Transcript Illustrative Pediatric Infectious Diseases Cases-2016

Illustrative Pediatric Infectious
Diseases Cases-2016
Blaise L. Congeni M.D.
Patient TL
 Patient is 11yo, wm, who presents with a history
of a fall during soccer 3 weeks prior to this
admission, at which time he struck his head. He
then was evaluated and followed using the
concussion protocol. Over the next week he
experienced worsening headache, but no URI
complaints. Shortly prior to first admission he had
fever and then AMS. CT shows sinusitis and
subdural empyema. Sinus grew MSSA and
subdural grew S. anginosus.
 He was sent home on iv ceftriaxone and
metronidazole and at follow up he was completely
Patient LP
 8 yo with 8 days of fever and 6 days of
cough.
 She had consistently demonstrated fever of
about 102.
 Because of worsening cough and persistent
fever the patient was given ceftriaxone and
then cefdinir.
 Because of failure to improve the pt. was
admitted.
CASE
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4 year old
Low grade fever
Decreased activity
WBC 30,000 (40% eosinophils)
TOXACARA
• Species
• T. canis
• T. catis
• Delayed type and immediate hypersensitivity
reactions
• Granuloma formation
• eosinophilia
Principles and Practice of Ped Inf Dis, Prober and Long
TOXOCARA
VLM
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Usually <5 yrs old, hx pica
Fever, hepatosplenomegaly, LRT symptoms
Eosinophilia, elevated IgG, IgM
EIA for Toxocara; titer 1:32
• Less sensitive for ocular disease
TOXOCARA
TREATMENT
• Albendazole 10mg/kg/day - divided q12 - for 5
days (400 mg bid x 5 days)
• Ocular involvement longer course
• Corticosteroids as adjunctive treatment
CUTANEOUS LARVAL MIGRANS
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Creeping eruption
Southern U.S.
Dog hookworm - Ancyclostoma caninum
Via bare feet
Self-limiting, or oral albendazole or invermectin
CASE
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4 yo previously well
fever x 3 wks
Intermittent abdominal pain
No n/v/d
No travel, no ill contacts
Cat and dog at home
BARTONELLA SEROLOGY
IgG >1:512
IgM >1:160
IgG >1:1024
IgM 1:80
HEPATOSPLENIC CAT-SCRATCH
DISEASE
Arisoy et al CID, 1999;28:778
• 19 patients
• Age: 2y 4m – 11y 8m
• 12/19 male
• All with h/o exposure
• CSD initial dx 21%
Arisoy et al CID, 1999;28:778
Margileth, AM, Ped Infect Dis J, 1992; 11:474
TOXOPLASMOSIS
• Humans intermediate hosts
• Ingest oocysts of T. gondii
• Feline feces
• Raw or undercooked meat
• Disease
• Lymphadenopathy
• Retinochoroiditis
• Congenital disease
CL 17 yo WM
 Hospitalized for 3 day, 1 week PTA for fluid
and catecholamine refractory shock thought
to be due to gastro. At that time he was noted
to have fever, fatigue, emesis and diarrhea.
Following discharge he was back to ER w
eyelid swelling, and 3 days later he was to ER
a second time for fevers to 104, fatigue,
emesis and one episode of diarrhea.