Blaise L Congeni MD Patient TL Patient is 11yo wm who presents with a history of a fall during soccer 3 weeks prior to this admission at which time he struck his head He then was evaluated and followed using the concussion protocol Over the next week he experienced worsening headache ID: 544775
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Illustrative Pediatric Infectious Diseases Cases-2016
Blaise L. Congeni M.D.Slide2Slide3Slide4Slide5
Patient TL
Patient is 11yo, wm, who presents with a history of a fall during soccer 3 weeks prior to this admission, at which time he struck his head. He then was evaluated and followed using the concussion protocol. Over the next week he experienced worsening headache, but no URI complaints. Shortly prior to first admission he had fever and then AMS. CT shows sinusitis and subdural empyema. Sinus grew MSSA and subdural grew
S. anginosus.
He was sent home on iv ceftriaxone and metronidazole and at follow up he was completely asymptomatic; a routine MRI was obtained. Slide6Slide7
Patient LP
8
yo
with 8 days of fever and 6 days of cough.
She had consistently demonstrated fever of about 102.
Because of worsening cough and persistent fever the patient was given
ceftriaxone
and then
cefdinir
.
Because of failure to improve the pt. was admitted.Slide8Slide9Slide10Slide11Slide12
Case
4 year old
Low grade fever
Decreased activity
WBC 30,000 (40% eosinophils)Slide13
Toxacara
Species
T. canis
T. catis
Delayed type and immediate hypersensitivity reactions
Granuloma formation
eosinophiliaSlide14Slide15
Principles and Practice of Ped
Inf
Dis, Prober and LongSlide16
Toxocara
VLM
Usually <5 yrs old, hx pica
Fever, hepatosplenomegaly, LRT symptoms
Eosinophilia, elevated IgG, IgM
EIA for Toxocara; titer
1:32
Less sensitive for ocular diseaseSlide17Slide18
Toxocara
treatment
Albendazole 10mg/kg/day - divided q12 - for 5 days (400 mg bid x 5 days)
Ocular involvement longer course
Corticosteroids as adjunctive treatmentSlide19
Cutaneous Larval Migrans
Creeping eruption
Southern U.S.
Dog hookworm -
Ancyclostoma caninum
Via bare feet
Self-limiting, or oral albendazole or invermectinSlide20
Case
4 yo previously well
fever x 3 wks
Intermittent abdominal pain
No n/v/d
No travel, no ill contacts
Cat and dog at homeSlide21Slide22
Slides 21,22 courtesy J Bower MDSlide23Slide24Slide25
Bartonella
Serology
IgG >1:512
IgM >1:160
IgG >1:1024
IgM 1:80Slide26
Hepatosplenic Cat-Scratch Disease
Arisoy et al CID, 1999;28:778
19 patients
Age: 2y 4m – 11y 8m
12/19 male
All with h/o exposure
CSD initial dx 21%Slide27
Arisoy et al CID, 1999;28:778Slide28
Margileth, AM, Ped Infect Dis J, 1992; 11:474Slide29
Toxoplasmosis
Humans intermediate hosts
Ingest oocysts of
T. gondii
Feline feces
Raw or undercooked meat
Disease
Lymphadenopathy
Retinochoroiditis
Congenital diseaseSlide30Slide31Slide32
CL 17 yo
WM
Hospitalized for 3 day, 1 week PTA for fluid and
catecholamine
refractory shock thought to be due to gastro.
At
that time he was noted to have fever, fatigue, emesis and diarrhea. Following discharge he was back to ER w eyelid swelling, and 3 days later he was to ER a second time for fevers to 104, fatigue, emesis and one episode of diarrhea
.Slide33Slide34