CURRENT ESSENTIALS PEDIATRICS - part 10 pps

Ascaridworms as long as 10 cm are sometimes passed in stool ■ Differential Diagnosis • Acute and chronic GI infection • Recurrent abdominal pain of childhood • Gall bladder and biliary d

Chapter 29 Parasitic Infections 479

Pinworms—Enterobius vermicularis

■ Essentials of Diagnosis

• Small nematode (5–10 mm long) lives in the colon Eggs deposited

on the perianal skin usually at night

• Major symptom is intense anal pruritis

• Scratching contaminates the fingers allowing transmission to tacts and autoinfection Transmission in contaminated fomites iscommon

con-• Migration of worms to vagina and urethra may cause vaginitis andurinary tract infection

• Worms can be seen on the perianal skin while the child is sleeping

• Eggs may be obtained for microscopic identification on a piece

of transparent tape pressed to the child’s anus in the morning

• Launder bedsheets and night clothes frequently

• Keep hands and nails clean Prevent scratching by wearing wear to bed

under-• Check and treat all affected family members at the same time

• Pyrantel pamoate single does (11 mg/kg) is effective Single-dosemebendazole and albendazole also effective

• Reinfection at school from untreated classmates is common

■ Pearl

Parents freak out over this common harmless infection My old sitology professor, Dr Harold Brown, always advised parents that “pin- worms are found even in the seats of the mighty,” meaning that even the cleanest child from the most immaculate home gets pinworms.

para-29

480 Current Essentials: Pediatrics

Ascariasis—Ascaris lumbricoides

■ Essentials of Diagnosis

• Fecal-oral spread of ova from human to human

• Swallowed ova hatch in intestine Larvae penetrate intestine, entervenous system, travel to lungs, are coughed up, and swallowed.Larvae mature in the intestine

• Many infestations are asymptomatic Severe infestations causepain, weight loss, anorexia, diarrhea, vomiting, and rarely intes-tinal perforation or obstruction of small bowel, bile ducts or appendix

• Larvae migrating through the lungs may cause eosinophilic monia (Löffler syndrome)

pneu-• Ova can be seen by microscopic examination of stool Ascaridworms as long as 10 cm are sometimes passed in stool

■ Differential Diagnosis

• Acute and chronic GI infection

• Recurrent abdominal pain of childhood

• Gall bladder and biliary disease

■ Treatment

• Ascariasis is usually self-limited because the adult worms live

<1 year Since adult worms lay 1000 eggs per day, it is preferable

to treat all cases

• Mebendazole, pyrantel pamoate, albendazole are highly effective

• In cases of intestinal or biliary obstruction, use piperazine because

it narcotizes worms and helps relieve obstruction

• Surgical removal of obstructing ascaris worms from intestine orbiliary tract is sometimes required

■ Pearl

Freezing weather kills ascaris ova in the soil preventing endemic tation in nontropical areas.

infes-29

30

Fungal Infections

Blastomycosis—Blastomyces dermatitidis 483

Coccidiomycosis—Coccidioides immitis 484

Histoplasmosis—Histoplasma capsulatum 485

Pneumocystis—Pneumocystis jiroveci 486

481

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Chapter 30 Fungal Infections 483

• Dissemination first causes ulcerative or warty skin lesions withlater spread to bones, prostate, testes, larynx, lymph nodes, kid-neys, and brain

• Immunodeficient patients at highest risk for chronic pneumoniaand disseminated disease

• Diagnosis by culture or visualization of fungus in sputum, lungbiopsy Antibody tests available

• Extensive radiographic evaluation in suspected disseminated tions to identify all sites of infection

• Disseminated disease resembles bacterial infections of bone, tral nervous system (CNS), and other organs

cen-■ Treatment

• No treatment for mild pulmonary or skin blastomycosis

• Amphotericin B for life-threatening infection in promised patients or CNS infection

immunocom-• Itraconazole and ketoconazole for less severe infections Boneinfection requires up to 1 year of therapy

