Case 2

A 2-year 8-month-old girl is brought into the department following a 3 min generalised tonic-clonic convulsion whilst at nursery. The nursery staff accompanying her report that she was well earlier in the day, but had been noted to be slightly irritable and hot to touch before the convulsion. On her arrival, she is post-ictal and has a temperature of 38.8 degrees. Her initial primary survey is normal and her observations are satisfactory.

She has been previously fit and well and has no medical problems. She has never had seizures in the past.

What would you do now?

Your examination reveals a well looking child with no rash or meningism, normal ears and throat, heart sounds normal with capillary refill time (CRT) <2 s, chest clear, abdominal examination normal. You can find no obvious cause for her temperature.

Which of the following is true?

Urine dipstick reveal leukocytes, nitrites and blood. The child returns to normal as the fever settles, and after a period of observation is discharged home with a course of cefalexin.

Urine culture later confirmed a very growth of E. Coli.

Under what circumstances would the child need imaging? (Select all that apply)

Progress:

You discharge the patient on oral cefalexin. Two days later, the following culture result is obtained:

Culture:

• Heavy growth of Proteus mirabilis
• Sensitive to: co-amoxiclav, cefalexin, ciprofloxacin
• Resistant to: amoxicillin, nitrofurantoin

What actions are most appropriate after the antibiotic course has been completed?