Bacterial Conjunctivitis

A 10-month-old boy with an asymptomatic rash is brought to your office by his mother. The rash, which began on the legs and spread to the arms, face, and buttocks, has been present for 3 days. Other than rhinorrhea and nasal congestion for the past 3 to 5 days, the infant has been well, although fussier than usual, especially at night. His appetite is normal. The rash has persisted despite the application of bacitracin, petroleum jelly, and cortisone. He has had no sick contacts with a similar rash or illness. His immunizations are up-to-date.

“Drug rash” is a common pediatric complaint in both inpatient and outpatient settings. This term, however, denotes a clinical category and is not a precise diagnosis. Proper identification and classification of drug eruptions in children are important for determining the possibility of-and preventing progression to-internal involvement. Accurate identification is also important so that patients and their parents can be counseled to avoid future problematic drug exposures.

A 12-year-old girl presented to the emergency department with progressing generalized inflammatory symptoms (fever and malaise), visual difficulty, severe inspiratory dyspnea, and 2 painless lesions on the right upper lip that had persisted for a few days. She had been well until 2 days before presentation, when she noticed a small pimple-like lesion above the right upper lip that was followed rapidly by facial edema, erythema, and constitutional symptoms.

Most children who present with undifferentiated rash and fever-or fever and rash and nonspecific physical findings-have a benign viral illness. However, identifying those few who have an early or atypical presentation of a more serious disease is vitally important. Here-clues that can help.

A 3-month-old African American boy was referred for evaluation of poor weight gain and vomiting. The infant had been evaluated by his primary care physician 15 times within the past 6 weeks; he had no change in symptoms despite various treatments.

Selective IgA deficiency (SIGAD) is the most common immunodeficiency disorder; it affects about 1 in 200 to 900 persons. Most affected children are asymptomatic.

Although it has been more than 40 years since Kawasaki disease was first described, it is still something of a medical mystery.

A 4-month-old boy was transferred to our center from a community care hospital because of persistent fever (temperature up to 39.4°C [103°F]) of 5 days’ duration. He also had decreased activity, increased irritability, occasional vomiting after feedings, and a few episodes of loose stool.

A 13-year-old boy was brought to the emergency department (ED) with a generalized itchy rash of 2 days' duration. For the past 3 days, he had dry, itchy eyes with a purulent discharge (Figure 1) and nonbilious emesis 2 or 3 times per day, with some blood streaks in the vomitus on the third day of illness.

A 4-day-old girl was brought to the emergency department (ED) for evaluation of a copious discharge from the right eye with associated swelling and redness of the eyelid (Figure 1). The discharge began 2 days earlier and had become profuse and yellow-green. Chemosis and injection of the conjunctiva of the right eye were also noted (Figure 2).

ABSTRACT: Children who present with rash and fever can be divided into 3 groups: the first group includes those with features of serious illness who require immediate intervention. The second and third groups include those with clearly recognizable viral syndromes and those with early or undifferentiated rash. The morphology of lesions among children with symptoms of serious illness offers clues to the underlying cause. Purpura or ecchymoses in a well-appearing child may not be associated with serious illness; a large percentage of children who present with fever and purpura have Henoch-Schönlein purpura. Kawasaki disease typically manifests with blanching rash and fever. Vesicular or bullous lesions and fever are the hallmark of erythema multiforme, toxic epidermal necrolysis, and staphylococcal scalded skin syndrome. Umbilicated papules and pustules are the sine qua non of molluscum contagiosum and varicella.

Children who present with rash and fever can be divided into 3 groups: the first group includes those with features of serious illness who require immediate intervention. The second and third groups include those with clearly recognizable viral syndromes, and those with early or undifferentiated rash.

Vital signs were normal. The patient had left-sided periorbital edema with slight ecchymosis and enophthalmos. There was conjunctival injection of the left eye, but no hyphema was noted. Pupils were equal, round, and reactive. Extraocular muscles revealed some restriction with upward gaze. Tympanic membranes were intact without hemotympanum. Nasal and oral examination findings were normal.

