Fever
Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat
Case 1: 7 months old girl
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3 days fever
General condition worsening last 2 days
Sleepy, but gives good contact when awake
Eats less than usual, but drinks OK and has wet
dipers
• No rhinorrhea, coughing, vomiting or diarrhea
• Previously healthy
Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat
Examination
• Sleeps initially, but wakes up and gives contact
• No smile, uncomfortable, but the mother is able to
calm her
• Skin color and turgor normal. Mucus membranes wet
• Tonus OK
• Capillary refill time 2 sec
• RR 45, HF 160, T 39,5, SaO2 95%
• Auscultation: normal heart and lung sounds
Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat
Lab
• CRP 235
• Urine bag sample: leukocytes +++, blood +, protein
+, nitritis –
• Catheter sample confirms the results, with positive
microscopi
Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat
Management
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Diagnosis?
Admit to hospital?
Other solutions?
Follow up?
Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat
Urinary Tract Infections
Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat
History
• General condition
– Feeding
– Consciousness
– Hydration (diuresis)
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Fever
Focal infectious symptoms?
Vomiting
Previous history: ultrasound during pregnancy
Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat
Clinical examination
• Typically no focal signs of infection
• General appearance – septic?
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Respiratory frequence
Heart Rate
Capillary refill time
Skin colour
Consciousness
Activity
Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat
Laboratory investigations
• Urine sample
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Leukocytes sensitive, nitritis specific
Collection bag sample can only be used to exclude UTI!
Midflow sample, catheter or bladder puncture
Microscopy
Urine culture
• Blood sample
– CRP, WBC, kreatinin, Na, K, Hb, urea, blood gases
– Blood culture
Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat
Imaging
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Chest x-ray?
Ultrasound
Voiding cystourethrogram
DMSA
– Scintigraphy
– Acute diagnostic of pyelonephritis and chronic renal scarring
Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat
Treatment
• Oral
– Mecillinam, Trimetoprim-sulpha, (3rd gen cefalosphorin),
(Amoxicillin-clavulanate)
• i.v
– ampicillin-gentacimin, mecillinam, cefotaxim
Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat
Risk factors
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<6months
Septic
No effect of treatment within 48 hours
Pathologic prenatal ultrasound
Residiving pyelonephritis
Non E.coli
Unusual presentation (older boys)
Heredity for vesikuloureteral reflux
High kreatinin or BP
Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat
Case 2: 2 months old boy
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High fever 1,5 day
No vomiting or diarrhea
Eats ok, diuresis normal
General condition slightly reduced, more sleepy
Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat
Examination
• No smile, but excellent contact. Good activity
• No focal signs
• Auscultation: normal
Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat
Lab:
• CRP 131
• Urine sample (mid flow): Leukocytes 3+, blood 2x,
protein 2+, nitritis +
• Admit to hospital?
Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat