Pediatric emergency medicine trisk 597

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Clinical findings

Radiographic and other
findings

Pulmonary

Fever, cough, weight loss;
hemoptysis and night
sweats are rare in young
children

The most common CXR
findings are hilar or
mediastinal adenopathy,
parenchymal
consolidations, freeflowing pleural
effusions; cavitary
lesions are rare in young
children. TSTs are
positive in most, but can
be anergic in
overwhelming TB
disease.
AFB cultures positive in
20–40%

Peripheral
Painless enlargement (2–4 CXR abnormal in up to

lymphadenopathy
cm) of anterior, posterior
33%.
cervical, submandibular, TSTs positive in most.
or supraclavicular nodes AFB cultures positive in
with no signs of
75%.
inflammation. Fever or
other constitutional
symptoms seen in 50–
60%
Meningeal

Three well-described
CXR abnormal in up to
stages:
90%.
I: Headache, fever,
CT brain findings can
constitutional symptoms
include hydrocephalus,
leptomeningeal
II: Cranial nerve palsies,
enhancement,
meningismus, some
tuberculomas, and
alterations in mental
vascular infarcts.
status
III: Obtunded or comatose CSF findings: lymphocytic

pleocytosis with high


Skeletal

Miliary

a Mycobacterium

CSF protein and low
CSF glucose.
TST positive in
approximately 30%.
AFB cultures positive in
20–30%.
Most commonly spondylitis CXR abnormal in 50%.
(particularly of the
MRI is the best diagnostic
thoracolumbar spine),
modality.
arthritis, and
TSTs positive in most.
osteomyelitis
AFB cultures of bone
positive in up to 75%.
Fever, hepatomegaly,
CXR with diffuse granular
splenomegaly, failure to
pattern, sometimes with
thrive. Meningitis is seen

superimposed focal
in up to 20% of cases of
airspace disease.
miliary TB.
TST is very insensitive.
AFB cultures positive in up
to 50%.

tuberculosis also can affect the genitourinary tract, peritoneum, skin, and middle ear.
CXR, chest radiograph; TST, tuberculin skin test; AFB, acid-fast bacilli; CT, computed tomography; CSF,
cerebrospinal fluid.


e-TABLE 94.18
TREATMENT OF TYPHOID FEVER
Disease type

Treatment

Uncomplicated with no
suspected resistance

Ciprofloxacin or ofloxacin
Adult:
500 mg twice daily po or IV for 7–10 days
Pediatric:
30 mg/kg/day (maximum dose: 1,000 mg po
or IV) for 7–10 days
Or Azithromycin
Adult:

1 g po × 1, then 500 mg po daily × 5–7 days
Pediatric:
10–20 mg/kg (max 1 g) po daily × 5–7 days
Azithromycin
Adult:
1 g po × 1, then 500 mg po daily × 5–7 days
Pediatric:
10–20 mg/kg (max 1 g) po daily × 5–7 days
Ceftriaxone or other third-generation
cephalosporin
Adult:
Ceftriaxone 2–3 g IV daily or cefixime 20
mg/kg/day divided twice daily for 7–14
days
Pediatric:
Ceftriaxone 100 mg/kg/day IV daily
(maximum: 4 g/day) or cefixime 20
mg/kg/day divided twice daily (maximum
dose: 400 mg/dose) × 10–14 days

Uncomplicated illness with
suspected or known
resistance

Severe illness a

a Bacteremia,

sepsis, meningitis, abscess, osteomyelitis, or in human immunodeficiency virus (HIV)infected patients, initial therapy with a parenteral third-generation cephalosporin should be initiated.
Aminoglycosides are not recommended for severe typhoid. The treatment duration for meningitis is 4 wks,

and 4–6 wks for osteomyelitis. Severe enteric fever, with shock and altered mentation, is an indication for
systemic corticosteroids–dexamethasone 3 mg/kg followed by 1 mg/kg every 6 hrs for a total course of 48
hors.


e-TABLE 94.19
CLINICAL PRESENTATIONS AND DIAGNOSIS OF DENGUE