Pediatric emergency medicine trisk 602

Neurotoxicity Ocular effects Pancreatitis Postural hypotension High-dose acyclovir, quinolones Cidofovir, didanoside, enfuvirtide, ethambutol, linezolid, quinolones, rifabutin, voriconazole Didanosine, dolutegravir, lamivudine, pentamidine, ritonavir, stavudine, trimethoprim-sulfamethoxazole, zalcitabine Maraviroc e-TABLE 94.29 SIGNS AND SYMPTOMS OF HUMAN IMMUNODEFICIENCY VIRUS INFECTION IN CHILDREN Recurrent fever Developmental delay Failure to thrive Chronic or recurrent diarrhea Chronic or recurrent parotitis Chronic or recurrent oral thrush Lymphadenopathy Hepatomegaly Splenomegaly Acquired microcephaly Wasting syndrome Bacteremia e-TABLE 94.30 EVALUATION OF SYMPTOMS IN THE CHILD WITH HUMAN IMMUNODEFICIENCY VIRUS INFECTION Symptom Possible etiologies a ED-based evaluation Fever, acute Otitis media, sinusitis, pneumonia, adenitis, SSTI, CMV Fever, prolonged CMV, EBV, MAC, tuberculosis, fungal pathogens; recurrent otitis, parotitis, or sinusitis; malignancy; immune reconstitution syndrome PJP, bacterial pneumonia (pneumococcus, GAS, nontypeable H influenzae, Moraxella species), tuberculosis, MAC, CMV, fungal pathogens (histoplasmosis, coccidioidomycosis, blastomycosis) Asthma is most common, followed by viral etiologies Specific HIV-associated diagnoses: PCP, lymphoid interstitial pneumonitis, pneumonia, congestive heart failure (due to cardiomyopathy) Cervical adenitis (GAS, S aureus, Bartonella ), suppurative parotitis, condylomata, molluscum, folliculitis, HSV CBC, blood culture UA/urine culture as per febrile infant/toddler guidelines CXR if leukocytosis, respiratory symptoms, or hypoxemia Evaluation for acute fever and CMV antigenemia, CMV/EBV PCR Cough Wheezing Soft tissue infections Pulse oximetry, CXR, arterial blood gas, LDH (elevated in PCP), CBC, blood culture Children may need to undergo bronchoscopy to secure adequate specimens for silver stain and other diagnostic studies Pulse oximetry, CXR if has no prior wheezing history, arterial blood gas, LDH (elevated in PCP); EKG, BNP, cardiac enzymes if cardiac etiology suspected Wound cultures (bacterial and viral) and Gram stain; blood cultures should be obtained in the ill-appearing child or the febrile child; consider need for drainage of abscesses Dermatitis Diarrhea Hematologic Neurologic Seborrheic dermatitis, scabies, molluscum contagiosum, varicella (can be severe in terms of number of lesions or hemorrhagic component), measles (may have severe pneumonitis and/or occur without the characteristic rash), syphilis, purpura or petechiae secondary to overwhelming sepsis, Kaposi sarcoma, medication-associated rashes ( e-Table 94.28 ) See e-Table 94.26 While viral infections remain the most common cause, Salmonella is the most common bacterial etiology and often is associated with bacteremia Drug effects, concomitant infections (mycobacterial, CMV, parvovirus B19, fungal infection), HIV infection, nutritional deficits, malignancy AIDS encephalopathy (indolent loss of milestones, acquired microcephaly progressing to paresis and extrapyramidal signs); progressive multifocal leukoencephalopathy (caused by a polyoma Often a clinical diagnosis; varicella can be confirmed using direct fluorescent antibody assays; measles via serology; syphilis diagnosis is described in eTable 94.26 Guaiac, stool leukocytes (stool lactoferrin), stool culture (for Salmonella, Shigella, Yersinia, Campylobacter, E coli ), C difficile toxin, Cryptosporidium/Giardia assay CBC, reticulocyte count, peripheral smear, iron panel CT brain to evaluate for mass lesions prior to lumbar puncture; CSF for routine studies in addition to acidfast and fungal culture/stains, serum and CSF cryptococcal antigen