Infectious disease Fever of unknown origin: Fever >14d, T>38.

3C on mult occasions, uncertain etiology Ddx includes: infection, CT disease, malignancy, other (IBD, kawasaki, drug) s/s: conjunctivitis, LAD, joint tenderness, thrush, heart murmurs, organomegaly, etc Diagnostic eval: - CBC + diff, electrolytes, BUN and creatinine, LFTs, alk phos, UA - Blood, urine, stool, CSF cultures - ESR, CRP - CXR, skin test for TB Condition Definition Epidemiology Etiology

Acute otitis media

Inflammation of middle ear

Narrowing of eustachian tube by edema in URI --> Eustachian tube vaccuum draws secretions in children: from nasopharynx to middle - angle of entry ear (horizontal) MCC: - short length - S. pneumo - decr tone - H. influenza - Moraxella

Sinusitis

Bacteremia and sepsis: Occult bacteremia - appears in well-appearing child with no obvious source of infection - highest in children 2-24 mo, T >39.0C, leukocytosis - MCC S. pneumo, resolves spontaneously Sepsis: bacteremia + systemic response, altered organ perfusion - Neonates: GBS, enteric gram neg, listeria - Children <5: S. pneumo, N. meningitidis - Children > 5: S. aureus - Other: Salmonella, pseudomonas, viridans strep - Evaluation: Blood, urine, CSF cultures, CXR if respiratory signs present Signs/symptoms Ddx Otitis media with effusion: fluid behind TM but no inflammation (no fever/ear pain) - no abx Myringitis: inflammation of eardrum - no abx Otitis externa (swimmer's ear): ear pain, but TMs looks normal, erythematous canal - topical abx drops Treatment 1. High dose amoxicillin, topical abx if perforated 2. augmentin, PO second or 3rd gen cephalosporin, or IM ceftriaxone S. pneumo: 50% penicillin resistant. H. influenza and M. catarrhalis: beta- lactamase activity Consider tympanostomy tube if moderate hearing loss, recurrent AOM

Ear pain, fever, fussiness, URI sxs TMs bulging, opaque, aberrant light reflex, decr mobility

ection

Complications Hearing loss, otitis media externa Meningitis (MC intracranial) Atopic constitution increases risk for recurrent OM Mastoiditis: severe, but uncommon - high fever, tenderness of mastoid bone

High Yield facts

Decr mobility of TM is most specific sign