84 Febrile Children in the Tropics

Shunmay Yeung 12/11/18

How do you measure fever in kids? Axillary, or chemical dot strips on forehead in < 1 month

Risk Factors for Kids:

  • Age (neonates are so different to kids)
  • Local Epidemiology (Geography + Season)
  • Host Immunity (Immunisations, HIV, Nutrition, Sickle Cell)
  • Family contacts, animals
  • Intake
  • Insect bites
  • Water Exposure

Why does sickle cell act as risk for infection : Functionally Asplenic, Also increased risk of osteomyelitis

Why might parents treat kids with antimalarials and abx in the community : Drugs are cheaper than doctors, drugs are more accessible than doctors, drugs are closer than doctors (geographically)

What do most parents in tropics do prior to seeking doctor : Treat themselves with

What do most tropical health health centres use to assess manage kids: Integrated management of childhood illnesses (IMCI)) (Syndromic approach with triage and key symptoms, splits into neonates and kids

What does the IMCI (Integrated management of childhood illnesses) start with? : Danger Signs Triage, identify sick kids

What first syndrome does the IMCI (Integrated management of childhood illnesses) evaluate with kids (after danger signs)? : Fever, then recommends Malaria RDT

What’s the unexpected problem with the increase in use of malaria RDTs when evaluating sick kids: More antibiotics given! (More negative RDTs = More abx prescribed for other cause)

What do WHO recommend for documentation for kids to have and doctors to use? : Child Health Record

What is the Child Health Record? : WHO recommended: growth chart, immunisations, maybe hospital visits

What is the common differential / serious differential for 10 months with fever: Malaria, Meningitis, Pneumonia, URTI, Urine, Viral, Typhoid, Systemic Infection

When is it safe to perform a lumbar puncture? : SAFE **Seizures, Additional Factors (Shock, Unstable, Coag Disorder), Focal Neuro Signs, E*xpressive (Deteriorating Conscious Level) - But also, if they’ve an open fontanelle it’s generally always safe if there’s no SOL on CT

Which three main tests would you want for kids with fever to catch common/important causes? : RDT, Urine, LP

Why is it important to catch urine infections in kids? : Invasive, can have long term consquences with renal failure from scarring

Difference in mortality in kids admitted with and without bacteraemia: Bacteraemia = 1/3 deaths. No bacteraemia = 1/20 deaths

Top causes in under 5 mortality globally: Pneumonia (15%), Diarrhoea, Injury (5%), Malaria (5%)

Generic first line abx for kids presenting with fever : Ceftriaxone (once a day, easy, covers loads)

clarify this one: Initial steps for kids with fever: Paracetamol, Check Glucose, Early Abx, Repeat Review

clarify this one: What organisms cause meningitis in kids (and neonates) in ten months globally : Hib (should be down with vaccines), Strep Pneumoniae (should be down with vaccines), Gram Negatives in neonates

What should you think if are patients not getting better with abx (Surgical Sieve) : Right bug, but problem with the drug? (virulent forms, resistance, dose, adherence, absorption, penetration) Wrong bug? (atypical, TB, parasite, fungal) Problem with host? (Immunity, Structural problem like fistula, Foreign Body)

How long should you give abx before starting to think again? : 48 hours

Fever, Rash, Conjunctivitis, Sore Throat in kid, what should you think? : MEASLES, Group A Strep, Adenovirus, Parvovirus, Arbovirus

Complications of measles : Pneumonia, Encephalitis, Blindness, Otitis

Risk Factors for measles? : Age < 5, Malnutrition, HIV/AIDS, Crises

Treating measles? : Treat complications Vitamin A

Complications group A strep? : Acute Rheumatic, Chronic Cardiac, Chronic Glomerulonephritis, Sepsis

How do you treat Group A Strep : 10 Day penicillin

How do you dx group A strep? : Clinical dx, throat swab (rapid strep A test)

Painful Joints and legs and Fever, multiple episodes, think : Bacterial Infection, Juvenile Idiopathic Arthritis, Malignancy

Why do you get vitamin A in measles? : Measles makes you vitamin A deficient. Vitamin A deficiency increases risk of complication (pneumonia, eye) and deaths