; F: social response
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what is the interpretation of the yale observation scale?>
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score 10: incidence of SBI is 2.7%; score 11-15 incidence is 26%; Score >16 incidence of SBI is 92.3%
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what groups are commonly affected by UTIs?
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females and uncircumcised males
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ToF: there is an equal gender incidence of UTIs under 3 months of age
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TRUE
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which groups over age 3 months is likely to get UTIs
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females
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the incidence of UTI is as high as 15.5% in __ __ under 24 months with a temp of >or= to ___
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white girls; 39
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what are the acceptable means of getting a urine specimen to be cultured?
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suprapubic aspiration; catheterization; clean mid stream void (only older children)
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what specimens are never acceptable for culture?
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bagged specimen
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ToF: a negative UA rules out UTI
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FALSE
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ToF: the gram stained smear of urine sediment is not a sensitive screen for UTI
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false it is
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what is the gold standard for dx UTI?
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urine culture
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nitrite levels in UA have high ___ but a poor __-
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specificity; sensitivity
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ToF: a routine UA is sensitive enough to use as a screening tool for UTI?
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FALSE
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what number of organisms are needed from a clean catch, straight cath and SPA to determine UTI?
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100K; 10K and 1K
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what is the false positive rate from bag specimen urine?
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85%
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what has the highest sensitivity for detecting UTI?
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gram stain for bacteria on uncentrifuged urine
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what is looked at with LPs?
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cell count, gram stain, cluc/protein; Cx
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when are chest xrays indicated?
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when pt has tachypnea; retractions; focal auscultatory findings or PO2 level of less than 95%; or if they have wbc> 20K or rectal temp > 102.2
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which group of children has the highest risk for fevers?
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neonates (0-28days)
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what should be done with febrile neonate when hsv suspected?
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hsv PCR
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what are the IV antibiotics to give febrile neonates?
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ampicillin and cefotaxime
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how long do febrile neonates get observed during admission for fever?
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48 hours or until source is found
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what is option 1 for management of neonate (29-90days) with fever?
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cbc, bld cx, csf, UA, Ucx; if wbc <15K and anc<10K then give ceftriaxone 50mg/kg fu in 24 hours
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what is management option 2 for neonate (29-90days) with fever?
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cbc, UA, Ucx. No bld Cx, CSF; no abx; parents carefully observe child at home and re-examine in 24 hours. Must have reliable parents
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ToF: LPs are often needed for children 3-36 months with fever
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FALSE
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what is the most common cause of OB in age 3-36 months
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UTI
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what is meningitis?
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inflammation of membranes surrounding the brain and spinal cord
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what is the morbidity and mortality of meningitis in neonate? In infants and children? What is the sequelae %?
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20%; 5-10% (shock=90%); 25-50%
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what are the organisms to cause meningitis in the neonate?
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GBS, ecoli, listeria, HSV, enterovirus, CMV
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what are the organisms to cause meningitis in the 1-3 month old?
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strep pneumo, N. meningit, GBS, e coli, HSV, entervoirus
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what are the organisms to cause meningitis in the 3month-3 yr old?
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s pneumo, n. mening, H flu, enterovirus, arbovirus, hsv
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what cases meningitis in the 3-21 yr old?
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entero, arbovirus, hsv; s pneumo, N. meningitides
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what are the classic clinical manifestations of meningitis?
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fever, headache, neck pain, stiffness, NV, photophobia, irritiability
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what are the infant sxs of meningitis?
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irritability, solmnolence, bulging fontanelle, low grade fever
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what are the PE findings for meningitis?
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nuchal rigidity; kernig's sign; brudzinskis sign(neck flexion=hip flexion); seizures; SIADH;
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what shoud be done with pt with suspected meningitis and evidence of increased ICP or papiledema?
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get CT first then give Abx
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what is checked in the csf for possible meningitis?
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pleocytosis; decreased glucose; elevated protein; gram stain - for bacteria
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what are the neonate symptoms of herpetic meningitis?
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irritability and seizures
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what are the signs of herpetic meningitis in older children?
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bell's palsy and trigeminal neuralgia
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what are the empiric abx to give for suspected bacterial meningitis for the neonate?
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amp and cefotaxime
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what are the abx to give a 4-8 week old with suspected bacterial meningitis?
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amp and cefotaxime or ceftriaxone
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what are the abx to give a child > 8 weeks with suspected bact meningitis?
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ceftriaxone or cefotaxime
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what are the symps of kawasakis?
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fever for at least 5 days; and four of the five (bilateral bulbar conjunctivitis; mucosal changes; erythema, edema of ext periungual desquamation; rash; cervical adenopathy >1.5cm often unilateral)
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what is the tx for kawasakis?
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admit; O2 if needed; IVIG 2gm/kg x1; aspirin
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