Findings: mucocutaneous ulcers, erythematous maculopapular rash, pharyngitis, lymphadenopathy, fever, myalgias, IV drug use and sexual promiscuity, flu-like symptoms, negative for EBV
Anaplasmosis
Category: generalpediatrics-Infectious Disease 2
Findings: found in Northeastern US, anemia, fever, headache, leukopenia, thrombocytopenia, elevated transaminases
Notes: Caused by Anaplasma phagocytophilum from tick. Ehrlichia is similar but is seen in a Southeastern US state like Arkansas.
Anti-DNase B Titer
Category: generalpediatrics-Infectious Disease 2
Findings: skin infection a few weeks ago, hematuria, edema, hypertension, abdominal pain
Notes: Anti-DNase B titer is best test after skin infection with Streptococcus pyogenes, causing poststreptococcal glomerulonephritis. ASO titer may not be elevated in skin infection compared to pharyngeal infection. You may also see a low C3 and normal C4.
Question: What is the best lab to confirm a disease with these findings?
Azithromycin
Category: generalpediatrics-Infectious Disease 2
Findings: watery to mucopurulent eye discharge in 7 day old neonate, blood-stained eye discharge, swelling of eyelids, chemosis
Notes: Test with nucleic acid amplification test (NAAT)and if positive, treat with 3 day course of oral azithromycin or 14 day course of oral erythromycin . Also then test for N. gonorrhea. If untreated, may cause corneal and conjunctival scarring. Mother and her partner should also be tested for C. trachomatis infections.
Question: Which antibiotic do you use to treat the following?
Babesiosis
Category: generalpediatrics-Infectious Disease 2
Findings: high fevers, hemolytic anemia, smear with Maltese cross, transmitted by Ixodes tick
Notes: Treat with atovaquone and azithromycin or quinine and clindamycin
Question: What fits these findings?
Bartonella Henselae
Category: generalpediatrics-Infectious Disease 2
Findings: axillary lymphadenopathy, history of cat scratch on hand
Notes: Do not incise lymph node as this will cause a persistent sinus tract. Treat with azithromycin.
Chlamydia Psittaci
Category: generalpediatrics-Infectious Disease 2
Findings: contact with birds, high fevers, pneumonia, splenomegaly, rigors
Congenital Rubella
Category: generalpediatrics-Infectious Disease 2
Findings: purpura rash, patent ductus arteriosus, cataracts with microphthalmia, radiolucencies in metaphyseal long bones, hepatosplenomegaly, hemolytic anemia, microcephaly
Question: What fits these findings?
Cryptosporidium
Category: generalpediatrics-Infectious Disease 2
Findings: watery diarrhea for weeks, cysts in stool, self-limiting
Notes: Test using direct fluorescence antibody or PCR
Question: Which organism causes these findings?
Ehrlichia Chaffeensis
Category: generalpediatrics-Infectious Disease 2
Findings: rash like Rocky Mounted Spotted Fever, leukopenia, lymphopenia, treated with doxycycline
Question: What fits these findings?
Epiglottitis
Category: generalpediatrics-Infectious Disease 2
Findings: high fever, drooling, dysphagia, patient leaning forward with chin thrust out, thumbprint sign on xray
Notes: Most commonly caused by Haemophilus influenzae. Hospitalize immediately to secure airway.
Question: What fits these findings?
Giardia
Category: generalpediatrics-Infectious Disease 2
Findings: watery foul-smelling diarrhea, flatulence, sulfuric belching, most common gastrointestinal parasite found in internationally adopted children
Notes: Diagnose with stool antigen or PCR. Treat with metronidazole.
Question: What fits these findings?
Hemolytic Uremic Syndrome (HUS)
Category: generalpediatrics-Infectious Disease 2
Findings: kidney failure, oliguria, thrombocytopenia with purpura, hemolytic anemia, helmet cells and schistocytes
Notes: Caused by E. coli O157 H7 from undercooked beef like in a hamburger, unpasteurized milk. Do not treat with antibiotics as this may worsen HUS by releasing large quantities of bacterial toxin.
Question: What fits these findings?
Histoplasmosis
Category: generalpediatrics-Infectious Disease 2
Findings: calcifications that look like TB on x-ray, pulmonary fibrosis, exposure to bird droppings, travel to Ohio or Mississippi, pneumonia, splenomegaly, palate ulcers
Notes: Treat with amphotericin or fluconazole.
Question: What fits these findings?
Legionella
Category: generalpediatrics-Infectious Disease 2
Findings: diarrhea, pneumonia, headache, confusion, associated with contaminated water such as from cruise ships or hospitals