Pediatric emergency medicine trisk 576

TABLE 94.20
DIAGNOSIS AND TREATMENT OF COMMON INFECTIONS IN RETURNED TRAVELERS


Disease

ED-based testing

Definitive diagnosis

Treatment

Amebiasis

Stool (better for colitis) or
serum (better for hepatic
abscess) antigen detection
Serology (better for hepatic
abscess)
Ancillary: leukocytosis,
anemia, elevated ALT;
abdominal imaging to
help differentiate from
pyogenic abscesses,
Echinococcus, and
malignancy
Thick and thin smears with
Giemsa/Wright staining
Anemia, low haptoglobin,
elevated lactate

dehydrogenase, and
reticulocyte count;
thrombocytopenia
common
Serology (acute and
convalescent titers)
Lab should be notified that
Brucella is suspected as
cultures require an
incubation of 4 wks
minimum

Microscopy to detect
eggs in stool or
antigen detection
(stool, serum) or
serology

Noninvasive or asymptomatic disease: p
a luminal agent)
Colitis: metronidazole
Amebic abscess: metronidazole + parom
luminal agent

Serology

Trimethoprim-sulfamethoxazole and rifa
wks
Addition of an aminoglycoside should b
days in case of suspected meningitis, e

osteomyelitis

Campylobacter

Stool culture

Stool culture

Chagas

Giemsa Staining or direct
Giemsa staining
wet mount
Serology testing available
by CDC for chronic cases

Fluid resuscitation
Azithromycin (10 mg/kg) × 3 days
Benznidazole for 60–90 days or
Nifurtimox available through CDC; seek

Chikungunya

Usually a clinical diagnosis:
fever + severe
arthralgia/arthritis +
travel to or residence in
endemic area within 15
days of symptom onset +
virologic evidence

Stool culture with use of
salt-containing media
(TBS)
Ancillary: may see
hypoglycemia,
hypokalemia, and other
electrolyte disturbances
secondary to dehydration
Stool culture for oocysts

Babesiosis

Brucella

Cholera

Cryptosporidium

Visualization of
Mild–moderate: atovaquone + azithromy
trophozoites
quinine for 7–10 days
(Maltese cross)
If parasitemia >10% (especially in asple
Antibody detection by
significant anemia, or hepatorenal or p
indirect
compromise, exchange transfusion sh
immunofluorescence
assays

PCR is preferred in
Supportive, nonsteroidal anti-inflammato
early stages
Small series have noted possible benefit
Serology: IgM usually
chloroquine, but these have not been v
detectable in 2–7
days (lasts <3–4 mo)

Stool culture

Fluid resuscitation
Antibiotics (fluoroquinolones, tetracycli
severity and duration—important to p
spread

Stool culture for

Most do not require therapy


Cutaneous larval
migrans
Dengue

Diphtheria

E. coli (0157:H7)
Filariasis

Giardia

Hantavirus

(use of formalin ethyl
oocysts
acetate stool
concentration method is
recommended and at least
three stool specimens
collected on separate days
are required because
shedding can be
intermittent
Clinical diagnosis
Clinical diagnosis

Nitazoxanide bid x 3 days (100 mg for 1
11 yo; 500 mg for ≥12 yo)

PCR is best modality for all
stages
Ancillary:
Stage 1: Thrombocytopenia,
leukopenia, elevated
hepatic transaminases
Stage 2: DIC,
hypoalbuminemia, severe
thrombocytopenia

Stage 3: No specific
laboratory findings
Clinical diagnosis
confirmed by
nasopharyngeal or
cutaneous lesion cultures
(positive cultures should
be sent to CDC)
Conventional Stool culture

Stage 1: PCR or
ELISA
Stage 2: PCR
Serologic tests crossreact with other
flaviviral infections
or flaviviral
vaccines (e.g.,
yellow fever,
Japanese
encephalitis virus)

Supportive care, fluid resuscitation

Nasopharyngeal or
cutaneous lesion
cultures

IV equine antitoxin
Erythromycin (oral or parenteral)
Penicillin G IM or IV for 14 days

Stool culture

Supportive care

Microscopic detection of
microfilaria on blood
smears obtained at night
PCR and immunologic
testing also available
Stool culture (sensitivity is
higher for diarrheal stool
specimens)
PCR
Serology, PCR
Ancillary:
thrombocytopenia,
metabolic acidosis,
elevated creatinine,
elevated hepatic
transaminases
Culture not recommended
due to risk to laboratory
personnel

Microscopic detection Microfilaria of W. bancrofti: Diethylcarb
of microfilaria on
(DEC) 2 mg/kg × 1 dose, or 50 mg DE
blood smears
old × 1 dose

obtained at night

Hemorrhagic fever Serology
viruses (other
Ancillary:
than dengue)
thrombocytopenia,

Albendazole 15 mg/kg daily for 3 days (
mg/day) or ivermectin 200 µg/kg once

Stool culture
Metronidazole 5–7 days; tinidazole (for
(sensitivity is higher
mg/kg (max: 2 g) as a single dose, or
for diarrheal stool
days (100 mg for 1–3 yo; 200 mg for
specimens)
≥12 yo)
Serology (should be
sent to CDC)

Supportive care

Serology (subject to
cross-reaction with

Supportive
Lassa: ribavirin highly effective if given
illness