• Surgery to remove devitalized bone, drain abscess, or removearea of resistant pulmonary infection

■ Pearl

Alveolar macrophages inhibit the transformation of the inhaled dial form of Blastomycosis into its invasive yeast form This is the basis for the resistance to infection in healthy individuals.

coni-30

484 Current Essentials: Pediatrics

human-to-• >50% of primary infections are asymptomatic

• Symptomatic primary disease may be mild (fever and arthralgia) orsevere (influenza-like illness with fever, nonproductive cough, severepleurisy, myalgia, arthralgia, headache, night sweats, anorexia)

• 10% of infected children have indurated ulcers at inoculation site,contiguous tissue infection, regional adenopathy, erythemanodosum or multiforme

• Disseminated disease occurs in neonates but is rare in children Sites

of dissemination are meninges, single bone or joint, kidney, lung

• Diagnosis made by identifying endospore-containing spherules insputum, pus, cerebrospinal fluid (CSF), or biopsy CSF shows

↑protein, ↓glucose, and mononuclear cells (70% with eosinophils).Antibodies (precipitins) appear by 2–3 weeks

• 50% of symptomatic cases have infiltrates and hilar adenopathy

on chest x-ray

■ Differential Diagnosis

• Primary lung infection resembles viral, bacterial, or mycoplasmapneumonia

• Subacute presentation resembles TB, histoplasmosis, blastomycosis

• Chronic lung or disseminated disease resembles cancer, TB, otherfungal infections

■ Treatment

• No treatment for mild pulmonary disease in normal hosts

• Amphotericin B for patients with prolonged fever, weight loss,severe pneumonia, or any form of disseminated disease

• Amphotericin B for high-risk groups—neonates, pressed patients, pregnant women, and patients with high antibodytiters

immunosup-• Fluconazole or itraconazole preferred for less severe disease andmeningitis

• Lifelong itraconazole after meningitis prevents relapse

• Surgical excision of pulmonary cavities, pulmonary abscess, ing nodes, cutaneous sinus tracts and bone

drain-■ Pearl

Erythema nodosum or erythema multiforme in a child with iomycosis is a favorable sign indicating a good immune response to the organism with probable clearing of infection.

coccid-30

Chapter 30 Fungal Infections 485

Histoplasmosis—Histoplasma capsulatum

■ Essentials of Diagnosis

• Fungus endemic in east/central United States, Mexico, and SouthAmerica Bat and bird feces contaminate soil with spores whichare inhaled by humans

• Infection occurs in >66% of children in endemic areas Most areasymptomatic causing scattered pulmonary calcifications

• Acute lung infection—influenza-like illness with fever, myalgia,arthralgia, cough, weight loss, night sweats, pleurisy

• Dissemination occurs mainly in immunocompromised patients andinvolves the reticuloendothelial system causing hepatosplenomegaly,anemia, fever, bone marrow failure Mortality very high

• Eye, brain, heart valves, pericardium, intestine, skin, adrenals can

be affected in disseminated disease

• Organism visible by microscopy in macrophages but not sputum,urine, or CSF Cultures yield organisms in 1–6 weeks Histoplasmaantigen in sputum, urine, blood, CSF is the fastest and most sen-sitive test

• No treatment for mild infections

• Amphotericin B for severe or protracted pulmonary disease, seminated disease, children <1 year

dis-• Itraconazole for milder disease and after initial favorable response

to amphotericin B

■ Pearl

Of the 3 most common fungi in the United States that cause disease in normal hosts (Coccidioides, Histoplasma, and Blastomyces); Histoplasma is the one most likely to reactivate if the individual later becomes immunosuppressed.

