Pediatric emergency medicine trisk 603

Oncologic

a Infections

virus), meningitis
assays; Toxoplasma, CMV,
(tuberculosis, cryptococcal
EBV titers
and other fungal pathogens),
encephalitis (viral,
Toxoplasma ), infarcts; drug
effects
Non-Hodgkin lymphomas,
CBC, peripheral smear, LDH,
leiomyomas,
uric acid, serum
leiomyosarcomas (all three
chemistries, oncology
EBV associated), Kaposi
consultation
sarcoma (HHV-8
associated), anal and
cervical carcinomas (HPV
associated)

more common and/or more severe in HIV-infected children than in immunocompetent children.
CMV, cytomegalovirus; CBC, complete blood count; UA, urinalysis; CXR, chest radiograph; EBV,
Epstein–Barr virus; MAC, Mycobacterium avium complex; PCR, polymerase chain reaction; PJP,
Pneumocystis jiroveci pneumonia; GAS, group A streptococcus; LDH, lactate dehydrogenase; HIV, human
immunodeficiency virus; EKG, electrocardiogram; BNP, B-type natriuretic peptide; HSV, herpes simplex
virus; AIDS, acquired immunodeficiency syndrome; CT, computed tomography; CSF, cerebrospinal fluid;

HPV, human papillomavirus; HHV, human herpes virus.


e-TABLE 94.31
CRITERIA FOR THE DIAGNOSIS OF NEONATAL AND EARLY
CONGENITAL SYPHILIS


Diagnostic
criteria

Symptoms, laboratory
findings

Absolute

Treponema pallidum
visualized
Major clinical Condylomata lata

Osteochrondritis,
perichondritis

Snuffles

Minor clinical Fissures

Cutaneous lesions

Mucous patches

Hepatomegaly, splenomegaly

Details
Dark field microscopy
Raised, nontender, moist
lesions on skin; highly
infections (contact
precautions should be used)
Most common manifestation
(60–80%): humeral and
femoral involvement most
common. Serrated
appearance to epiphysis on
long-bone XRs
Appears between 1 and 12
wks of age; severe longlasting whitish to bloody
nasal discharge
Fissures around mouth, nares,
anus; easily bleed, heal with
scarring. While not a
common finding, fissures
are somewhat specific (but
not pathognomonic) for
congenital syphilis
Maculopapular rash more
common on hands/feet; can
be bullous, and if present at
birth is often disseminated
(pemphigus syphiliticus);
highly infections (contact

precautions should be used)
Painless patches on mouth,
genitals
Hepatomegaly almost


Lymphadenopathy
CNS signs

Hemolytic anemia

CSF anomalies

Serologic

Certainty of
diagnosis
Definite
Probable

uniformly seen
Generalized nontender
adenopathy
Meningitis, meningismus,
seizures, cranial nerve
palsies, hydrocephalus,
pituitary dysfunction
Coombs negative, associated
with cryoglobulinemia.
Other hematologic findings:

thrombocytopenia,
leukopenia, or leukocytosis
Seen in approximately 20%:
CSF pleocytosis or elevated
CSF protein

1. Reactive (nontreponemal)
RPR (serum), VDRL (CSF)
serologic tests for syphilis FTA-ABS, TP-PA, or MHA2. Reactive treponemal test
TP
3. Reactive serologic test for
syphilis that does not revert
to nonreactive within 4 mo
4. Rising titer over 3 mo

Absolute clinical criterion
Any of the following:
• Serologic criteria three or
four
• One major criterion and
serologic criterion one or
two
• Two or more minor clinical
criteria and serologic
criterion one or two
• One major and one minor
clinical criterion