Infectious Diseases

A 15-year-old Hispanic boy with refractory T-cell acute lymphoid leukemia was hospitalized because of fever and pain and swelling of the right knee of 3 days' duration. The patient was taking nelarabine for a recurrence of his leukemia, which was diagnosed a year earlier. He appeared nontoxic. His temperature was 39.28C (102.68F). Other vital signs were within normal limits. The right knee was warm and tender, with mild restriction of movement.

A 16-year-old Asian American girl presented for evaluation of a cyst on the anterior neck that had become enlarged and inflamed over the past 9 months. She also had a productive cough for 1 month. There was no history of night sweats, weight loss, or fever.

One week after vaccination with diphtheria, tetanus, and acellular pertussis/inactivated poliovirus/hepatitis B, Haemophilus influenzae type b, pneumococcal conjugate, and rotavirus, this 2Z\x-month-old infant presented with a vesicular rash. No other children in the home had a rash. The infant's primary caregiver was the grandmother, who had shingles 2 weeks earlier.

A 23-month-old girl presented with an erythematous papular rash on her torso that extended in a linear pattern around to the back. The mother first noticed the rash while bathing the child 3 days earlier. The child had no associated itching, irritability, or fever, but she had mild rhinorrhea preceding the rash that resolved without treatment. The patient and her older sibling were cared for at home by their mother.

The Department of Health and Human Services is offering one-time pandemic flu response planning grants to the US health care community.

The Centers for Disease Control and Prevention have launched a Web site to help prepare for this year's flu season.

Asthma inhalers, pediatric vaccination, and government funding of children's health insurance are the talk of the town this month.

ABSTRACT: The pre-middle school well child visit is now an important landmark on the vaccine schedule. The pre-kindergarten visit no longer has the distinction of being the last of the visits for "school shots." Pediatricians should emphasize this point at the 4- to 6-year-old well child visit so that parents are aware of the need for another series of vaccines in about 5 years.

ABSTRACT: College is a time of new exposures, risk-taking, and adventure. Thus, protection with proper immunization is paramount. Pediatricians should offer the recommended vaccines whether required for college entry or not. When the young adult comes to the office to have the college health form completed and signed, seize the opportunity to tout the benefits of pre-college vaccination.

ABSTRACT: Vaccination must be promoted before and on entry into elementary school. Not only does vaccination provide substantial health benefits to society, it is the law. The recommended childhood vaccination schedule changes on a yearly basis. Similarly, state vaccination requirements for school entry also may change yearly to accommodate these recommendations. Pediatricians need to remain abreast of the most recent vaccine information and to offer all vaccines at the appropriate well child visits. The goal is to limit the number or eliminate altogether the need for catch-up vaccines when the time comes for entry into elementary school.

This rash on a teenage boy's palms began on his hands and spread to his torso and upper and lower extremities over several days. He had no pain or pruritus. Two weeks before the lesions appeared, he had experienced fatigue, fever, and myalgia of 1 week's duration.

ABSTRACT: Because almost one tenth of American children aged 2 to 11 years have untreated tooth decay, a physical examination that includes inspection of the mouth is crucial. Look for cavitated or noncavitated lesions, dental fillings, and missing teeth; gingivitis and/or plaque, chalky white spots, or deep fissures on the teeth suggest dental decay. Dental care strategies that can be discussed at well-child visits include the benefits of daily flossing and brushing with fluoridated toothpaste, limited intake of dietary sugar, the establishment of a dental home, and use of protective mouthguards and face protectors during sport activities. Fluoride supplementation can be prescribed for children exposed to inadequate amounts in the water supply. The Caries-Risk Assessment Tool can help identify children at high risk for tooth decay. The pediatrician can have a great impact on ensuring that children obtain necessary dental care; a literature review found that children referred to a dentist by a primary care provider were more likely to visit a dentist than those not referred.

This infant was brought to the emergency department after a week-long exacerbation of her atopic eczema. She had not received any therapy for her eczema or for these erosions.

An otherwise healthy 3-year-old girl was brought for evaluation of fever, sore throat, and shaking chills of 12 hours' duration. She had beefy-red, posterior oropharyngeal erythema and a scarlatiniform rash on her shoulder that had been present for a few hours. The rash faded out over her chest but reappeared in the perineum and lower abdomen. She also had vulvovaginal inflammation with surrounding erythema. The mother was surprised to see the inflammation, but in retrospect added that the child had complained of vaginal discomfort as well. A rapid antigen test for group A b-hemolytic streptococci (GABHS) from a swab of the oropharynx was positive.

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.

This 17-year-old presented with multiple boils in the perineum and under breast and skin folds. The lesions produced a malodorous discharge (which caused problems with peer acceptance at school) and were increasing in size. Oral antibiotics had not helped. The patient was admitted for intravenous antibiotic therapy.

A scaly, erysipeloid rash had erupted in the axillae of an 8-year-old boy and spread to the buttocks and thighs within 2 days. The child complained only of pruritus. The rash had worsened despite treatment with clindamycin for 4 days.

A study led by researchers from the University of Maryland School of Medicine finds giving the nasal spray flu vaccine to elementary school students can significantly help reduce the impact of influenza on children and members of their family. The study compared families of children who attend schools where the vaccine was given with families of children in schools not targeted to receive the vaccine. The results of the study were published in the December 14, 2006 edition of The New England Journal of Medicine.

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.

I appreciated the excellent photograph of cutaneous leishmaniasis thatCPT Kenneth Brooks recently contributed to Photoclinic (CONSULTANT, June2004, page 1018, Figure).

If the promise of new vaccines, such as Gardasil, is to be achieved, pediatricians and family physicians must be relieved of the burdens associated with purchasing and administering them.

The lesion on this 6-year-old boy occupies almost the entire left side of his nose. The mother attributed it to an injury her son had sustained 2Z\x weeks earlier, when he was hit in the face by a baseball. The sharply defined, slightly elevated, pink macule had fine papules with an annular flat area at its inferior central aspect. A potassium hydroxide preparation of scrapings from the lesion was negative for hyphae. However, fungus culture grew Cladosporium species.

Results of a new survey of 503 caregivers who have a child with asthma reveal that few families are prepared to control their child's asthma even as the cold and influenza season gets underway. The survey found that many parents don't understand how to properly control asthma: 38%, for example, think that medication is needed only when a breathing problem occurs, and 44% agree with the statement that an asthma attack can be prevented by having the child take a rescue medication.