Pediatrics(2)
.pdf-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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-