Acute Retroviral HIV Syndrome

Category: generalpediatrics-Infectious Disease 2

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


Leptospirosis

Category: generalpediatrics-Infectious Disease 2

Findings: swimming in fresh water, myalgias, headaches, fever, nonexudative conjunctival erythema, jaundice, elevated creatinine

Notes: Treat mild disease with doxycycline or penicillin, and moderate or severe disease with IV ceftriaxone or cefotaxime

Question: What fits these findings?


Mumps

Category: generalpediatrics-Infectious Disease 2

Findings: bilateral parotiditis that may start out unilateral, fever, pancreatitis, orchitis

Notes: Self-limiting disease

Question: What fits these findings?


Mycobacterium Tuberculosis

Category: generalpediatrics-Infectious Disease 2

Findings: night sweats, fevers and chills, weight loss, supraclavicular lymphadenopathy

Question: What fits these findings?


Peritonsillar Abscess

Category: generalpediatrics-Infectious Disease 2

Findings: dysphagia, unable to open mouth fully, muffled voice, enlarged tonsils, fever


Polio

Category: generalpediatrics-Infectious Disease 2

Findings: descending paralysis, fever, undervaccination


Poststreptococcal Glomerulonephritis (PSGN)

Category: generalpediatrics-Infectious Disease 2

Findings: skin or throat infection 2 weeks ago, hematuria, proteinuria, hypertension, edema, low C3, normal C4

Question: What fits these findings?


Tularemia

Category: generalpediatrics-Infectious Disease 2

Findings: swollen inguinal lymph node, fever, ulcer, myalgias, location Arkansas-Missouri-Oklahoma, exposure to rodent or rabbit

Notes: Caused by Francisella tularensis. Treat with gentamicin or streptomycin.

Question: What fits these findings?