Typhoid and Malaria: Now in Your Waiting Room
July 1st 2007We frequently see children who have just returned from India with fever, diarrhea, and constitutional symptoms. It is our job to determine whether they have a benign viral illness or something more serious. Some of the children have received malaria prophylaxis (usually mefloquine [Lariam] and occasionally atovaquone and proguanil [Malarone]). The number of children who have been vaccinated against hepatitis A infection is certainly on the rise, but few have been vaccinated against typhoid fever.
Group A -Hemolytic Streptococcal Vulvovaginitis
July 1st 2007An otherwise healthy 3-year-old girl was brought for evaluation of fever, sore throat, and shaking chills of 12 hours' duration. She had beefy-red, posterior oropharyngeal erythema and a scarlatiniform rash on her shoulder that had been present for a few hours. The rash faded out over her chest but reappeared in the perineum and lower abdomen. She also had vulvovaginal inflammation with surrounding erythema. The mother was surprised to see the inflammation, but in retrospect added that the child had complained of vaginal discomfort as well. A rapid antigen test for group A b-hemolytic streptococci (GABHS) from a swab of the oropharynx was positive.
Indurated Lesion on Child's Metacarpophalangeal Joint
July 1st 2007A 6-year-old girl is brought for evaluation of an asymptomatic indurated erythematous lesion that erupted on the metacarpophalangeal joint of one hand 2 weeks ago. The patient has no history of trauma or exposure and is otherwise healthy.
Update on Pediatric Rheumatology
July 1st 2007ABSTRACT: Dramatic progress has been made in our understanding of pediatric rheumatic disease. Various classification systems help identify juvenile idiopathic arthritis (JIA), which involves unique considerations that distinguish it from rheumatoid arthritis in adults. Vaccination issues are important for children with JIA. Renal involvement with systemic lupus erythematosus (SLE) is more common and more severe in children than in adults, but treatment of children who have SLE is similar to that of adults. Neonatal lupus erythematosus may occur in infants whose mothers have SLE. Juvenile dermatomyositis is associated with significant morbidity and mortality. Kawasaki disease is a common vasculitis of childhood, especially in infants and toddlers. Each of at least 8 major familial periodic fever clinical syndromes has specific distinguishing characteristics.
Young Child With Hematuria and Dysuria
July 1st 2007A 3-year-oldgirl is brought to the office because of a 1-week history of hematuria and dysuria. Her mother had noticed bright red blood in the child's urine and diaper. The child did not have dysuria initially but later complained of a burning sensation. A week earlier, the patient had been seen at an urgent care center. Oral trimethoprim/sulfamethoxazole was prescribed after urinalysis showed numerous red blood cells and few white blood cells. However, the hematuria persisted.
Photoclinic: Fragile X Syndrome
July 1st 2006During a routine physical examination, a 3-year-old boy was noted to have speech delay and hyperactive behavior. The child was born at term to a 25-year-old mother with epilepsy, which was managed with phenytoin. His birth weight was 3.5 kg (7.8 lb); he had no neonatal problems or features of fetal Dilantin syndrome. However, he had undergone bilateral hydrocele and inguinal hernia repair and tube placement for recurrent ear infections. His half sister (from his mother's previous marriage) needs help in reading and math. His father is healthy.