30

486 Current Essentials: Pediatrics

• At-risk patients develop fever tachypnea, dyspnea, nonproductivecough with rapid progression to respiratory failure if untreated

■ Differential Diagnosis

• In immunocompetent infants, primary pneumocystis infection

resembles Chlamydia trachomatis pneumonia

• Differential in immunocompromised children—influenza, ratory syncytial virus, CMV, adenovirus, bacterial and fungalpneumonias

respi-• Noninfectious diseases with hypoxia and tachypnea—pulmonaryembolus, pulmonary hemorrhage, congestive heart failure, lym-phoid interstitial pneumonitis, pneumothorax

30

Acoustic neuroma

in neurofibromatosis, type 2,116

Acquired hemolytic anemiaautoimmune, 139nonautoimmune, 139severe, chronic, 139Acquired immunodeficiencysyndrome (AIDS) (Humanimmunodeficiency virus[HIV]), 464

Activated charcoalfor amphetamine poisoning,403

for antihistamine poisoning,404

for arsenic poisoning, 405for barbiturate ingestion, 420for belladonna alkaloid poisoning,406

for cyclic antidepressant toxicity,411

for salicylate poisoning, 419Acute flaccid paralysis, 120Acute intracranial hypertension,393

Acute lymphoblastic leukemia(ALL), 149

consolidation therapy for,149

intensification therapy for,149

maintenance therapy for, 149Acute myeloid leukemia (AML),150

genetic subtypes of, 150Acute otitis media (AOM), 288bacterial, 288

risk factors for, 288viral, 288Acute pancreatitis, 89

Index

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for chicken pox, 452

for Epstein Barr virus infection,

454

for erythema multiforme, 258

Acyl-CoA dehydrogenase deficiency

in infectious mononucleosis,454

in Treacher Collins syndrome,238

Alagille syndrome, 27Albendazolefor ascariasis, 480for giardiasis, 474for pinworms, 479

for Taenia saginata infestation,

476for visceral larva migrans, 475Albuterol

for whooping cough, 442Alcohol poisoning, 402gamma-hydroxybutyrate overdosewith, 422

Alkali injury, 409Alkaline phosphatase

in Wilson disease, 85Alkalinizationfor cyclic antidepressant toxicity,411

Allergic conjunctivitistreatment of, 271Allergic rhinitis, 287Allergies

cow’s milk, 64Alport’s syndrome, 248

Amanita poisoning, 416

Ambiguous genitalia, 185evaluation and gender assignmentfor, 185

Ambylopia, 277Amebiasis, 473Amikacin, for tularemia, 441Aminoglutethimidefor adrenocortical hyperfunction,193

Aminoglycosides, 433for group B streptococcalinfection, 426Amiodarone, for arrhythmia

in digitalis toxicity, 421Amitriptyline

for recurrent abdominal pain,67

Amitriptyline toxicity, 411

Index 489

Amoxicillin

for acute otitis media, 288

for Lyme arthritis, 438

Ampicillin plus aminoglycoside

for neonatal bacterial sepsis,

from milk ingestion, 64

Androgen, for nonfunctional testes,

Angiography

in pulmonary sequestration, 13

Angiomas tufted, 265Angiotensin-converting enzyme(ACE) inhibitorsfor Alport syndrome, 248for heart failure

in rheumatic fever, 37Ankle sprain, 340Ankylosis of joints

congenital, fibrous (See

Arthrogryposis multiplexcongenita)

Anomalous left coronary syndrome,30

Anomalous origin of left coronaryartery from pulmonary artery,30

Anopheline mosquito

Plasmodium species transmission

by, 471Anorexia nervosa, 361mortality in, 361Anterior cruciate ligament (ACL)injury, 335

Anterior drawer testfor anterior talofibular ligament,340

Antiandrogen and aromataseinhibitor

for precocious puberty in boys,188

Antiarrhythmicsfor cardiac disease

in Friedreich ataxia, 229Antibiotics

for acute otitis media, 288for bacterial diarrhea, 59for bacterial pneumonia, 7for bites, 398

