Pediatric emergency medicine trisk 602

Neurotoxicity
Ocular effects
Pancreatitis

Postural
hypotension

High-dose acyclovir, quinolones
Cidofovir, didanoside, enfuvirtide, ethambutol, linezolid,
quinolones, rifabutin, voriconazole
Didanosine, dolutegravir, lamivudine, pentamidine,
ritonavir, stavudine, trimethoprim-sulfamethoxazole,
zalcitabine
Maraviroc

e-TABLE 94.29
SIGNS AND SYMPTOMS OF HUMAN IMMUNODEFICIENCY VIRUS
INFECTION IN CHILDREN
Recurrent fever
Developmental delay
Failure to thrive
Chronic or recurrent diarrhea
Chronic or recurrent parotitis
Chronic or recurrent oral thrush

Lymphadenopathy
Hepatomegaly
Splenomegaly
Acquired microcephaly
Wasting syndrome
Bacteremia

e-TABLE 94.30
EVALUATION OF SYMPTOMS IN THE CHILD WITH HUMAN
IMMUNODEFICIENCY VIRUS INFECTION


Symptom

Possible etiologies a

ED-based evaluation

Fever, acute

Otitis media, sinusitis,
pneumonia, adenitis, SSTI,
CMV

Fever,
prolonged

CMV, EBV, MAC,
tuberculosis, fungal
pathogens; recurrent otitis,
parotitis, or sinusitis;
malignancy; immune
reconstitution syndrome
PJP, bacterial pneumonia
(pneumococcus, GAS,

nontypeable H. influenzae,
Moraxella species),
tuberculosis, MAC, CMV,
fungal pathogens
(histoplasmosis,
coccidioidomycosis,
blastomycosis)
Asthma is most common,
followed by viral etiologies.
Specific HIV-associated
diagnoses: PCP, lymphoid
interstitial pneumonitis,
pneumonia, congestive
heart failure (due to
cardiomyopathy)
Cervical adenitis (GAS, S.
aureus, Bartonella ),
suppurative parotitis,
condylomata, molluscum,
folliculitis, HSV

CBC, blood culture
UA/urine culture as per febrile
infant/toddler guidelines
CXR if leukocytosis,
respiratory symptoms, or
hypoxemia
Evaluation for acute fever and
CMV antigenemia,
CMV/EBV PCR

Cough

Wheezing

Soft tissue
infections

Pulse oximetry, CXR, arterial
blood gas, LDH (elevated in
PCP), CBC, blood culture
Children may need to undergo
bronchoscopy to secure
adequate specimens for
silver stain and other
diagnostic studies
Pulse oximetry, CXR if has no
prior wheezing history,
arterial blood gas, LDH
(elevated in PCP); EKG,
BNP, cardiac enzymes if
cardiac etiology suspected

Wound cultures (bacterial and
viral) and Gram stain; blood
cultures should be obtained
in the ill-appearing child or
the febrile child; consider

need for drainage of
abscesses
Dermatitis

Diarrhea

Hematologic

Neurologic

Seborrheic dermatitis, scabies,
molluscum contagiosum,
varicella (can be severe in
terms of number of lesions
or hemorrhagic component),
measles (may have severe
pneumonitis and/or occur
without the characteristic
rash), syphilis, purpura or
petechiae secondary to
overwhelming sepsis,
Kaposi sarcoma,
medication-associated
rashes ( e-Table 94.28 )
See e-Table 94.26
While viral infections remain
the most common cause,
Salmonella is the most
common bacterial etiology
and often is associated with

bacteremia
Drug effects, concomitant
infections (mycobacterial,
CMV, parvovirus B19,
fungal infection), HIV
infection, nutritional
deficits, malignancy
AIDS encephalopathy
(indolent loss of milestones,
acquired microcephaly
progressing to paresis and
extrapyramidal signs);
progressive multifocal
leukoencephalopathy
(caused by a polyoma

Often a clinical diagnosis;
varicella can be confirmed
using direct fluorescent
antibody assays; measles
via serology; syphilis
diagnosis is described in eTable 94.26

Guaiac, stool leukocytes (stool
lactoferrin), stool culture
(for Salmonella, Shigella,
Yersinia, Campylobacter, E.
coli ), C. difficile toxin,
Cryptosporidium/Giardia
assay

CBC, reticulocyte count,
peripheral smear, iron panel

CT brain to evaluate for mass
lesions prior to lumbar
puncture; CSF for routine
studies in addition to acidfast and fungal
culture/stains, serum and
CSF cryptococcal antigen