1. Fever

2. Case 1: 7 months old girl 3 days fever
General condition worsening last 2 days
Sleepy, but gives good contact when awake
Eats less than usual, but drinks OK and has wet dipers
No rhinorrhea, coughing, vomiting or diarrhea
Previously healthy

3. Examination Sleeps initially, but wakes up and gives contact
No smile, uncomfortable, but the mother is able to calm her
Skin color and turgor normal. Mucus membranes wet
Tonus OK
Capillary refill time 2 sec
RR 45, HF 160, T 39,5, SaO2 95%
Auscultation: normal heart and lung sounds

4. Lab
CRP 235
Urine bag sample: leukocytes +++, blood +, protein +, nitritis –
Catheter sample confirms the results, with positive microscopi

5. Management
Diagnosis?
Admit to hospital?
Other solutions?
Follow up?

6. Urinary Tract Infections

7. History General condition Fever Focal infectious symptoms? Vomiting
Feeding
Consciousness
Hydration (diuresis)
Fever
Focal infectious symptoms?
Vomiting
Previous history: ultrasound during pregnancy

8. Clinical examination Typically no focal signs of infection
General appearance – septic?
Respiratory frequence
Heart Rate
Capillary refill time
Skin colour
Consciousness
Activity

9. Laboratory investigations
Urine sample
Leukocytes sensitive, nitritis specific
Collection bag sample can only be used to exclude UTI!
Midflow sample, catheter or bladder puncture
Microscopy
Urine culture
Blood sample
CRP, WBC, kreatinin, Na, K, Hb, urea, blood gases
Blood culture

10. Imaging Chest x-ray? Ultrasound Voiding cystourethrogram DMSA
Scintigraphy
Acute diagnostic of pyelonephritis and chronic renal scarring

11. Treatment
Oral
Mecillinam, Trimetoprim-sulpha, (3rd gen cefalosphorin), (Amoxicillin-clavulanate)
i.v
ampicillin-gentacimin, mecillinam, cefotaxim

12. Risk factors <6months Septic No effect of treatment within 48 hours
Pathologic prenatal ultrasound
Residiving pyelonephritis
Non E.coli
Unusual presentation (older boys)
Heredity for vesikuloureteral reflux
High kreatinin or BP

13. Case 2: 2 months old boy High fever 1,5 day No vomiting or diarrhea
Eats ok, diuresis normal
General condition slightly reduced, more sleepy

14. Examination No smile, but excellent contact. Good activity
No focal signs
Auscultation: normal

15. Lab:
CRP 131
Urine sample (mid flow): Leukocytes 3+, blood 2x, protein 2+, nitritis +
Admit to hospital?