This document discusses fever of unknown origin (FUO) in children. It defines FUO as a fever over 38°C that cannot be explained after 3 weeks of outpatient evaluation or 1 week of inpatient evaluation. Potential causes are divided into infectious and non-infectious categories. A thorough history, physical exam, and targeted investigations are important to identify the cause. Based on patient location and immune status, FUO can be further classified as classic, healthcare-associated, immune deficient, or HIV-related FUO. The most common causes vary according to these classifications.
Approach to a patient with fever of unknown origin sunil kumar daha
Please find the power point on Approach to a patient with fever of unknown origin . I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Approach to a patient with fever of unknown origin sunil kumar daha
Please find the power point on Approach to a patient with fever of unknown origin . I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Dr. Theoklis Zaoutis - Antimicrobial Use and Stewardship in the Pediatric Out...John Blue
Antimicrobial Use and Stewardship in the Pediatric Outpatient Setting - Dr. Theoklis Zaoutis, Chief, Division of Infectious Diseases, Professor of Pediatrics and Epidemiology of the University of Pennsylvania, from the 2014 NIAA Symposium on Antibiotics Use and Resistance: Moving Forward Through Shared Stewardship, November 12-14, 2014, Atlanta, Georgia, USA.
More presentations at http://www.swinecast.com/2014-niaa-antibiotics-moving-forward-through-shared-stewardship
Fever and Hyperthermia and Pyrexia of unknown origin by Dr Mohammad Hussien for Medical Student .
Ass.Lecturer of Hepatogastroentrology at Kafrelsheikh University.
Pyrexia of unknown origin (PUO) may be defined as any febrile illness (temperature greater than 38°C) lasting 3 weeks or longer, without any obvious cause and failure to reach a diagnosis despite one week of inpatient investigation.
In these conditions there is thus a special need for a lab diagnosis
to guide the choice of
appropriate therapy.
Fever ≥ 38.3°C (>101°F) on several occasions
The syndrome of pyrexia of unknown origin (PUO) was first defined in 1961 but remains a clinical challenge for many physicians. Different subgroups with PUO have been suggested, each requiring different investigative strategies: classical, nosocomial, neutropenic, and HIV-related. This could be expanded to include the elderly as a fifth group. The causes are broadly divided into four groups: infective, inflammatory, neoplastic, and miscellaneous. Increasing early use of positron emission tomography–computed tomography (PET-CT) and the development of new molecular and serological tests for infection have improved diagnostic capability, but up to 50% of patients still have no cause found despite adequate investigations. Reassuringly, the cohort of undiagnosed patients has a good prognosis. In this article we review the possible aetiologies of
The definition of pyrexia of unknown origin (PUO) dates back to 1961; it was described as a persistent fever above 38.3°C (100°F) that evades diagnosis for at least 3 weeks, including 1 week of investigation in hospital. PUO and present a systematic clinical approach to the investigation and management of patients, recommending potential second-line investigations when the etiology is unclear
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
2. NORMAL BODY TEMPERATURE
• The hypothalamus is the heat-regulating center of
the body
• The normal body temperature ranges from 37.0
degree C and 37.5 degree C
• Evening temperatures being 0.5 degree C higher
than in the morning.
• Rectal temperature>oral temperature (0.4 degree C)
>axillary temperature (1 degree C)
3. • A rectal temperature with a glass- mercury or
digital-electronic thermometer is considered the
gold standard for taking temperatures
• Liebermeisters rule -The pulse rate rises about 15
beats/min for each degree centigrade rise of fever
4. FEVER
• Fever is a controlled increase in body
temperature above the normal hypothalamic
set point
• A rectal temperature of 38 degree C or more
(100.4 degree F)
• A temperature of 40 degree C or more is
termed as hyperpyrexia
8. PATTERNS OF FEVER
Intermittent fever - Fever that touches the
baseline for a few hours during the day.
• Seen in malaria, acute pyelonephritis, local
boils,furuncles,kala azar,sepsis
9. • Types of intermittent fever :
- Quotidian fever, with a periodicity of 24 hours,
typical of Plasmodium falciparum
- Tertian fever,with a 48 hour periodicity,typical
of Plasmodium vivax or Plasmodium ovale
-Quartan fever,with a 72 hour periodicity,typical
of Plasmodium malariae
10.
11. Remittent fever - Fever that fluctuates by more
than 1.5 degree F but never touches the baseline
in 24 hours
• Seen in infective endocarditis
12. Continuous fever - Fever that never touches the
baseline in 24 hours and fluctuates by less than
1.5 degree F in a day.