β-lactamfor bacterial pneumonia, 7broad-spectrum

for meningococcal meningitis,446

for cellulitis, 425orbital and periorbital, 276chronic diarrhea following, 60for epiglottitis, 293

for IgA deficiency, 163

for leukocyte adhesion deficiency

I, 162

for lung abscess, 9

for mannose binding lectin

for pyogenic arthritis, 322

for relapsing fever, 438

for Rocky Mountain spotted

for Vincent angina, 283

for urinary tract infection, 103

for viral pneumonia, 8

Anti-CD20 monoclonal antibody

for post-transplant

for childhood epilepsy, 111for lead poisoning, 415preoperative

for brain tumor surgery, 152Anticytokine therapy, topicalfor psoriasis, 257Antidepressantsfor conduct disorders, 379for fibromyalgia, 305for post-traumatic stress disorder,382

toxicity of, 411Antiestrogens (tamoxifen)for McCune-Albright syndrome,186

Antifungalsprophylacticfor chronic granulomatousdisease, 162

for myeloperoxidase deficiency,162

systemicfor chronic mucocutaneouscandidiasis, 167Anti-HCV antibodiesfor hepatitis C diagnosis, 80Antihistamine poisoning, 404Antihistamines

for pityriasis rosea, 256Anti-inflammatoriesfor anterior knee pain, 334for Crohn disease, 68for cystic fibrosis, 6for elbow pain, 338for erythema nodosum, 259for foot pain, 340for hip pain, 339for rotator cuff injury, 333Antioxidants, for Friedreich ataxia,118

Antispasmodicsfor recurrent abdominal pain, 67Antithymocyte globulin, adjunctive

for graft-versus-host disease, 169

Antiviralsfor bronchiolitis, 4for herpes gingivitis, 282for viral pneumonia, 8

in joint with mice, 325Lyme disease, 438pyogenic, 322rheumatoidjuvenile, 297tuberculous, 322Arthrogryposis multiplex congenita,312

Arthroscopic surgeryfor osteochondritis dissecans, 325Ascariasis, 480

in transient synovitis of hip, 323Asparaginase, for acute

lymphoblastic leukemia, 149Asperger syndrome, 374

Aspergillosis, bronchopulmonary, 5Aspiration pneumonia, in cerebralpalsy, 126

Asthma, 4, 6, 8Asthma––reactive airway disease, 18

in African American children, 18Ataxia

acute cerebellar, 118cerebellar, 166dominant, 118Friedreich, 118, 229polymyoclonus-opsoclonus, 118Ataxia-telangiectasia (A-T), 166conjunctival, 166

Atelectasis, 4

in whooping cough, 442α-Thalassemia, 135

Hb H disease, 135

AT III concentratefor disseminated intravascularcoagulation, 144

AT III deficiency, 145Atomoxetine, for attentiondeficit/hyperactivity disorder,369

for digitalis toxicity, 421

for mushroom poisoning, 416

in fetal alcohol syndrome, 370

hyperactive impulsive type,

from hip dislocation, 339

of proximal femur

(Legg-Calvé-Perthes disease), 324

Azathioprine

for acquired hemolytic anemia,

139

for autoimmune hepatitis, 82

for Crohn disease, 68

for polyarteritis nodosa, 302

for systemic lupus erythematosus,

300

Azithromycinfor cat scratch cervical adenitis,291

for cat scratch disease, 431for chlamydial infection,447

for cystic fibrosis, 6for gonorrhea, 445for Legionnaire disease,444

for psittacosis, 443for shigellosis, 434for streptococcal impetigo, 267for whooping cough, 442for whooping cough exposure,442

B

Baclofen, for cerebral palsy, 126Bacterial agents

in infectious hepatitis, 73Bacterial conjunctivitis, 271Bacterial endocarditis, 39

Bacterial infections See specific

infectionsacute diarrhea in, 59

in measles, 459Bacterial pathogens, inpneumonia, 7Bacterial pericarditis, 39Bacterial sepsis, neonatal, 354Bacterial vaginosis, 360

Bacteroides fragilis

in necrotizing fasciitis, 425

β1Adrenergic blockersfor hyperthyroidism, 177

β2Agonistsfor asthma-reactive airwaydisease, 18

Ballistic activityfor foot pain, 340Balloon angioplastyfor cardiac malformations causingright-sided obstruction, 27peripheral pulmonic stenosis,27

