NSG 6435 Infectious Diseases in Children

NSG 6435 Infectious Diseases in Children

NSG 6435 Infectious Diseases in Children

A Case Scenario of Infectious Diseases in Children

Case Study Overview

 In this scenario, I will discuss the case of an 18-month old child who has a history of high fever ranging from 101-104.7F. Laboratory tests conducted included blood and urine culture, complete blood count and a comprehensive metabolic panel which were all negative. The vital signs include a temperature of 101.5F, HR of 120b/min, RR of 20b/min a BP of 90/40mmHg. On physical examination, the child had palmar redness, an injected conjunctiva, magenta-coloured lips and rashes on the diaper area.

Differential Diagnosis

  1. Kawasaki Disease.  The disease occurs in two phases with the first phase having a classic symptom of high fever for about five days. The fever does not respond to antibiotic therapy and may persist for up to three weeks if no treatment is provided (Sari, New burger, Burns & Takahashi, 2016). Besides, laboratory tests cannot detect the disease, and the diagnosis is concluded from the presenting symptoms while eliminating the presence of other conditions. Other presenting symptoms include erythema in the eyes, rash in the groin region, chest or the stomach, swollen and purple-red palms, red and cracked lips and a strawberry-like tongue (New burger, Takahashi & Burns, 2016). The second phase starts after two weeks of the onset of fever, and the skin begins to peel on the feet and hands (Sosa, Brower & Divanovic, 2019). In this case study, the child had a history of fever of 101-104.7⁰F for seven days, and currently has a body temperature of 101.5⁰F. There is also palmar redness, inflamed conjunctiva, red-coloured lips and rashes in the diaper area.
  2. Scarlett Fever. This is a condition that results from a Streptococcal bacterial infection and is characterized by a high fever of 101⁰F and a sore throat (Wessels, 2016). The disease responds to bacterial therapy; however, if not treated, it can affect major body organs. Scarlet fever presents with tachycardia, petechiae on the mucous membranes and small lesions on the soft palate (Wessels, 2016). A red rash also erupts on the neck, axilla region and chest, causing the affected part to have a rough and dry texture (Wessels, 2016). Skin folds of the groin region, armpits and neck also become erythematous. In this scenario, the baby had signs and symptoms of a high HR of 120beats/min, high fever and had a rash around the groin region.
  3. Staphylococcal Scalded Skin Syndrome (SSSS). This syndrome is caused by Staphylococcus aureus and presents with a maculopapular rash (Staiman, Hsu & Silverberg, 2018). Symptoms include general body weakness, fever and irritability. Positive findings on physical examination include conjunctivitis, blisters on the infected site, and tender skin on palpation (Staiman, Hsu & Silverberg, 2018). The signs and physical findings in the case study that support this diagnosis include an injected conjunctiva, fever and an excoriating rash.

Most Concerning Differential Diagnosis

            Kawasaki disease is the differential diagnosis that is of most concern in this scenario. The child’s signs and symptoms had typical characteristics of Kawasaki disease such as high fever lasting for seven days, rash, palmar redness, inflamed conjunctiva and red-coloured lips. Furthermore, the condition occurs as a result of inflamed blood vessels caused by an attack of the vessels by the immune system (Newburger, Takahashi & Burns, 2016). Besides, it is a risk of Coronary Artery Disease and consequently, sudden death if not appropriately managed. Untreated cases of Kawasaki disease can further lead to heart complications, inflammation of major blood vessels and arrhythmias.

NSG 6435 Infectious Diseases in Children
NSG 6435 Infectious Diseases in Children

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Additional Diagnostic Tests

 I will recommend other laboratory and imaging studies to facilitate narrowing down of the differential diagnosis to the most likely medical diagnosis for the patient. These will include:

  1. Echocardiograph (ECG). An ECG will help to identify aneurysms in the coronary arteries and also evaluate for dilation and the presence of thrombi in the arteries (Sosa, Brower & Divanovic, 2019). Coronary artery aneurysm is a common complication of Kawasaki disease, and an ECG will help to rule out its presence and also manage if there are positive findings.
  2. Liver Function Tests (LFTs). An LFT test will assist in evaluating the functioning of the liver and also the level of circulating liver proteins in the blood (Sosa, Brower & Divanovic, 2019). Besides, symptoms of the Liver disease are manifested in the eyes and skin. Low levels of Albumin protein is associated with severe Kawasaki disease.
  3. Biopsy. A biopsy of the affected diaper area will help in identifying the causative factor of the excoriating rashes.

Caregiver Health Education

            I will offer health education to the child’s primary caregiver to minimize the occurrence of potential complications and also reduce anxiety. Education on adherence to medical treatment will be emphasized to ensure that the child does not have complications (Sosa, Brower & Divanovic, 2019). In addition, I will advise the caregiver to take the child for scheduled child-well clinic for observation and immunization. I will also teach the caregiver on the appropriate measures to take when the child has fever such as exposing the child, giving oral fluids and performing sponge births (Monsma, Richerson & Sloand, 2015). Furthermore, I will advise the caregiver to bring the child for follow-up for monitoring of complications. The hygiene of the child will be highlighted, especially of the diaper area by proper cleaning and drying to avoid spreading the rash to other body parts. Lastly, I will offer advice on avoidance of over-the-counter medications but to seek immediate medical attention when the baby presents with symptoms such as fever.

References

Monsma, J., Richerson, J., & Sloand, E. (2015). Empowering parents for evidence‐based fever management: An integrative review. Journal of the American Association of Nurse Practitioners, 27(4), 222-229.

Newburger, J. W., Takahashi, M., & Burns, J. C. (2016). Kawasaki disease. Journal of the American College of Cardiology, 67(14), 1738-1749.

Saji, B. T., Newburger, J. W., Burns, J. C., & Takahashi, M. (Eds.). (2016). Kawasaki disease: current understanding of the mechanism and evidence-based treatment. Berlin, Germany: Springer.

Sosa, T., Brower, L., & Divanovic, A. (2019). Diagnosis and Management of Kawasaki Disease. JAMA paediatrics, 173(3), 278-279.

Staiman, A., Hsu, D. Y., & Silverberg, J. I. (2018). Epidemiology of staphylococcal scalded skin syndrome in US children. British Journal of Dermatology, 178(3), 704-708.

Wessels, M. R. (2016). Pharyngitis and scarlet fever. In Streptococcus pyogenes: Basic Biology to Clinical Manifestations. Oklahoma, OK:University of Oklahoma Health Sciences Center.