Findings: painless ulcer that becomes black eschar, painless induration, pruritic blisters, farm animals, flu-like illness
Question: What fits these findings?
Ascaris Lumbricoides
Category: generalpediatrics-Infectious Disease
Findings: intestinal obstruction, bronchitis, shifting infiltrates on chest x-ray, eosinophilia
Notes: Treat with albendazole or pyrantel pamoate
Aspergillus
Category: generalpediatrics-Infectious Disease
Findings: lung infiltrates, eosinophilia, cough
Notes: Treat with itraconazole and steroids. If invasive, treat with amphotericin.
Question: What fits these findings?
Bartonella Henselae
Category: generalpediatrics-Infectious Disease
Findings: tender lymphadenopathy, history of cat or dog exposure, self-limiting
Notes: Generally self-limiting but treat immunocompromised patients or ones who have severe symptoms with antibiotics such as macrolides, doxycycline, bactrim, or cephalosporins.
Question: What fits these findings?
Ceftriaxone
Category: generalpediatrics-Infectious Disease
Findings: three day old full term infant with purulent conjunctivitis, no hyperbilirubinemia
Notes: Treat suspected neonatal gonococcal conjunctivitis with single dose of IM or IV ceftriaxone and admit to hospital to observe for response to therapy. If infant is preterm, has hyperbilirubinemia, is getting calcium-infused fluids, use IV or IM cefotaxime or ceftazidime to prevent precipitation and displacement of bilirubin from albumin. Irrigate eye frequently to clear discharge.
Question: Which antibiotic do you use to treat the following?
Findings: anemia, fatigue, coughing and wheezing, abdominal pain, malnutrition
Notes: Hookworm enters bare feet through soil, then goes to lungs and gastrointestinal system. It consumes nutrients and causes iron deficiency anemia. Treat with albendazole and potentially iron supplementation.
Notes: Commonly caused by both bacteria and viruses. Most common bacterial causes are group A streptococcus and S, aureus. Consider anaerobic bacteria if child had history of poor oral hygiene and tularemia if child had contact with sick pets such as rabbits. Viruses such as EBV and CMV may cause subacute or bilateral presentations. Cat scratch disease, toxoplasmosis, TB, and non-tuberculous mycobacteria may also be considered. Noninfectious causes include neoplasms, Kawasaki, MIS-C, and PFAPA among others. Well-appearing children with minimal tenderness may be monitored while labs including cultures, CBC, and inflammatory markers should be obtained and empiric antibiotics started to treat S. aureus and GAS if there are signs of significant clinical illness.
Question: What fits these findings?
Oral Vancomycin
Category: generalpediatrics-Infectious Disease
Findings: severe Clostridium difficile infection in pediatric patient
Notes: Metronidazole may be recommended in fulminant disease.
Question: Which antibiotic do you use in the following scenario?
Notes: Usually caused by group A strep. Treat with IV Unasyn and then Augmentin.
Question: What fits these findings?
Pertussis
Category: generalpediatrics-Infectious Disease
Findings: symptoms of mild URI, cough lasting several weeks in infants or adolescents, paroxysms of coughing, no or little fever, normal CBC, apnea in infant
Notes: Treat with azithromycin
Question: What fits these findings?
Retropharyngeal Abscess
Category: generalpediatrics-Infectious Disease
Findings: hyperextension of neck, fever, difficulty swallowing, lymphadenopathy
Question: What fits these findings?
Rocky Mountain Spotted Fever
Category: generalpediatrics-Infectious Disease
Findings: hyponatremia, thrombocytopenia, headache, lethargy, arthralgias, petechiae, rash starting at extremities and moving centripetally
Notes: Treat with doxycycline immediately if suspected. Usually found in mid-Atlantic states ranging from Virginia to New York (name is misnomer).
Question: What fits these findings?
Scarlett Fever
Category: generalpediatrics-Infectious Disease
Findings: strawberry or white tongue, sandpaper rash in creases
Question: What fits these findings?
Shigella
Category: generalpediatrics-Infectious Disease
Findings: high fever, tenesmus, bloody diarrhea, vomiting, seizures, rectal prolapse, elevated WBC and bandemia
Notes: Diagnose with stool culture. Treat severe cases with ceftriaxone or macrolide.
Question: What fits these findings?
Topical Ivermectin
Category: generalpediatrics-Infectious Disease
Findings: head lice resistant to two applications of permethrin
Notes: Also continue to comb out nits.
Question: What is the second line treatment for the following?
Toxocara Canis
Category: generalpediatrics-Infectious Disease
Findings: multiple systems affected, wheezing, abdominal pain, hepatosplenomegaly, leukocytosis, eosinophilia
Notes: Causes visceral larva migrans as round worms may migrate to intestines and lungs. Obtain serial chest x-rays.
Notes: Obtain IgM titers. Treat with sulfadiazine or pyrimethamine. Is different from CMV as lesions in Toxoplasma are diffuse instead of periventricular as in CMV.
Question: What fits these findings?
Tularemia
Category: generalpediatrics-Infectious Disease
Findings: fever, lymphadenopathy, ulcers, hepatosplenomegaly, exposure to rabbits or deer
Notes: Treat with streptomycin, gentamicin, doxycycline, or ciprofloxacin.