Pediatric emergency medicine trisk 598

Type
Asymptomatic

Clinical presentation

Approximately 50% of infected individuals remain
asymptomatic
Undifferentiated
Relatively benign febrile illness
fevers
Typically in young children experiencing their first
infection
Many go undiagnosed because of similarities with other
febrile illnesses
Dengue fever
Fever and develop two or more of the following:
without warning • Nausea or vomiting
signs
• Myalgias and/or arthralgias
• Diffuse erythematous maculopapular rash
• Leukopenia
• Positive tourniquet test (inflation of a blood pressure cuff
for 5 min results in >10–20 petechiae per square inch; a
measure of capillary fragility)
Dengue with
Symptoms of dengue without warning signs with any of
warning signs
the following additional symptoms:
• Abdominal pain or tenderness
• Persistent emesis
• Fluid overload (ascites, pleural effusion)

• Mucosal bleeding
• Lethargy
• Hepatomegaly (liver edge appreciable 2 cm below costal
margin)
• Increased hemoglobin (from hemoconcentration) and
thrombocytopenia
Severe dengue
Symptoms of dengue with warning signs with any of the
fever or dengue
following:
shock syndrome • Severe plasma leakage with resultant:
• Shock
• Fluid accumulation resulting in respiratory distress or
failure
• Severe bleeding


• Severe end-organ involvement:
• Hepatic transaminases >1,000 IU/L
• Impaired consciousness
• End-organ failure
e-TABLE 94.20
INFLAMMATORY VERSUS NONINFLAMMATORY DIARRHEA
Mechanism

Symptoms
Stool quality
Anatomic site
Pathogens

Inflammatory

Noninflammatory

Destruction of enteric
mucous membranes
resulting in inflammatory
response. Release of
neutrophils and
erythrocytes in stool.
Abdominal pain, fever,
tenesmus
Small volume, frequent,
blood and mucus present
Distal ileum and colon
Enteroinvasive E. coli
Enterohemorrhagic E. coli
Campylobacter spp.
Salmonella spp.
Shigella spp.
Clostridium difficile
Entamoeba histolytica

Osmotic: inability to
breakdown disaccharides
Secretory: intestinal
epithelial cells are
stimulated to secrete fluid
Abdominal pain, nausea,
vomiting

Large volume, watery stool
Proximal small intestine
Enterotoxigenic E. coli
Vibrio cholera
Campylobacter spp.
Salmonella spp.
Bacillis cereus
Cryptosporidium hominis
Giardia intestinalis


e-TABLE 94.21
INDICATIONS FOR POSTEXPOSURE PROPHYLAXIS FOR RABIES
Scenario a

Recommendation

Livestock, rodents, rabbits, hares

Rarely require prophylaxis; verify
with local health authorities to see if
cases have been reported in these
animals in your region
Prophylaxis is only needed if animal
displays signs of rabies

Dogs, cats, ferrets known to be
vaccinated or available for 10-day
observation period
Dogs, cats, ferrets who are unavailable Consult with local health authorities to

for observation
see if cases have been reported in
these animals in your region
Any mammal available for
Immediate immunization and RIG
observation who develops signs of
rabies
Contact with bats, woodchucks, or
Immediate immunization and RIG
wild carnivores (coyotes, foxes,
unless animal available for
skunks)
observation
Bat found in room with a sleeping or Immediate immunization and RIG
nonverbal child
unless animal available for
observation
Contact with rabies patient
Touching an infected patient or contact
with noninfected body fluids does
not require prophylaxis
a Exposure

is defined as a bite, scratch, open wound or contact with saliva, cerebrospinal fluid, or brain
tissue.
RIG, rabies immune globulin.


e-TABLE 94.22
COMMON CAUSES OF DYSENTERY IN THE RETURNED

TRAVELER