ABSTRACT: 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.

A 12-year-old girl was brought by her parents for evaluation of a spot in her eye, which they feared might be an embedded foreign body. She had nominal eye discomfort, which was probably secondary to attempted removal of the object. The child could not recall having dust particles in the eye, and she had no previous eye lesion.

A 10-year-old boy had a 3-day history of an itchy eye. His mother thought he had somehow cut his upper left eyelid.

The rash on the upper torso, arms, and back of an 11-year-old started after he had a headache and fever for 3 days. The patient also has a distinctive pharyngitis with redness and some petechiae.

Sixteen-year-old boy referred to pediatric emergency department (ED) by his primary care physician with a history of headache, blurred vision, and mild proptosis of right eye. Vision: 20/200 OD (right eye) and 20/25 OS (left eye).

A 17-year-old boy presents with a red, scaly rash on his trunk that began as a single lesion on his left flank. The generalized eruption had developed within 24 to 48 hours. The patient's father has psoriasis.

A 13-year-old Hispanic boy presented to emergency department with a 1-day history of red eyes. The eye changes were not associated with vision changes, increased tearing, discharge, pain, fever, or trauma.

A 17-year-old Haitian girl who was visiting Florida presented to the emergency department after she experienced pain and a change in vision in her left eye. Her right eye was asymptomatic. For the past 3 to 4 days, she had been wearing a pair of colored contact lenses she bought for fun at a discount store.

The child has orbital cellulitis, an infection with sometimes serious sequelae that involves the soft tissue of the orbit posterior to the orbital septum. Children are more likely than adults to contract orbital cellulitis; the median age of those affected is 7 years. Preseptal cellulitis--the other major infection of the ocular and adnexal orbital tissue--involves the soft tissue of the eyelids and periocular region anterior to the orbital septum and is considered less severe.

Tuberculosis (TB) remains one the most important infectious diseases in the world. More than 8 million people are infected every year. The vast majority of infections--95%--occur in developing countries, where the disease accounts for 25% of avoidable adult deaths.

Photo Essay: A Collage of Infectious Diseases in Children Perichondritis Periorbital Cellulitis Bacterial Conjunctivitis Roseola Infantum (Exanthem Subitum) Tinea Corporis ("Ringworm")

A 3-year-old boy with high fever, malaise, anorexia, and drooling of 3 days' duration was brought to the emergency department (ED). A bacterial throat infection was diagnosed, and oral antibiotic therapy was started.

Poisons have been a threat to the health and well-being of humankind for millennia. Given the ubiquitous nature of potential poisons, exposure to a toxin should be included in the differential diagnosis of patients with unexplained illnesses or unusual presentations.

Gonorrhea (aka "the clap," or "the drip") is caused by sexually transmitted Neisseria gonorrhoeae--a Gram-negative diplococcus. One of the most common reportable diseases in the United States, gonorrhea frequently affects sexually active adolescents. Approximately 30% of the 350,000 annual cases involve 15- to 19-year-olds. (That percentage is thought to be an underestimate!) Those most often infected are young women 15 to 24 years old. Recent data suggest that infection rates are higher among teens who are homeless or pregnant, and in those from a minority group or an economically disadvantaged background.

For 2 days, a 4-year-old girl had complained of discomfort and a yellow discharge from the left eye. The left conjunctiva was hyperemic, but there was no preauricular lymphadenopathy.

THE CASE: A 3-year-old boy is brought to the office by his mother. The previous evening, she had noticed a single large red spot on the back of his thigh. This morning, his whole body was covered with a similar rash, and he had a temperature of 38.8°C (102°F). The mother administered 1 dose of acetaminophen at home for the fever; the rash was asymptomatic.

The parents of this child are concerned that her eyes are “crossed.” Is this condition cause for concern?