THÔNG TIN TÀI LIỆU
An unusual process that produces a sepsis-like picture is infant botulism (see Chapter 94 Infectious Disease Emergencies ) The symptoms of this illness are caused by neurotoxins elaborated by Clostridium botulinum An infant with botulism is afebrile with lethargy, a weak cry, and possibly dehydration The parents may note a gradual progression with this illness that is preceded by constipation The disease is associated with the ingestion of honey, breastfeeding, a recent change in feeding practices, a rural environment, and/or nearby construction Infants are generally well perfused with normal cardiovascular parameters (unlike sepsis), but notably hypotonic and hyporeflexic, and may have increased secretions caused by bulbar muscle weakness The presence of a facial droop, ophthalmoplegia, and decreased gag reflex are consistent with botulism, and are rare findings with sepsis The diagnosis of infant botulism is usually made clinically A stool specimen that identifies toxins of C botulinum is diagnostic, but requires considerable time for identification Electromyography will show decreased muscle action potential with the “staircase” phenomenon in this disease, but this is rarely performed A young baby with a ventriculoperitoneal shunt in place because of hydrocephalus can develop serious complications that cause the baby to appear extremely ill (see Chapter 122 Neurosurgical Emergencies ) Shunt infection could present with fever and irritability Abdominal tenderness may be found on examination, as well as erythema or pus around the shunt itself The definitive diagnosis is made by shunt aspiration or lumbar puncture Shunt obstruction may result in increased intracranial pressure that causes a young infant to present with lethargy or poor feeding On examination, the baby may have bradycardia, apnea, coma, opisthotonic posturing, bulging fontanel, or cranial nerve VI palsy A CT scan or fast MRI will demonstrate ventricle size and indicate the adequacy of shunt function Child Abuse Consider intracranial hemorrhage from child abuse in the very ill infant (See Chapter 87 Child Abuse/Assault and ED Clinical Pathway for Evaluation/Treatment of Children with Physical Abuse Concerns; https://www.chop.edu/clinical-pathway/abuse-physical-clinical-pathway ) Vigorous shaking of an infant or throwing the baby against a soft surface such as a mattress or sofa can produce subdural or subarachnoid hemorrhages that may of sufficient volume to cause shock The history may or may not be helpful A report that the infant was well and is now suddenly in critical condition raises suspicion of abuse The parents may note that the child had respiratory distress at home; only a few admit to shaking the infant On examination, the infant may appear
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