0071643192.pdf

PEDIATRICS

TREATMENT

■ Primary prevention of rheumatic fever: Treat strep pharyngitis with antibi-

otics within 9 days of symptom onset.

■ Secondary treatment once rheumatic fever is diagnosed

■ High-dose aspirin

■ Antibiotics to treat residual strep infection

COMPLICATIONS

■ Damage to heart valves

■ Recurrent episodes of acute rheumatic fever

INFECTIOUS DISEASES

Fever in Children <3 Years Old

In general, fever is defined as a rectal temp 38.0°C (100.4°F). Oral and axil-

lary temps are typically 0.6°C (1.0°F) and 1.1°C (2.0°F) lower than rectal

temps, respectively. Serious bacterial infection (SBI) includes bacteremia,

meningitis, urinary tract infection, bacterial pneumonia, or bacterial gastroen-

teritis. In general, the workup for fever is determined by age at presentation in

conjunction with other factors such as underlying medical conditions (eg,

cancer, immunosuppression) and coexisting factors (eg, immunization status).

Low-risk criteria have been proposed for febrile infants <8 weeks (see

Table 5.10).

TABLE 5.10. Rochester Criteria and Philadelphia Protocol Low-Risk Criteria

ROCHESTERCRITERIA PHILADELPHIAPROTOCOL

Infant appears generally well. Infants >28 days old

Infant has been previously well. Infant Observation Score ≤ 10

■Born at term (> 37 wk gestation) No recognizable bacterial

■No antibiotics perinatal infection on exam

■No unexplained Laboratory values:

hyperbilirubinemia ■WBC < 15,000/mm^3

■No previous antimicrobial therapy ■Band-to-neutrophil ratio <0.2

■No previous hospitalization ■WBC≤10/hpf on microscopic

■No chronic or underlying illness exam of spun urine

■Not hospitalized longer than mother ■WBC≤8/hpf and Gram negative

No evidence of skin, soft tissue, stain in a nonbloody CSF specimen

bone, joint, or ear infection No evidence of a discrete

Laboratory values: infiltrate on CXR as determined

■WBC 5000–15,000/mm^3 by an attending physician

■Absolute band count ≤15,000/mm^3 Stool smear negative for blood

■WBC≤ 10/hpf on microscopic exam and few or no WBCs

of spun urine (for infants with diarrhea)

■WBC≤5/hpf on microscopic exam of a

stool smear (for infants with diarrhea)