Transcript Visual Diagnosis Part 2 - Emory University Department of Pediatrics

Highlights from the National
Pediatric Infectious Disease
Seminar (NPIDS)
Kalpesh Patel, MD
Department of Pediatric
Emergency Medicine
May 2, 2007
Saturday, April 14
 Parasitology for the Pediatriciain
• Gary D. Overturf, MD
• Univ of New Mexico HSC
 AIDS Update: Global Impact of HIV/AIDS
Pandemic
• Octavio Ramilo, MD
• UT Southwestern and advisor to Ministry of Health in Spain
 Visual Diagnosis Part 2
• James H. Brien, DO
• Scott and White Hospital, Temple, Texas
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Parasitology for the Pediatrician
 Intestinal Protozoa
 Giardia
• Transmission at high altitude ski areas in U.S.
• New agents for treatment: Nitazoxanide (Alinia)
 No oral absorption of active compound, only
active metabolites in blood. Absorption
decreased by food
 Cryptosporidia
• New agents Alinia and Albendazole (Albenza)
 Albendazole – broad spectrum antiparasitic
– Includes giardia, hydatic cyst disease and
neurocysticercosis
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Parasitology for the Pediatrician
 Cyclosporiasis
• Similar to Cryptosporidiosis
• Tx with TMP/SMX
 Amoebae
• Naegleria fowleri – primary meningoencephalitis
• Balmuthia mandrillasis – granulomatous
encephalitis
• Acanthomoeba spp. – chronic recurrent keratitis
 Treatment of Amoebae is poor
 E. histolytica – treatment unchanged with
metronidazole
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Parasitology for the Pediatrician
 Malaria prophylaxis
 Chloroquine-Sensitive areas:
• Chloroquine 5mg/kg/wk, 1 wk before departure
and 4 wks after return
 Chloroquine-Resistant Areas:
• Mefloquine, weekly. 1 wk before and 4 wks after
• Doxycycline (>7yrs) 2mg/kg or 100mg/day, 2
days before and 4 wks after
• Atovaquone-proguanil
 Alternative tx to above
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Parasitology for the Pediatrician
 Pinworms: Enterobius vermicularis
• Asymptomatic carriage in 5-30%
• Eggs infectious within 6 hours, viable for 3 weeks
• Treatment with single dose mebendazole,
albendazole, or pyrantel pamonate (repeat in 2 wks)
 Sushi
• Sparganosis – subcutaneous swellings
• Anisakiasis – causes eosinophilic granulomas of
bowel and possibly acute abdomen
• Eustrongyloides – large larvae invade abdominal
cavity and cause acute abdomen
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Parasitology for the Pediatrician
 Cutaneous Larval Migrans
• Strongyloides and Ancylostoma spp.
• Creeping eruption with serpiginous lesions
• Treatment – symptomatic + topical thiabendazole
or PO albendazole
 Visceral Larval Migrans
• Toxocara canis and catis, ascaris
• Hypereosinophilia, hepatomegaly, fever,
pneumonitis
• Treatment – supportive + albendazole and/or
corticosteroids
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AIDS Update: Global Impact of
HIV/AIDS Pandemic
 Facts 1990-2005
• 38.6 million living with HIV
• 24.5 million in sub-Saharan Africa
 Rates stabilized in all areas except South
Africa
• 4.1 million new infections/year
• 2.8 million deaths/year
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AIDS Update: Global Impact of
HIV/AIDS Pandemic
 AIDS ABC’s
• Abstain
• Be faithful
• Circumcision, Condoms, Counseling and testing
 Circumcised men 3X less likely to become infected
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Diaphragms
Exposure prophylaxis
Female-controlled microbicides
Genital tract infection control
HSV-2 suppressive treatment
Immunization
AIDS Update: Global Impact of
HIV/AIDS Pandemic
 Recommended prophylaxis for all people (infected
+ uninfected) as a cost effective measure
 2 promising vaccines
• HVTN 502/Merck 023
 Adenovirus vectors
 Phase 2b trial in progress in US, Puerto Rico +
5 other countries
• NIAID/VRC DNA/rAd5 Candidate Vaccine
 Uses multiclade multigene constructs – DNA,
plasmid vector prime, + adenoviral vector
 Phase 2 human trials
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Visual Diagnosis Part 2
 Case 10
• 15 y/o with epididymitis, Group A strep
pharyngitis and Herpes cold sore
 Case 11
• 6 year old with rash, LAD, 18K WBC, Tx with
Keflex X 5 days
 4X4 cm right inguinal LAD
 Rash involves lips, but no other mucous
membranes
 Rash on palms and soles
• Dx: Erythema Multiforme (EM)
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Visual Diagnosis Part 2
• Urticaria usually have central clearing, EM has
central darkening
• EM shows perivenular inflammation or vacuolar
interface dermatitis on skin biopsy
• Steven’s Johnson – Must have at least 2 mucous
membranes involved
 Case 12
• 6 month old acute febrile illness
• Brudinski’s sign not very accurate
 Case 13
• Chronic Osteomyelitis in a fractured/refractured
arm not healing
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Visual Diagnosis Part 2
 Case 14
• 11 mo old admitted for RSV bronchiolitis,
improving and D/C’d on hospital day 3
• Developed secondary fever to 104F and resp
distress and readmitted
• Mediastinal mass found on CXR and CT Chest
• How do you treat mediastinal abscess?
 1. Azithromycin + Ceftriaxone
 2. Clindamycin + Ceftriaxone
 3. Vancomycin + Azithromycin
 4. Ceftriaxone + Vancomycin
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Visual Diagnosis Part 2
 Answer: 4. Ceftriaxone + Vancomycin + surgical
drainage/debridement
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