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Pediatrics(2)

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-Cause

-- Bacteria (Salmonella typhi)

-Signs and Symptoms

-- Fever and malaise

-- dull frontal headache

-- Poorly localized abdominal discomfort

-- Anorexia, nausea and diarrhea or constipation

-- A coated tongue, tender abdomen, hepatomegaly, and

-splenomegaly are common

-- Febrile convulsions

-- Jaundice may occur

-Note: There is no thyphoid fever without fever or hypothermia in infants!!!

-Diagnosis

-- On examination, key diagnostic features of typhoid are:

-• Fever with no obvious focus of infection

-• No stiff neck or other specific signs of meningitis, or a

-lumbar puncture for meningitis is negative (note: children

-with typhoid can occasionally have a stiff neck)

-• Signs of systemic upset, e.g. inability to drink or breastfeed,

-convulsions, lethargy, disorientation/confusion, or

-vomiting

-• Rose spots on the abdominal wall (in light-skinned

-children)

-• Hepatosplenomegaly, tense and distended abdomen

-Typhoid fever can atypically be present in young infants

-as an acute febrile illness with shock and hypothermia. In

-areas where typhus is common, it may be very difficult to

-distinguish between typhoid fever and typhus by clinical

-examination alone. The differential diagnosis is broad and

-includes malaria, amebiasis, dengue fever, leishmaniasis, and other causes of bacterial gastroenteritis.

-Diseases

-Complications

-- GIT: gastrointestinal bleeding, intestinal perforation, abdominal

-mass due to abscess formation

-- CVS: Asymptomatic electrocardiographic changes, myocarditis, shock

-- CNS: Encephalopathy, delirium, psychotic behaviour, meningitis, impairment of coordination

-- Hematologic: Anemia, disseminated intravascular coagulation

-- Respiratory: Bronchitis, pneumonia (salmonella enterica

-serotype typhi, streptococcus pneumoniae)

-- Cardiovascular (myocardite)

-- Others: Focal abscess, pharyngitis, relapse and chronic carriage

-- Chronic carriers frequently have high serum antibody titers

-against the Vi antigen, which is a clinically useful test for rapid identification of such patients

-Investigations

-- FBC (may show leucocytosis more common in children or leucopenia, thrombocytopenia, severe anaemia follows intestinal

-bleeding)

-- Blood culture (Gold standard) will isolate the bacteria during the first 2 weeks of illness

-- Stool culture will isolate the bacteria during the later period of illness

-- Plain x-rays of abdomen in erect position will show gas under

the diaphragm if there is gut perforation

-Note: Bone marrow cultures may be positive in as many as 50% of patients after as many as five days of antibiotics.

-Serology — Serologic tests such as the Widal test are of limited clinical utility in endemic areas because positive results may represent previous

-infection. Positive serology only, shall never be a base for treatment of typhoid fever (several clinicians in Rwanda are still using this )

-Management

-Pharmacological

-• Paracetamol to reduce fever

-• Rectal Diazepam if there are convulsions and blood

-transfusion in case of severe bleeding

-• ciprofloxacin 10mg/kg (max400mg) every 12 hours

-

ciprofloxacin 15mg/kg (max500mg) orally every 12 hours

-

for7-10 days

-

• ceftriaxone 50 mg/kg every 12 hours IV for 7-14 days

-

Or

-• cefotaxime 50 mg/kg IV every 6 hours for 7-14days

-Follow up review: check for the following

-• Efficacy of treatment: fever

-• Perforation (abdominal pain, tenderness, transit)

-• Myocarditis (cardiac frequency, cardiac auscultation)

-References

-1. Hadjiloizou and Bourgeois: (2007) Antiepileptic drug treatment in

-children. Expert Rev neurotherapeutics, Updated to 2011.

-2. Loddenkemper, T., & Goodkin, H. (2011). Treatment of Pediatric

-Status Epilepticus. In H. S. Singer (Ed.), Pediatric neurology. In

-current Treatment Options in neurology. Springer Science + Business

-Media. dOI 10.1007/s11940-011-0148-3

-3. Miller, G. (2009) clinical Features of cerebral Palsy. In: UpTodate.,

-Patterson, MC (Ed), UpTodate, Waltham, MA.

-4. Miller, G. Epidemiology and Etiology of Cerebral Palsy. In

-UpTodate., Patterson, MC (Ed), UpTodate, Waltham, MA.

- 5. Miller, G., Management and Prognosis of cerebral Palsy. In

-UpTodate., Patterson, MC (Ed), UpTodate, Waltham, MA.

-6. World Health Organization (2005). Pocket Book of Hospital care

-for children. Geneva, Switzerland: WHO Press.

-7. Wilfong, A., Management of status epilepticus in children. In

-UpTodate., Nordii, d (Ed), UpTodate, Waltham, MA.

-8. Wilfong, A. Treatment of seizures and epileptic syndromes in

-children. In UpTodate., Nordii, d (Ed), UpTodate, Waltham, MA.

-9. American diabetes association. (2007) clinical practice

-recommendations:. Diabetes care. 2007 Updated 2010

-10. http://emedicine.medscape.com/article/801117-overview

-11. Hume, Petz LD et al: (1996 ) clinical Practice of Transfusion

-Medicine (eds.) 3rd

-edition. Published by new York, churchhill

-Livingstone 1996: 705 – 732.

-12. European Society of CardiologyL 2004) Guidelines on Prevention,

-diagnosis and Treatment of Infective Endocarditis Executive

-Summary, European Heart Journal (2004) 25, 267–276

-13. Gene Buhkman. (2011): The PIH guide to chronic care Integration

-for Endemic communicable Diseases. Rwanda Edition

-14. GREGORY B. LUMA et al. (2006): Hypertension in children and

-Adolescents. American Family Physician. Volume 73, Number 9

-15. Brian W. McCrindle. (2010) Assessment and Management of

-Hypertension in Children and Adolescent.

-16. American Heart Association. Stroke, and cardiovascular Surgery

-and Anesthesia,. 2005; 111: e394-e434

-17.protocol of pediatrics Malysia

-18. protocol of pediatrics Rowanda

-19. Netter”s pediatrics

-20. Illusterated text book of Pediatrics

-21.Texas protocol of Pediatrics

-

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