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1、CoreTutorialinPediatricInfectiousDiseasesforThirdYearMedicalStudents InfectiousDiseaseEmergencies?Howwouldyouevaluatethispatient?Asixteen-year-oldgirlpresentswithfeverandlowerabdominalpainbutdeniesurinaryurgencyorfrequency.Sheissexuallyactiveandusescondomsinfrequently.?Howwo
2、uldyouevaluatethispatient?Asixteen-month-oldpresentswithahistoryofnasaldischargeforthepastweekpresentswithaswollen,redeyeandfeversto1030F.LearningObjectivesBeabletorecognizeaninfectiousdiseaseemergencyUnderstandtheage-appropriateapproachtodiagnosisandinitialmanagementofinfectio
3、usdiseaseemergenciesBefamiliarwithvariousagentswithbioterrorismpotentialBacteremiaandSepsisBacteremia=PresenceofpathogenicbacteriainthebloodofmildlyormoderatelyillchildIncidencepeakatage6to18monthsSee“Fever”tutorialforcompletediscussionofwork-upandmanagementSepsis=Bacteremiawit
4、hserioussystemicillnessPathogensbirthto2months:GroupBStreptococcus,E.coliolderinfants:Strep.pneumoniae,N.meningitidis,GroupAStreptococcus,S.aureus,SalmonellaRiskfactorsneoplasia,immunodeficiencysyndromes,immunosuppressivetherapy,asplenia,sicklecelldiseaseSepsisSignsandSymptomsf
5、ever,tachycardia,tachypnea,hypotension,metabolicacidosis,thrombocytopenia,leukocytosis(leukopeniawithoverwhelminginfection)Work-upCBCbloodculturecoagulationstudies,electrolytes,LFT’s,BUNandcreatinineTreatmentfluids,vasopressors;closemonitoringinICUage<2months:ampicillinandgenta
6、micinorcefotaximeage>2monthsceftriaxoneorcefotaxime+/-vancomycinMeningococcemiaNeisseriameningitidisPeakincidenceisfirstyearoflife,40%inage<5yrsRiskfactorsincludeovercrowding,poverty,cigarettesmokeexposure,priorrespiratoryinfection,congenitalimpairmentofphagocytosisTransmission
7、byrespiratorydroplets,closedirectcontactEndotoxin(lipopolysaccharide)causesendothelialdamage,systemicinflammatoryresponseCanprogressfromasymptomatictodeathwithinhoursMeningococcemia,con’tSignsandsymptomsFever,headache,myalgiasAlteredmentalstatus,highfeverorhypothermia,tachypnea
8、,hypotensionPetechialrashprogressingtopurpuramaybegina
