Paediatrics - Queensland Health - Queensland Government

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Immune complications 5. Follow up Most children will require evacuation / hospitalisation If not evacuated / hospitalised the child requires close follow up with daily review including weight, BP and urinalysis. If there is any deterioration, consult MO Refer to next MO clinic Following discharge, most children will require at least monthly weight, BP and urinalysis (it takes a considerable time for haematuria to resolve) following glomerulonephritis but persisting proteinuria is of more concern. Some children will be on antihypertensives for a period of time after the illness and will require more frequent monitoring of BP If urinalysis shows protein on follow up, collect urine for urine protein / creatinine ratio If persistent proteinuria refer to Paediatrician for follow up Blood should be tested to check the immune system complement factor serum complement (C 3 ) level has returned to normal after three months; an MSU should also be sent Review at 3, 6, 9 and 12 months 6. Referral / consultation Consult MO on all occasions of suspected glomerulonephritis Most will need paediatric referral and follow up If C 3 does not return to normal refer to Paediatrician References 1. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents, The Fourth Report on the Diagnosis, Evaluation and Treatment of High Blood Pressure in Children and Adolescents. Pediatrics, 2004. 114 (2): p. 555. 2. <strong>Queensland</strong> <strong>Government</strong>. Acute Post-streptococcal Glomerulonephritis Control of Communicable Diseases Protocol Manual 2009 [cited 2011 May]; Available from: qheps.health.qld.gov.au/cdpm/index/ apsgn.htm. 3. Therapeutic Guidelines. Impetigo. 2009 [cited 2010 December]. 574 Controlled copy V1.0 Primary Clinical Care Manual 2011
Immune complications Acute rheumatic fever Recommend In Aboriginal and Torres Strait Islander communities where there are high rates of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) treat streptococcal throat and skin infections early Any case of arthritis with fever in a child should be considered as possible ARF or septic arthritis and transferred to hospital for investigation and confirmation of diagnosis Regular penicillin prophylaxis is critical to prevent recurrences of ARF, which can lead to the development or worsening of RHD Background ARF is an auto-immune response to bacterial infection with group A Streptococcus (GAS) [1] in the throat (and possibly the skin); it affects the heart, joints, nervous system and skin Aboriginal and Torres Strait Islander Australians living in rural or remote settings are known to be at high risk. Those living in urban settings, Maori and Pacific Islander people and, potentially immigrants from developing countries also may be at high risk [2] ARF is predominantly a disease of children aged between 5 and 14 years although recurrent episodes may continue well into the fourth decade of life [1] Patients with recurring ARF have a higher risk of developing RHD RHD is a chronic condition resulting from scarring and deformity of the heart valves following ARF Related topics Upper respiratory tract infection - child Upper respiratory tract infection - adult Bacterial skin infections Bone and joint infections - child Acute rheumatic fever and rheumatic heart disease prophylaxis 1. May present with • Fever and malaise • Painful tender swollen joints. Symptoms classically seen to progress from one joint to another (migratory polyarthritis) however only one joint may be affected (aseptic monoarthritis). Any joint can be involved but most commonly affects the large joints of the limbs - knees, ankles, elbows • Abdominal pain • Inability to weight-bear or walk unaided • Uncontrollable jerky movements of the trunk, face and / or limbs (Sydenham’s chorea), that disappear when asleep • Skin rash. This is rare, but highly suggestive of ARF (can be difficult to see in dark skinned people) • Small nodules over bony areas such as elbows and knees; again rare • History of a sore throat or skin infection within the previous 2 - 3 weeks • Breathlessness (if cardiac involvement), chest pain • Abnormal heart sounds 2. Immediate management Not applicable Primary Clinical Care Manual 2011 Controlled copy V 1.0 575
Page 1 and 2: Section 6 Paediatrics
Page 3 and 4: Paediatric presentation History and
Page 5 and 6: Paediatric presentation Presentatio
Page 7 and 8: Paediatric presentation Standard cl
Page 9 and 10: Paediatric presentation Physical ex
Page 11 and 12: Child with fever Fever is usually a
Page 13 and 14: Child with stridor Stridor is a har
Page 15 and 16: Any history of significant trauma?
Page 17 and 18: Meningitis Meningitis Recommend Co
Page 19 and 20: 6. Referral / consultation Consult
Page 21 and 22: Respiratory problems • For the ch
Page 23 and 24: Respiratory problems 1. May present
Page 25 and 26: Respiratory problems 4. Management
Page 27 and 28: Child < 3 months Contact MO immedia
Page 29 and 30: Immune complications Acute post st
Page 31: Immune complications Schedule 4 Ben
Page 35 and 36: Immune complications Australian gui
Page 37 and 38: presence of RHD Place person on Re
Page 39 and 40: Ear problems • Clean the ear usin
Page 41 and 42: Ear problems Acute otitis media (A
Page 43 and 44: Ear problems Schedule 4 Roxithromyc
Page 45 and 46: Ear problems 4. Management • Give
Page 47 and 48: See Simple analgesia back cover Ear
Page 49 and 50: Ear problems 6. Referral / consulta
Page 51 and 52: Ear problems 5. Follow up Children
Page 53 and 54: Ear problems Ear discharge in the p
Page 55 and 56: Ear problems 4. Management • Cons
Page 57 and 58: Ear problems Schedule 4 Flumethason
Page 59 and 60: Ear problems Foreign body / insect
Page 61 and 62: Gastrointestinal problems Acute gas
Page 63 and 64: Gastrointestinal problems 4. Manage
Page 65 and 66: Gastrointestinal problems • Bottl
Page 67 and 68: Gastrointestinal problems Nutrition
Page 69 and 70: 5. Follow up Review 1 - 2 days aft
Page 71 and 72: Gastrointestinal problems Intestin
Page 73 and 74: Gastrointestinal problems Schedule
Page 75 and 76: Gastrointestinal problems 4. Manage
Page 77 and 78: Gastrointestinal problems Intussusc
Page 79 and 80: Gastrointestinal problems • Perfo
Page 81 and 82: Gastrointestinal problems Backgroun
Page 83 and 84:
Schedule 2 Folic Acid Gastrointesti
Page 85 and 86:
Urinary tract problems References 1
Page 87 and 88:
Urinary tract problems ○ where no
Page 89 and 90:
Bone and joint problems 3. Clinical
Page 91 and 92:
Abuse and neglect 2. Immediate mana
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Paediatrics - Queensland Health - Queensland Government

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