U n i v e r s i t y o f S o u t h C a r o l i n a S c h o o l o f M e d i c i n e . D e p a r t m e n t o f P e d i a t r i c s

PEDIATRICINFECTIOUSDISEASECONSULTANDREFERRALGUIDELINESDIAGNOSIS EVALUATIONPRIORTOREFERRAL WHENTOREFER WHATTOSEND

RecurrentFevers

History:

• Historyofrecentviralillnesses• Mothershouldkeepadetailedfeverdiarywithdatesoffever

onset,howmanydaysthefeverslast,doesantipyreticshelp,anysymptomsassociatedwiththefevers(ulcers,pharyngitis,lymphadenopathy,etc)

• Pastmedicalhistoryincludingrecurrentinfections(OM,sinusitis,skininfections)

• Immunesystemproblemsinthefamily

PhysicalExam:

• Observeanddocumentmouthulcers,lymphadenopathy,

pharyngitis,rashes,etc

Patienthasapatterntotherecurrentfevers

Recurrentfeversare

occurringmorethanexpectedforchildhoodviralillnesses

Feversareassociatedwith

pneumonias,skininfections,invasivediseases,etc

ParentsareconcernedandwishtohaveaPediatricID

consult

AllLabsresultsincludingserology(CMV,EBV,etc),CRP,

ESR,GASscreeningtest,culturesorany

otherinfectiousdiseaselabworkup

Clinicnotes

FeverDiary

Listcurrentmedicines

RecurrentSinusitis

History:

• Frequencyofsinusitis• Familymemberswithsimilarsignsorsymptoms• Recentsinussurgeries

• Immunesystemproblemsinthefamily

Labs:

• Cultureandsensitivityofsinusesduringaninfection• NasalswabforMRSAifappropriate

PositiveMRSAcultureinthefaceofrecurrentsinusitis

Recurrentsinusitissecondarytomultidrug

resistantorganisms(MRSA,Pseudomonas,etc)orfungus

Parentsareconcernedand

wishtohaveaPediatricIDconsult

Clinicnotes,treatmenthistory

Mustsendcultureandsensitivity

Listofcurrent

medicines

U n i v e r s i t y o f S o u t h C a r o l i n a S c h o o l o f M e d i c i n e . D e p a r t m e n t o f P e d i a t r i c s

DIAGNOSIS EVALUATIONPRIORTOREFERRAL WHENTOREFER WHATTOSEND

FeverofUnknownOrigin History:

• Feverforhowlong• Frequencyoffever• Anyothersymptomswithfever

• Anyotherfamilyhistorywithrecentfeversorviralillness• SignificantPMHxincludingsinusitis,UTIs,etc

PhysicalExam:

• Anypertinentpositivesincludingrashes,pharyngitis,conjunctivitis,desquamationofskin,sinustenderness,teeth

pain,lungfindings

Labs:

• InitialworkupincludingCBC,CMP,UAandurineculture/bloodculture(ifappropriate),CRP(ifappropriate),rapidGAS(ifappropriate)

• AllneededserologytestswillbeorderedbyPedsID

Patientcontinuestohavefever>14days

ParentsareconcernedandwishtohaveaPediatricID

consult

Clinicnotes

Treatmenthistory

AllLabresultsincludingCBCs,culturesandsensitivities,CRP,ESR

orotherinfectiousdiseaseslabs

Listofcurrentmedicines

U n i v e r s i t y o f S o u t h C a r o l i n a S c h o o l o f M e d i c i n e . D e p a r t m e n t o f P e d i a t r i c s

DIAGNOSIS EVALUATIONPRIORTOREFERRAL WHENTOREFER WHATTOSEND

RecurrentAbscesses History:

• Frequentorrecurrentfuruncles• Familymemberswithsimilarsignsorsymptoms• Recentdrainage,I&Dorsurgeries

• Immunesystemproblemsinthefamily

PhysicalExam:

• Observeforotherreservoirsofinfections• Considerotherinfections

Labs:

• Mustdocultureandsensitivitytestingofwounds/lesions• NasalswabforMRSA

PositiveMRSAcultureinfaceofrecurrentskininfections

PositiveMRSAcultureinthe

faceofrecurrentskininfections

RequestingdocumentationonMRSAdecolonizationfor

appropriatepatients

ParentsareconcernedandwishtohaveaPediatricIDconsult

Clinicnotes,treatmenthistory

Mustsendcultureandsensitivity

Listofcurrent

medicines

Tipsforaneffectivevisit: Formoreinformationcall(803)434‐7950• Talkwithyourpatientandfamilyaboutthereasonforthereferralandthequestionstobeanswered.• Pleasesendallpertinentinformationaheadoftimetoallowustobetterserveourpatientsandtheirfamilies.