• Seen in enteric fever,lobar
pneumonia,brucellosis,typhus.
13.
14. Pel-ebstein fever - Fever lasting for 3-10 days
followed by an afebrile period of 3-10 days
• Seen in hodgkins lymphoma
15. CLASSIFICATION OF FEVER
Fever with focus Fever without focus
Fever
without
localizing
signs
Fever of
unknown
origin
( refers to a rectal
temperature of 38 degree
C or higher as the sole
presenting feature)
16. FEVER OF UNKNOWN ORIGIN
• Children with fever,documented by a health care
provider,for which cause could not be identified
even after 3 weeks of evaluation as an outpatient
or after 1 week of evaluation in the hospital
17. CLASSIFICATION
• 4 categories :
1. Classic FUO
2. Health care associated FUO
3. Immune deficient FUO
4. HIV – related FUO
18. CLASSIC FUO
• Definition: fever of > 38 degree C ,lasted for > 3
wks, >2 visits or 1 wk in hospital
• Patient location : community , clinic or hospital
• Leading causes : cancer , infections , inflammatory
conditions, undiagnosed , habitual hyperthermia
• History emphasis : H/O travel , contacts , animal &
insect exposure , medications , immunization ,
family history , cardiac valve disorder
19. • Examination emphasis : oropharynx , temporal
artery , abdomen , lymph nodes , spleen , joints ,
skin , nails , genitalia , lower limb deep veins .
• Investigation emphasis : Imaging , biopsies ,
erythrocyte sedimentation rate , skin test
• Management : Observation , outpatient
temperature chart , investigations , avoidance of
empirical drug treatment
• Time course of disease : For months
20. HEALTH CARE ASSOCIATED FUO
• Definition : Fever of > 38 degree C ,lasted for > 1
week , not present or incubating on admission
• Patient location : Acute care hospital
• Leading causes : Hospital acquired infections ,
post- operative complications , drug fever
• History emphasis : Operation & procedures ,
devices used , anatomic considerations , drug
treatment
21. • Examination emphasis : Wounds , drains , devices
, sinuses , urine
• Investigation emphasis : Imaging , bacterial
cultures & other microbiological investigations
• Management : Depends upon situation
• Time course of disease : Lasts for weeks .
22. IMMUNE DEFICIENT FUO
• Definition : Fever of > 38 degree C , lasted for
> 1 wk & negative culture after 48 hrs
• Patient location : Hospital or clinic
• Leading causes : Majority are due to
infections but cause has been documented in
only 40-60%
• History emphasis : Stage of chemotherapy ,
drugs administered , underlying
immunosuppressive disorders
23. • Examination emphasis : Skin folds , IV sites ,
lungs, perianal area
• Investigation emphasis : Chest radiograph ,
bacterial cultures
• Management : Antimicrobial treatment
• Time course of disease : Lasts for days .
24. HIV – RELATED FUO
• Definition : Fever of >38 degree C , >3 wks for
outpatients , >1 wk for inpatients & HIV infection
confirmed
• Patient location : Community , clinic or hospital
• Leading causes : HIV (primary infection) , typical
& atypical mycobacteria , CMV , toxoplasmosis ,
cryptococcosis , lymphomas , immune
reconstitution inflammatory syndrome (IRIS)
• History emphasis : drugs,exposures,risk
factors,travel,contacts,stage of hiv infection
25. • Examination emphasis : Mouth , sinuses , skin ,
lymph nodes , eyes , lungs,perianal area.
