Study Document
Infectious Conditions in a Pediatric Patient Case Study
Pages:2 (778 words)
Sources:4
Document Type:Case Study
Document:#95297378
Infectious Conditions in a Pediatric Patient
What will be your differential diagnoses for this patient?
Chickenpox
Measles
Rubella
Scarlet fever
Erythema infectiosum (5th disease) -- human parvovirus
Exanthema subitum or Roseola infantum
Non-polio entero-viruses (e.g., echovirus, coxsackievirus) (Long, 2016; de Graaf et al., 2016; Long, Pickering & Prober, 2012)
What specific physical exam findings support these differential diagnoses?
Chickenpox:
• Palmar redness
• Excoriating diaper-area rashes
Measles:
• Injected conjunctiva
• Excoriating diaper-area rashes
Rubella:
• Excoriating diaper-area rashes
Scarlet fever:
• Magenta-colored lips
• Palmar redness
• Excoriating diaper-area rashes
Erythema infectiosum (5th disease) -- human parvovirus
• Excoriating diaper-area rashes
Exanthema subitum or Roseola infantum
• Excoriating diaper-area rashes
Non-polio entero-viruses (e.g., echovirus, coxsackievirus):
• Excoriating diaper-area rashes
• Red macula
• Magenta-colored lips
• Palmar redness
Of the differential diagnoses you listed, which would be the most concerning?
Non-polio enteroviruses
What additional diagnostic tests will you recommend? Why?
PCR (Polymerase chain reaction) testing, cell cultures obtained from the patient's cerebrospinal fluid, stool, or blood, and additional immunologic examinations (de Graaf et al., 2016; Thong et al., 2017).
PCR -- This is the most dependable enterovirus diagnosis test which recognizes the virus's genetic matter and is offered by specialized labs. It is commonly employed in times of virus outbreaks (e.g., the 2014 American EV-D68 epidemic) (Zhuge et al., 2015). Its alternative, cell cultures, are not as sensitive, and are incapable of spotting all enteroviruses. As such examinations aim at amplifying and detecting RNA/DNA segments highly specific to particular genetic organisms or sequences, applying them in non-polio enterovirus diagnoses will prove highly valuable. PCR tests aim at detecting a shared genetic area within enteroviral subtypes. Test results are provided within a day. This makes identification more precise (97%), time-efficient and sensitive (95%) (Zhuge et al., 2015).
Cell culture (using the patient's stool, saliva, blood, and spinal fluid) -- This approach, as well as that of conducting immunological examinations of the patient's cerebrospinal fluid, blood or stool, is not as successful in detecting enteroviruses, which may be present within the patient's cerebrospinal fluid, stool, pharynx, and blood.
Serologic testing -- This technique employs a number of titers for the identification of a trend of increasing levels of antibody between two and four weeks. A single enteroviral antibody level may be found among healthy individuals. Thus, serology observation is vital to identifying a growth in levels by four times.
What would…
Sample Source(s) Used
References
de Graaf, H., Pelosi, E., Cooper, A., Pappachan, J., Sykes, K., MacIntosh, I.,. .. & Tebruegge, M. (2016). Severe enterovirus infections in hospitalized children in the South of England: clinical phenotypes and causative genotypes. The Pediatric infectious disease journal, 35(7), 723.
Long, S. S. (2016). Diagnosis and management of undifferentiated fever in children. Journal of Infection, 72, S68-S76.
Long, S. S., Pickering, L. K., & Prober, C. G. (2012). Principles and practice of pediatric infectious disease. Elsevier Health Sciences.
Thong, W. Y., Han, A., Wang, S. F., Lin, J., Isa, M. S., Koay, E. S. C., & Tay, S. K. H. (2017). Enterovirus infections in Singaporean children: an assessment of neurological manifestations and clinical outcomes. Singapore medical journal, 58(4), 189.
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