SEVERE MALARIA

 generalized multiple convulsions: more than two episodes in 24 h

 impaired consciousness, including unrousable coma
 generalized weakness (prostration) or lethargy, i.e. the child is unable walk or sit up without
assistance
 deep laboured breathing and respiratory distress (acidotic breathing)
 pulmonary oedema (or radiological evidence)
 abnormal bleeding
 clinical jaundice plus evidence of other vital organ dysfunction
 severe pallor
 circulatory collapse or shock with systolic blood pressure < 50 mm Hg
 haemoglobinuria (dark urine)
 Hypoglycemia (<45 mg/dL)
 Hyperparasitemia (>100.000/uL) -> rapid diagnostic test if blood smear not possible
 Severe anemia (Hb <5)
 High Serum Creatinin
 Lumbal Puncture to exclude bacterial meningitis. Treat by antibiotic if cannot perform LP

MALARIA

• fever (temperature ≥ 37.5°C or ≥ 99.5 °F) or history of fever

• a positive blood smear or positive rapid diagnostic test for malaria
• no signs of severe malaria:
– altered consciousness
– severe anaemia (EVF < 15% or Hb < 5 g/dl)
– hypoglycaemia (blood glucose < 2.5 mmol/litre or < 45 mg/dl)
– respiratory distress
– jaundice

SEPSIS

The child’s history helps determine the likely source of sepsis. Always fully undress the child and
examine carefully for signs of local infection before deciding that there is no other cause.

On examination, look for:

• fever with no obvious focus of infection

• negative blood fi lm for malaria
• no stiff neck or other specifi c sign of meningitis, or negative lumbar puncture for meningitis
• confusion or lethargy
• signs of systemic upset (e.g. inability to drink or breastfeed, convulsions, lethargy or
vomiting everything, tachypnoea)
• Purpura may be present.

ISK

In young children, urinary tract infection often presents as nonspecific signs. Consider a diagnosis of
urinary tract infection in all infants and children with:
 • fever of ≥ 38 °C for at least 24 h without obvious cause
• vomiting or poor feeding
• irritability, lethargy, failure to thrive, abdominal pain, jaundice (neonates)
• specific symptoms such as increased frequency, pain on passing urine, abdominal (loin) pain
or increased frequency of passing urine, especially in older children

Half of all infants with a urinary tract infection have fever and no other symptom or sign; so the only
way to make the diagnosis is to check the urine.

RHEUMATIC FEVER

Diagnosis of rheumatic fever is important because penicillin prophylaxis can prevent further
episodes and avoid worsening damage to the heart valves. Acute rheumatic fever is diagnosed
clinically by WHO criteria based on the revised Jones criteria (Table 20). The diagnosis is based on
two major or one major and two minor manifestations plus evidence of a previous group A
streptococcal infection.
Penyakit PDx PMx PEd

Meningitis TB CXR -> sugesstive TB

HIV
CSF
Konsul IKA
Sepsis CDC
Urinalisis
Kurtur darah
CXR
ISK Urine Lengkap Monitoring gejala dan cari Pasien ttp dikasih minum atau ASI
Dipstick urine penyebabnya ISK atas atau Jangan kasih NSAID untuk nyeri nya tapi Paracetamol
Kultur Urine bawah, ISK komplikata atau
USG jika curiga ISK kompleks simplex
Rheumatic Fever ASO Antibiotic prophylaxis Diet ketat natrium
CBC MRS
LED Kembali lagi 3-6 bulan untuk evaluasi profilaksis antibiotic
CRP dan evaluasi katup (?)
CXR
Echo