• Investigation emphasis : Blood & lymphocyte
count , serologic tests , chest X-ray , stool
examination, biopsies of lung , bone marrow &
liver for cultures and cytologic tests , brain
imaging
• Management : Antiviral & antimicrobial
protocols , vaccines , revision of treatment
regimen , good nutrition
• Time course of disease : Lasts for weeks to
months
26. CAUSES OF PUO
•Infectious causes • Non infectious causes
Infectious causes
-> Bacterial –
salmonella,brucellosis,meningococcal,mycoplasma
pneumonia,TB,actinomycosis
-> Sphirochaetal -B burgdorferi ,leptospirosis ,relapsing
fever,syphillis
-> Parasitic-
amoebiasis,giardiasis,toxoplasmosis,babesiosis,malaria
-> Fungal-blastomycosis,histoplasmosis,coccidiodomycosis
27. -> Chlamydial -lym venereum,psittacosis
-> Rickettsial -Q fever,tick borne typhus,rocky
mountain spotted fever
-> Viruses –CMV,HIV,hepatitis
-> Local septic infection -dental abscess,subphrenic
abscess,sinusitis,tonsillitis,hepatic
abscess,bronchiectasis,mastoiditis
-> Local infection without pus formation -
UTI,ulcerative colitis ,diverticulitis,phlebitis,regional
enteritis
29. HISTORY
History should be taken from the child or reliable
informant
• AGE
-> 1-5 yrs - common causes are RTI,UTI,diarrhoea and
osteomyelitis
->5-10 yrs-measles,mumps,chicken pox,typhoid
->10yrs- TB, typhoid ,rheumatic fever
• GENDER -> Females-urinary tract infections,pelvic
infections
-> Males-allergic fever(hay fever), typhoid ,
tuberculosis,malaria
30. • ADDRESS -> endemic regions for malaria and
japanese encephalitis,epidemics,out breaks in
that area
• CHIEF COMPLAINTS -> History of fever and
other symptoms should be taken in
chronological order,give clue towards system
involved
eg:-
fever,dysuria ,loin pain –UTI
fever ,drowsiness ,convulsions - meningitis,
encephalitis
34. • PROGRESSION -> Viral fever peaks in 2 days and declines
-> Bacterial fever worsens day by day without treatment
-> Parasite fever like malaria shows cyclical cold,hot and
sweating stages.
• TYPE -> Continuous-Pneumonia ,uti
-> Remittent-Viral, collagen vascular diseases
-> Intermittent - Malaria , Brucellosis
-> Step ladder fever-Typhoid.
• Associated with ->
Chills and rigors- Malaria,brucellosis ,otitis media
Myalgia- brucellosis,dengue,bartonellosis
Sweating-Meningitis , TB ,Bacteraemia ,Malaria
35. • History of travel to endemic areas,how long,any
precautions.
• Epidemics in resident area
• Pets - toxoplasmosis,visceral larva migrans
• Contact with animals – leptospirosis,brucellosis
• Tick bites-relapsing fever, Q fever
• Blood transfusion - malaria,hepatitis-B
• Migrating joint pains - Rheumatic fever
• Loss of weight-malignancies
• History of recurrent fever,oral thrush -
immunocompromised
• Joint pains,rash,photosensitivity - autoimmune
36. • Past history - of surgeries(occult infection)
• Family history - similar complaints suggest
infectious disease,genetic background-familial
dysautonomia(recurrent hyperpyrexia)
• Personal history - diet -> unpasteurized
milk(brucellosis,TB),raw egg (salmonella)
• Loss of appetite - malignancies ,TB
• Immunization history - vaccination induced
fever. e.g,DPT,measles
• Treatment history - drug induced fever
37. PHYSICAL EXAMINATION
• Careful and complete examination
• Repetitive examination to pick up subtle or new
signs
• Look for the child’s general appearance, built and
nourishment,
for temperature pattern ,
pulse rate –relative bradycardia in typhoid, meningitis
dengue,
Skin – look for rashes , petechiae, splinter
hemorrhages, subctaneous nodules
39. Tenderness to tapping over sinus – sinusitis
Oral cavity - Hyperemia of pharynx
Tender tooth –> periapical abscess
Recurrent oral candidiasis –> disorder of immune system
Neck - Enlargment or tenderness of thyroid gland –> thyroiditis
Heart- Murmur –> infective endocarditis
Abdomen –
Splenomegaly –> malaria, kala azar , CML
Abdominal tenderness -> pelvic abccess
Loin tenderness -> pyelonephritis
Hepatomegaly- > liver abscess , primary or metastatic malignancy
40. Muscle and bone –
Point tenderness- occult osteomyelitis or bone
marrow invasion from neoplasms
Painful and swollen joints – arthritis –> rheumatic
fever
Rectal examination – pelvic abscess,adenitis
41. INVESTIGATIONS
• On IP or OP basis,
determined on a case by case basis,
OP if chronic
• CBC,DC
• Urine analysis
• Blood smear
• ESR
• Serologic tests
• Tuberculin test
• Blood and urine culture
• Bone marrow examination( aspiration and biopsy)
• Xray ,2D ECHO,USG,CT , MRI , Radionuclide scans
43. BLOOD SMEAR -> WITH GIEMSA
OR WRIGHT STAIN
MALARIA
TRYPANOSOMIASIS
RELAPSING FEVER
BABESIOSIS
44. ESR >30 mm ->
inflammation -> further
evaluation
ESR >100 mm ->
TB/malignancy/autoimmune/
kawasaki disease
45. • BLOOD CULTURES –
- Normally aerobic culture is done as anaerobic
culture gives low yield
- Repeated culture done in case of infective
endocarditis and osteomyelitis
- Poly microbial infection suggests GI infection.