Balloon aortoplasty, for aorticcoarctation, 28Balloon atrial septostomy, 33for TAPVR, 35

for transposition of great arteries,33

in cat scratch disease, 291, 431

Bat, rabies transmission from, 462

Behavioral therapy See also

Cognitive behavioral therapy

for attention deficit/hyperactivity

disorder, 369

for feeding refusal, 366

for temper tantrums, 368

Belladonna alkaloid poisoning,

406

Bell’s palsy See also Facial nerve

palsy (Bell’s palsy)

for renal tubular acidosis, 101Bile acid binders

forα-antitrypsin deficiency,84

Biliary carcinoma, risk of, 75Biliary obstruction, in ascariasis,480

Bilirubinunconjugated

in Crigler-Najjar syndrome, 77

in Gilbert syndrome, 76Binge drinking, 402Biopsy

for hepatocellular cancer, 88kidney

in renal vein thrombosis, 97liver

in chronic hepatitis C infection,80

for hepatocellular cancer, 88

in nonalcoholic fatty liverdisease, 83

renalfor idiopathic nephroticsyndrome, 96for interstitial nephritis, 95small intestinal mucosalfor celiac disease diagnosis,61

Biotinidase deficiency, 215Biotin supplementationfor biotin deficiency, 215for holocarboxylase synthetasedeficiency, 215

Bipolar affective disorder, 376Birds

toxoplasmosis from, 472West Nile encephalitis from, 456Birthmarks, vascular, 265Birth trauma, 344Bisphosphonatesfor osteogenesis imperfecta, 315Bites

animal, 398facialsuture, 398human, 398

494 Index

Bites (Cont.):

mosquito

West Nile encephalitis from, 456

tick, flea, deer fly

Blood glucose support

in hepatic glycogen storage

diseases, 203

Blood transfusion

for iron toxicity, 414

Blueberry muffin rash

of intrauterine rubella infection,

for fibrous dysplasia, 326

Bone marrow transplant

for osteogenesis imperfecta, 315

for sickle cell disease, 137

diagnostic triad for, 428Bowel resectionfor intestinal volvulus, 50

Bowleg See Genu varum

Brachial plexopathy, 332Brachycephaly, 237Bracing

for ankle sprain, 340for anterior cruciate ligamentinjury, 335

for lateral ligament injury, 337lumbosacral

for spondylolysis, 328for medial ligament injury,337

for posterior cruciate ligamentinjury, 336

for scoliosis, 317for tibial torsion, 320Bradycardia

in breath holding, 368

in digitalis toxicity, 421Brain death, 109Brain growthsynostoses and, 237Brain tumors, 152

Branched-chain ketoaciduria See

Maple syrup urine disease(branched-chainketoaciduria)Brancher enzyme deficiency,203

Breastasymmetry of, 361benign hypertrophy of, 361Breast disease, 361

Breast examination, 361Breast-feeding

in rotavirus diarrhea, 455Breast milk jaundice, 350Breath holding, 368

for acquired hemolytic anemia, 139

for chronic myeloid leukemia, 151

Butyrates, for spinal muscular

atrophy, 239

Butyrophenonesfor withdrawalfrom gamma-hydroxybutyrate,422

C

Café au lait macules, 264Caffeine citratefor apnea of prematurity, 343

Caffey syndrome See Infantile

cortical hyperostosisCalcipotriene, for psoriasis, 257Calcitonin, for hypercalcemia, 181Calcitriol, for hypophosphatemicrickets, 184

Calcium, dietary and supplementalfor galactosemia, 204

for hypoparathyroidism, 179Calcium channel antagonistfor supraventricular tachycardiaprophylaxis, 40

