Examkin

Question

Difficulty: HardPediatric Infectious Diseases

Correlate each pediatric clinical presentation with the most appropriate primary therapeutic intervention or management strategy.

  • A 21-day-old infant is evaluated for extreme lethargy and poor feeding. Physical examination reveals a bulging anterior fontanelle. Cerebrospinal fluid analysis demonstrates significant pleocytosis and the presence of Gram-positive rods.Initiate intravenous ampicillin and an aminoglycoside
  • A 5-year-old patient has experienced 6 days of unremitting fever. Clinical findings include bilateral nonexudative bulbar conjunctivitis, fissured erythematous lips, and noticeable erythema of the palmar and plantar surfaces.Administer intravenous immunoglobulin and high-dose acetylsalicylic acid
  • A 10-year-old patient residing in a heavily wooded region develops acute unilateral facial nerve palsy. The medical history is significant for an expanding erythematous annular lesion with central clearing noted two weeks prior.Prescribe an appropriate course of oral doxycycline
  • A 16-year-old adolescent presents with profound fatigue, generalized lymphadenopathy, and a new-onset, diffuse morbilliform eruption that appeared three days after initiating amoxicillin therapy for suspected streptococcal pharyngitis.Discontinue antibacterial therapy and provide supportive care

Answer

The neonate with Gram-positive rods requires ampicillin and an aminoglycoside. The child with prolonged fever and mucocutaneous changes requires intravenous immunoglobulin and high-dose acetylsalicylic acid. The child with an annular rash and facial palsy requires oral doxycycline. The adolescent with an amoxicillin-induced rash requires discontinuation of antibacterial therapy and supportive care.
Each clinical scenario uniquely describes a classic pediatric infectious or inflammatory disease requiring a highly specific initial intervention. Listeria meningitis mandates ampicillin due to intrinsic cephalosporin resistance. Kawasaki disease is an inflammatory vasculitis requiring IVIG and aspirin. Early disseminated Lyme disease with isolated facial palsy is treated with doxycycline. EBV-associated amoxicillin rash is a non-allergic viral phenomenon requiring cessation of the unnecessary antibiotic.

Step-by-Step Solution

1
Analyze the 21-day-old infant's presentation.
Identify Listeria monocytogenes meningitis based on age and Gram-positive rods in the CSF.
Listeria is a common neonatal pathogen that is uniquely resistant to third-generation cephalosporins, necessitating ampicillin in combination with an aminoglycoside for synergistic bactericidal activity.
2
Analyze the 5-year-old patient's presentation.
Diagnose Kawasaki disease based on fever for ≥5 days plus characteristic mucocutaneous findings.
Kawasaki disease is a medium-vessel vasculitis. Immediate treatment with intravenous immunoglobulin (IVIG) and high-dose aspirin is required to reduce systemic inflammation and the risk of coronary artery aneurysms.
3
Analyze the 10-year-old patient's presentation.
Identify early disseminated Lyme disease presenting with isolated cranial nerve VII palsy.
The history of erythema migrans followed by facial palsy points to Borrelia burgdorferi infection. Oral doxycycline is preferred as it effectively treats the underlying infection and achieves adequate CNS penetration.
4
Analyze the 16-year-old adolescent's presentation.
Recognize an amoxicillin-induced rash in the setting of infectious mononucleosis (Epstein-Barr virus).
When patients with EBV are erroneously prescribed aminopenicillins for presumed strep throat, a distinct, widespread immune-mediated rash often develops. Since the underlying cause is viral, stopping the antibiotic and providing supportive care is the correct action.

Key Concept

Empiric antimicrobial selection and management of distinct pediatric infectious and inflammatory syndromes.
Rate this question

Topics

Pediatric Infectious Diseases

More questions from this topic