• RADIOLOGICAL EXAMINATION –
of sinuses,mastoid,GIT,chest
• SEROLOGIC TESTS – widal test,ANA,RF,
for inf mononucleosis,cmv,brucellosis,toxoplasmosis
46. • RADIONUCLEIDE SCANS - These are mainly
helpful in detecting abdominal abscess &
osteomyelitis and in multifocal disease.
• ECHOCARDIOGRAPHY - detects vegetations on
valve leaflets in infective endocarditis
• ULTRASONOGRAPHY detects intra- abdominal
abscesses of liver and spleen
• CT SCAN AND MRI - detection of neoplasms,CT
scan guided aspiration and biopsy,MRI for
detecting osteomyelitis
47.
48. FEVER WITHOUT LOCALIZING SIGNS
• Fever of acute onset,with duration of <1 wk and
without localizing signs is a common diagnostic
dilemma in children < 36 months of age .
• Etiology and evaluation of this type depends
upon age of the child
• 3 age groups are considered :
I. Neonates
II. Infants > 1 month to 3 months of age .
III. Children > 3 months to 3 yrs of age .
49.
50.
51. NEONATES
• Neonates having fever without focus show limited
signs of infection -> difficult to clinically distinguish
between a serious bacterial infection & self limited
viral illness
• Every febrile neonate has to be hospitalized
• 7% risk of having serious bacterial infection
(sepsis,meningitis,UTI,enteritis,osteomyelitis,
pneumonia,septic arthritis)
• Organisms responsible - Group B streptococcus &
Listeria(Late onset sepsis & meningitis) ,
Ecoli,HSV,Enterovirus
52. • Blood ,urine ,CSF should be cultured
• CSF study should include cell counts, glucose,
protein levels,gram stain & culture
• HSV & Enterovirus polymerase chain reaction
• Stool culture,chest radiograph
• Combination antibiotics- ampicillin and
cefotaxime is recommended,
acyclovir if HSV is suspected.
53. 1 MONTH TO 3 MONTHS
• Majority of the cases are of viral origin
• Respiratory syncytial virus and influenza A in
winter season
• Entero virus in summer
54. • Also suspect serious bacterial infections
• Common bacteria : Group B
streptococci,listeria,salmonella
enteritis,ecoli,pneumococus,meningococcus,
hiB,staph aureus
• Common conditions : Pyelonephritis > Otitis media
> Pneumonia > Skin and soft tissue infections
• Based on blood ,urine ,CSF cultures,these infants
are classified in to low and high risk groups
55.
56.
57. •With out
antibiotics
under close
observation
• Empirical
antibiotic
therapy
• Ampicillin plus
either ceftriaxone/
cefotaxime
• If CSF shows
abnormal findings,
vancomycin
included against
penicillin resistant
S.Pneumoniae
LOW RISK HIGH RISK
58. 3 MONTHS TO 36 MONTHS
• 30% of these infants with fever have no
localizing signs of infection
• Majority are viral but serious bacterial
infection do occur
• Pathogens are same as in 1 to 3 months of age
• S.pneumoniae,meningococcus,salmonella,hiB
account for most of occult bacteremia
59. • Risk factors indicating occult bacteremia
1.temperature >39° c
2.WBC count >15000/micro litre
3.elevated ANC,band count
4.elevated CRP
5.elevated ESR
• It may resolve spontaneously without sequelae
or can lead to localized infections like meningitis,
pneumonia etc
60. • Management :
Child 3-36 mo and temperature
38-39 ° C
Reassurance that diagnosis is
likely self-limiting viral
infection, but advise return if
fever persists,temperatures >
39 ° C and
new signs / symptoms
Child 3-36 mo and temperature
> 39 ° C
-Hospitalization and prompt
antimicrobial therapy based on
the blood, urine ,CSF cultures
• Immunize against Hib and S.pneumoniae with
conjugate vaccine
If these measures are insufficient to make the blood temperature in the brain match the new setting in the hypothalamus, then shivering begins in order to use muscle movements to produce more heat. When the fever stops, and the hypothalamic setting is set lower; the reverse of these processes (vasodilation, end of shivering and nonshivering heat production) and sweating are used to cool the body to the new, lower setting.
Is a term applied to……….Petersdorf and Beeson Criteria- Fever higher than 38.3oC on several occasions.Duration of fever – 3 weeks.Uncertain diagnosis after one week of study in hospital