akinohanayuki ブログ

学位を持っても、センスのない、感染制御専門薬剤師のブログ.  I have Ph.D. but less sense ID pharmacist.

小児のFN

小児の不明熱

おそらく好中球機能に問題あり
免疫機能低下⁉︎

血液培養採取2日目の陽性なし

小児科医から相談

どーしますか?

免疫低下による発熱…

MCFG 6mg/kg (max 100mg)
ST合剤
血液培養陰性なんで抗緑膿菌は…
± VCM…


以下 UpToDate より小児の不明熱

●Fever of unknown origin (FUO) has a number of infectious and noninfectious causes. FUO is usually caused by common disorders, often with an unusual presentation. 

●The three most common etiological categories of FUO in children in order of frequency are infectious diseases, connective tissue diseases, and neoplasms. In many cases, a definitive diagnosis is never established and fever resolves. 

●Generalized infections that cause FUO typically have nonspecific presenting features. Obtaining a detailed history of exposures can be critical to making the diagnosis of these disorders. 

●When common localized infections cause FUO, they may have an unusual presentation. Careful and repeated history and physical examination, and careful review and interpretation of laboratory tests, can help to diagnose these infections. All findings, even those that may seem trivial, must be taken seriously. 

●Noninfectious causes of FUO include collagen vascular diseases (eg, juvenile idiopathic arthritis), neoplasms, central nervous system dysfunction, diabetes insipidus, Kawasaki disease, drug fever, factitious fever, inflammatory bowel disease, infantile cortical hyperostosis, and periodic fevers. 

●The diagnosis of fever of unknown origin (FUO) should be reserved for children with fever of at least eight days' duration in whom no diagnosis is apparent after initial evaluation either in the hospital or as an outpatient. 

●Infections are the most common causes of FUO in children, followed by connective tissue disorders and neoplasms. However, in many cases, a definitive diagnosis is never established and fever resolves. 

●A detailed history and physical examination are essential for all patients. These should be repeated on several occasions. 

●The history should include details about the fever, associated complaints, and exposures (eg, to ill contacts, animals, insects, travel, drugs). 

●The patient should be examined while febrile. Important aspects of the examination include vital signs, the skin, scalp, eyes, sinuses, oropharynx, chest, abdominal, and musculoskeletal and genitourinary systems. 

●We suggest the following tests as part of the initial evaluation 

•Complete blood count (CBC) and peripheral smear
•Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)
•Blood cultures
•Urinalysis and urine culture
•Chest radiograph
•Tuberculin skin testing
•Serum electrolytes, blood urea nitrogen (BUN), creatinine, and hepatic enzymes
HIV serology

●Additional tests and imaging studies should be based upon the findings of the history, examination, and initial tests. Diagnostic imaging of the nasal sinuses, mastoids, and gastrointestinal tract may be warranted eventually in children in whom FUO persists without explanation. 

●Empiric treatment with antiinflammatory medications or antibiotics generally should be avoided as diagnostic measures in children with FUO.