Pediatric emergency medicine trisk 599

Organism

Region

Vibrio
cholerae

Tropics.
Incubation period 1–3 Azithromycin (20
Particularly
days
mg/kg as a single
South Asia, Painless voluminous
dose; maximum
Southeast
dose: 1 g)
watery (rice-water)
Asia, and
diarrhea without
Africa
abdominal cramps or
fever
Complications include
dehydration,
hypokalemia,
metabolic acidosis,
hypovolemic shock,
coma, seizures, and
death
Worldwide
Incubation period 10

Azithromycin (6–20
hrs–6 days
mg/kg/day for 1–5
days; maximum
Enteropathic and
daily dose: 1,000–
enterotoxigenic:
1,500 mg) or
self-limited to
fluoroquinolones
watery diarrhea with
(e.g., ciprofloxacin
abdominal cramps
15 mg/kg twice
Shiga-toxin producing
daily for 3 days;
(STEC):
maximum: 500
hemorrhagic colitis
mg/dose);
—bloody or
rifaximin (200 mg
nonbloody stool
tid × 3 days) can be
Enteroinvasive: bloody
used in children
or nonbloody
≥12 yo
diarrhea with fever
Administration of

Enteroaggregative:
antibiotics to
watery and
children with
occasionally bloody
STEC infection is
diarrhea
controversial.

E. coli

Clinical
manifestations

Treatment


Campylobacter Worldwide
species

Incubation period 2–5 Azithromycin (10
days
mg/kg daily for 3
days) or
Diarrhea (bloody or
erythromycin (10
nonbloody),
mg/kg every 6 hrs
abdominal pain,
for 5 days)

malaise, and fever.
Can cause
Fluoroquinolone
bacteremia in young
resistance in the
children.
United States is
seen in up to 34%
of isolates, and this
class of antibiotics
is not approved for
Campylobacter
infection in the
United States


e-TABLE 94.23
CLINICAL MANIFESTATIONS AND DIAGNOSIS OF
SCHISTOSOMIASIS


Site

Species

Katayama
fever

All

Symptoms

Diagnosis

Fever, malaise, cough,
Serology; can help
rash, abdominal pain,
with speciation,
nausea, diarrhea,
but cannot
tender
differentiate
hepatosplenomegaly,
ongoing infection,
lymphadenopathy, and
recent infection, or
eosinophilia
past infection
Intestinal
S. mansoni, S. Low worm burden: may Identification of eggs
japonicum,
be asymptomatic or
in the stool
S. mekongi,
have mild symptoms
(several specimens
S.
may be necessary)
Moderate–severe worm
intercalatum

burden: mucoid
bloody diarrhea,
tender hepatomegaly.
Late findings: portal
hypertension, ascites,
esophageal varices,
and hematemesis.
Urinary
S. hematobium Dysuria, urgency,
Microscopic
frequency;
examination of
microscopic or gross
urine (egg
hematuria. Late
excretion in urine
findings: bladder
typically peaks
fibrosis and bladder
between noon and
cancer
3 pm); bladder
biopsy may be
necessary
Genital tract S. hematobium Males: obstructive
Microscopic
uropathy, rare
examination of
involvement of
urine (egg

prostate, testes,
excretion in urine
epididymis, and penis.
typically peaks
between noon and
Females: ulcerating
3 pm)
polypoid or nodular
lesions of the vulva,