Infectious Diseases

A 10-month-old boy with an asymptomatic rash is brought to your office by his mother. The rash, which began on the legs and spread to the arms, face, and buttocks, has been present for 3 days. Other than rhinorrhea and nasal congestion for the past 3 to 5 days, the infant has been well, although fussier than usual, especially at night. His appetite is normal. The rash has persisted despite the application of bacitracin, petroleum jelly, and cortisone. He has had no sick contacts with a similar rash or illness. His immunizations are up-to-date.

FDA has authorized for use a new test for the diagnosis of H1N1 influenza virus infections. This test was developed by the CDC.

“Drug rash” is a common pediatric complaint in both inpatient and outpatient settings. This term, however, denotes a clinical category and is not a precise diagnosis. Proper identification and classification of drug eruptions in children are important for determining the possibility of-and preventing progression to-internal involvement. Accurate identification is also important so that patients and their parents can be counseled to avoid future problematic drug exposures.

The precautionary list of things to avoid during pregnancy is a long one. In this issue, researchers from the CDC remind us that there is another pathogen of which pregnant women should be wary.

A 12-year-old girl presented to the emergency department with progressing generalized inflammatory symptoms (fever and malaise), visual difficulty, severe inspiratory dyspnea, and 2 painless lesions on the right upper lip that had persisted for a few days. She had been well until 2 days before presentation, when she noticed a small pimple-like lesion above the right upper lip that was followed rapidly by facial edema, erythema, and constitutional symptoms.

Most children who present with undifferentiated rash and fever-or fever and rash and nonspecific physical findings-have a benign viral illness. However, identifying those few who have an early or atypical presentation of a more serious disease is vitally important. Here-clues that can help.

On awakening in the morning, a 2-year-old girl was noted to have left-sided facial swelling and was brought to the emergency department. The child had had no fever, trauma to the area, pain, or difficulty in swallowing. Her medical history was unremarkable. Her immunizations were up-to-date; she had received both doses of the measles, mumps, and rubella (MMR) vaccine about 6 months before presentation. There were no sick contacts.

A 20-month-old boy brought to the emergency department with swelling on the right side of the neck and fever (temperature, 39.3°C [102.7°F]) of 1 day’s duration. The parents reported that the child had had intermittent fevers and poor weight gain for the past 3 months but no vomiting, diarrhea, rash, drooling, or difficulty in swallowing.

Identifying pandemic H1N1 flu in children may not be as easy as administering rapid influenza tests, according to 2 studies.

A 3-month-old African American boy was referred for evaluation of poor weight gain and vomiting. The infant had been evaluated by his primary care physician 15 times within the past 6 weeks; he had no change in symptoms despite various treatments.

Selective IgA deficiency (SIGAD) is the most common immunodeficiency disorder; it affects about 1 in 200 to 900 persons. Most affected children are asymptomatic.

For 3 months, a 9-year-old boy had swelling of the left upper arm. An MRI scan obtained at another facility 1 week after onset showed extensive edema of the soft tissue at the midhumeral level. Laboratory results, including complete blood cell (CBC) count and Lyme titer, were normal.

Among urban adolescent girls, sexually transmitted infections (STIs) often occur soon after the first occurrence of sexual intercourse.

A recent study demonstrated that long-term, low-dose trimethoprim-sulfamethoxazole (TMP-SMX) was associated with a modest decrease in urinary tract infections (UTIs) in children who had had at least 1 such symptomatic infection in the past.

The 39-practice physician hospital organization (PHO) related to the Cincinnati Children's Hospital Medical Center has increased its influenza immunization rate from 22% to 66% in 5 years.

One week earlier, a 14-month-old girl with a history of eczema was evaluated because of a diffuse rash of excoriated lesions, some of them purulent. She was afebrile. Worsening eczema with secondary infection was diagnosed. Treatment with oral clindamycin was prescribed. At follow-up, the lesions had worsened. The child had multiple excoriated papules, some of which had coalesced into plaques. She also had two 5-mm vesicles on her right shoulder. Eczema herpeticum was diagnosed clinically. Culture of the vesicles later grew herpes simplex virus (HSV).

The Food and Drug Administration (FDA) recently approved several agents for use in pediatric patients, including a new cervical cancer vaccine and a seasonal influenza vaccine.

A collection of links for the most current, comprehensive information on H1N1.

An editorial that examines the current status of H1N1 in the medical setting.

In early summer, an 8-year-old boy from rural central Virginia was brought for evaluation of a rash on his buttock. He had noticed the rash that morning, when it became pruritic. The father had removed a tick from the area about 10 days earlier. The child denied fever, headache, vomiting, fatigue, arthralgia, myalgia, and other symptoms.

When reaching under a shed for the frog she had been chasing, a 4-year-old girl was bitten by “something.” The parents thought the bite was from a snake because of reports of copperhead sightings in the area. The mother immediately brought the child to the emergency department (ED).

Letters to the editor about iron deficiency, encouraging vaccinating children in the hopsital, and more.

Public health agencies and schools have new federal guidance at their disposal for how to respond to 2009 H1N1 influenza in schools, thanks to recommendations from the Centers for Disease Control and Prevention. Recommendations encourage officials to weigh the risk of community-acquired flu with the decision to close schools or community functions.

Parents of a child who has a seizure and a fever may be concerned about epilepsy. They probably won?t be happy to learn it might be swine flu.

Alberta Children's Hospital in Calgary, Canada, has isolated one of its units due to three swine flu cases, according to health officials.

Although it has been more than 40 years since Kawasaki disease was first described, it is still something of a medical mystery.

Reviews of medical journal articles on adenoidectomy and tonsilectomy's connection to weight gain, the benefits of water over soda, and postpartum depression in moms of multiples.

The recent swine flu outbreak thankfully was not a pandemic. But it may have been the start of a new industry, for immunization for influenza H1N1.

The CDC has issued laxer guidance for school closings pertaining to H1N1 flu, recommending that only infected students and teachers remain at home.

The CDC and the Department of Health and Human Services co-hosted a Web "town hall" Q+A session about swine flu on Thursday.