Over 100.4/38
Peds fever
- confirm rectally if under 2yo
- ask about vax status
Qs for peds fever
0-21 days = full sepsis workup CBC, blood cultures, UA +culture, HSV, LP (do
need procalcitonin/CRP bc doing full wo)
WO if fever in under 2mo
22-56 days = depends on lab results ... if abnormal UA or >1 inflammatory ma
(procalcitonin, CRP, ANC) .... get LP
-abx
treatment for infant 0-21 with fever - acyclovir (bc HSV encephalitis/meningitis is common)
- admit
56d-24mo
- asymptomatic, consider UTI
wo in fever if >2mo
>24mo presentation guides work up
for both they are most often viral illness or easy bacterial infxn
- all infants <21days
indications for HSV testing
- infants 22-56 with RF
, - maternal vesicles and/or fever 48hrs before delivery
- postnatal oral HSV exposure
- vesicles or mucous membrane ulcers
- seizure
RF for HSV infants
- hypothermia
- pleocytosis or RBC in CSF
- leukopenia
- thrombocytopenia
CSF and serum HSV PCR
how to test HSV
- if vesicles present, unroof them and test fluid via HSV PCR
MC bacterial pathogens in the blood e.coli > GBS > strep pneumo
MC bacterial pathogens in the urine e.coli > klebsiella > enterococcus & enterobacter
MC bacterial pathogens in CSF E.coli > GBS > strep. pneumo
- gram negative Bordetella pertussis
-catarrhal stage= cold sx
Pertussis (whooping cough)
- paroxysmal stage = cough followed by inspiratory whoop, and emesis
- convalescent stage = residual cough
diagnosis of pertussis PCR or culture from nasopharyngeal swab
, - macrolide abx
treatment for pertussis - treat all close contacts with macrolide prophylaxis
- DTap vaccine to prevent (and give mom Tdap during pregnancy)
- atypical bacteria spread via respiratory droplets
- causes community-acquired pneumonia in school aged/teens
Mycoplasma pneumoniae
"walking pneumonia"
- dry cough, low grade fever, sore throat
- lung wheezing or crackles or can be clear
- urticaira, erythema multiforme
Presentation of mycoplasma pneumonie
- otitis media, bullous myringitis
infxn
- hemolytic anemia
- encephalitis, meningitis
- myocarditis, pericarditis, arthritis
- usually clinical
diagnosis and tx of mycoplasma
- can get CXR, PCR, serology
pneumoniae
- tx = Azithromycin
Peds fever
- confirm rectally if under 2yo
- ask about vax status
Qs for peds fever
0-21 days = full sepsis workup CBC, blood cultures, UA +culture, HSV, LP (do
need procalcitonin/CRP bc doing full wo)
WO if fever in under 2mo
22-56 days = depends on lab results ... if abnormal UA or >1 inflammatory ma
(procalcitonin, CRP, ANC) .... get LP
-abx
treatment for infant 0-21 with fever - acyclovir (bc HSV encephalitis/meningitis is common)
- admit
56d-24mo
- asymptomatic, consider UTI
wo in fever if >2mo
>24mo presentation guides work up
for both they are most often viral illness or easy bacterial infxn
- all infants <21days
indications for HSV testing
- infants 22-56 with RF
, - maternal vesicles and/or fever 48hrs before delivery
- postnatal oral HSV exposure
- vesicles or mucous membrane ulcers
- seizure
RF for HSV infants
- hypothermia
- pleocytosis or RBC in CSF
- leukopenia
- thrombocytopenia
CSF and serum HSV PCR
how to test HSV
- if vesicles present, unroof them and test fluid via HSV PCR
MC bacterial pathogens in the blood e.coli > GBS > strep pneumo
MC bacterial pathogens in the urine e.coli > klebsiella > enterococcus & enterobacter
MC bacterial pathogens in CSF E.coli > GBS > strep. pneumo
- gram negative Bordetella pertussis
-catarrhal stage= cold sx
Pertussis (whooping cough)
- paroxysmal stage = cough followed by inspiratory whoop, and emesis
- convalescent stage = residual cough
diagnosis of pertussis PCR or culture from nasopharyngeal swab
, - macrolide abx
treatment for pertussis - treat all close contacts with macrolide prophylaxis
- DTap vaccine to prevent (and give mom Tdap during pregnancy)
- atypical bacteria spread via respiratory droplets
- causes community-acquired pneumonia in school aged/teens
Mycoplasma pneumoniae
"walking pneumonia"
- dry cough, low grade fever, sore throat
- lung wheezing or crackles or can be clear
- urticaira, erythema multiforme
Presentation of mycoplasma pneumonie
- otitis media, bullous myringitis
infxn
- hemolytic anemia
- encephalitis, meningitis
- myocarditis, pericarditis, arthritis
- usually clinical
diagnosis and tx of mycoplasma
- can get CXR, PCR, serology
pneumoniae
- tx = Azithromycin
