THÔNG TIN TÀI LIỆU
Site Clinical findings Radiographic and other findings Pulmonary Fever, cough, weight loss; hemoptysis and night sweats are rare in young children The most common CXR findings are hilar or mediastinal adenopathy, parenchymal consolidations, freeflowing pleural effusions; cavitary lesions are rare in young children TSTs are positive in most, but can be anergic in overwhelming TB disease AFB cultures positive in 20–40% Peripheral Painless enlargement (2–4 CXR abnormal in up to lymphadenopathy cm) of anterior, posterior 33% cervical, submandibular, TSTs positive in most or supraclavicular nodes AFB cultures positive in with no signs of 75% inflammation Fever or other constitutional symptoms seen in 50– 60% Meningeal Three well-described CXR abnormal in up to stages: 90% I: Headache, fever, CT brain findings can constitutional symptoms include hydrocephalus, leptomeningeal II: Cranial nerve palsies, enhancement, meningismus, some tuberculomas, and alterations in mental vascular infarcts status III: Obtunded or comatose CSF findings: lymphocytic pleocytosis with high Skeletal Miliary a Mycobacterium CSF protein and low CSF glucose TST positive in approximately 30% AFB cultures positive in 20–30% Most commonly spondylitis CXR abnormal in 50% (particularly of the MRI is the best diagnostic thoracolumbar spine), modality arthritis, and TSTs positive in most osteomyelitis AFB cultures of bone positive in up to 75% Fever, hepatomegaly, CXR with diffuse granular splenomegaly, failure to pattern, sometimes with thrive Meningitis is seen superimposed focal in up to 20% of cases of airspace disease miliary TB TST is very insensitive AFB cultures positive in up to 50% tuberculosis also can affect the genitourinary tract, peritoneum, skin, and middle ear CXR, chest radiograph; TST, tuberculin skin test; AFB, acid-fast bacilli; CT, computed tomography; CSF, cerebrospinal fluid e-TABLE 94.18 TREATMENT OF TYPHOID FEVER Disease type Treatment Uncomplicated with no suspected resistance Ciprofloxacin or ofloxacin Adult: 500 mg twice daily po or IV for 7–10 days Pediatric: 30 mg/kg/day (maximum dose: 1,000 mg po or IV) for 7–10 days Or Azithromycin Adult: g po × 1, then 500 mg po daily × 5–7 days Pediatric: 10–20 mg/kg (max g) po daily × 5–7 days Azithromycin Adult: g po × 1, then 500 mg po daily × 5–7 days Pediatric: 10–20 mg/kg (max g) po daily × 5–7 days Ceftriaxone or other third-generation cephalosporin Adult: Ceftriaxone 2–3 g IV daily or cefixime 20 mg/kg/day divided twice daily for 7–14 days Pediatric: Ceftriaxone 100 mg/kg/day IV daily (maximum: g/day) or cefixime 20 mg/kg/day divided twice daily (maximum dose: 400 mg/dose) × 10–14 days Uncomplicated illness with suspected or known resistance Severe illness a a Bacteremia, sepsis, meningitis, abscess, osteomyelitis, or in human immunodeficiency virus (HIV)infected patients, initial therapy with a parenteral third-generation cephalosporin should be initiated Aminoglycosides are not recommended for severe typhoid The treatment duration for meningitis is wks, and 4–6 wks for osteomyelitis Severe enteric fever, with shock and altered mentation, is an indication for systemic corticosteroids–dexamethasone mg/kg followed by mg/kg every hrs for a total course of 48 hors e-TABLE 94.19 CLINICAL PRESENTATIONS AND DIAGNOSIS OF DENGUE ... daily po or IV for 7–10 days Pediatric: 30 mg/kg/day (maximum dose: 1,000 mg po or IV) for 7–10 days Or Azithromycin Adult: g po × 1, then 500 mg po daily × 5–7 days Pediatric: 10–20 mg/kg (max... mg/kg (max g) po daily × 5–7 days Azithromycin Adult: g po × 1, then 500 mg po daily × 5–7 days Pediatric: 10–20 mg/kg (max g) po daily × 5–7 days Ceftriaxone or other third-generation cephalosporin... cephalosporin Adult: Ceftriaxone 2–3 g IV daily or cefixime 20 mg/kg/day divided twice daily for 7–14 days Pediatric: Ceftriaxone 100 mg/kg/day IV daily (maximum: g/day) or cefixime 20 mg/kg/day divided
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