Calcium channel blockersfor Raynaud phenomenon, 303Calcium EDTA

for encephalopathy

in lead poisoning, 415Calcium infusionfor hypoparathyroidism, 179Calories, in neonatal jaundice, 350Cancer

hepatic, 88thyroid, 178

Candida albicans infection, 167 Candida vaginitis, 360

Candidiasis, oral, 290Cantharidin, for periungual warts,252

Capsulotomy, for arthrogryposismultiplex congenita, 312Caput, 344

Carbamazepinefor bipolar affective disorder, 376for childhood epilepsy, 111for fetal alcohol syndrome, 370for paroxysmal dyskinesia, 119Carbamoyl phosphate synthetasedefect, 207

Carbohydrate-deficient glycoprotein(CDG) syndromes, 220Carbohydrates

dental caries from, 281enteral/parenteral

for glutaric acidemia type 1, 216

for isovaleric acidemia, 214

for long- and medium-chain

for pneumothorax, 12Cats

de-worming for Toxocara, 475

Toxocara cati infection from, 475

toxoplasmosis from, 472Cat scratch disease, 291, 398, 431Caustic acid poisoning, 408Caustic bases, 409Caustic burns, of esophagus, 45Cefixime, for gonorrhea, 445Cefotaxime

for gonorrhea, 445for meningococcal meningitis,446

Ceftizoxime, for gonorrhea, 445Ceftriaxone

for acute rhinosinusitis, 287for gonorrhea, 445for group B streptococcalinfection, 426for Lyme arthritis, 438for meningococcal meningitis,446

for shigellosis, 434for tularemiarelapse-associated, 441Cefuroxime, for acute otitis media,288

Celiac disease, 49, 61Cellulitis

group A streptococcal, 425orbital, 276

periorbital, 276Cephalexin, for bites, 398Cephalohematoma, 344Cephalosporinsfor cervical adenitis, 291first-generationfor urinary tract infection, 103third-generation

for gastroenteritis, 432for necrotizing enterocolitis,355

for neonatal bacterial sepsis,354

for typhoid and paratyphoid fever,433

for brain tumors, 152

for Ewing sarcoma, 158

for hepatic cancer, 88

for Hodgkin disease, 153

for neuroblastoma, 154

for non-Hodgkin disease, 153

postoperative

for Wilms tumor, 155

for post-transplant

for plague, 440for psittacosis, 443for shigellosis, 434for tularemiarelapse-associated, 441Chlorinated hydrocarbon poisoning,413

Chloroquinefor active malarial infection, 471

prophylaxisfor malaria, 471Chlorothiazidesfor central diabetes insipidus

in infants, 174Choanal atresia

in CHARGE syndrome, 243Cholecystectomy

for cholelithiasis, 87

in hereditary spherocytosis, 134Cholecystitis, 49

Choledochal cystscystectomy for, 75Cholelithiasis, 87risk factors for, 87Cholestasisneonatalextrahepatic, 75intrahepatic, 74Cholesterol stonescholelithiasis from, 87Cholesterol supplementation

in Smith-Lemli-Opitz syndrome,222

Cholestyraminefor Crigler-Najjar syndrome,77

Chondromalacia, patellar, 334Chorea, in rheumatic fever, 37Choroiditis, 274

Chromosome 22 (22q11), deletion oflong arm, 32

Chronic airway hyper-reactivityfrom RSV infection, 4Chronic granulomatous disease,141

for streptococcal impetigo, 267

for whooping cough, 442

Cleft palate, 235

Clindamycin

for bacterial pneumonia, 7

for bacterial vaginosis, 360

for cellulitis/necrotizing fasciitis,

425

for resistant strains of malaria, 471

for streptococcal impetigo, 267

Coarctation of aorta, heart failure in,31

Cocaine toxicity, 401from body stuffing and bodypacking, 410

in combination drug use, 410

Coccidioides immitis

coccidiomycosis in, 484Coccidiomycosis, 484Coenzyme Q deficiency, 206

Cognitive behavioral therapy See

also Behavioral therapy

for depression, 375for obsessive-compulsivebehavior, 381for pervasive developmental disorders, 374Colectomy, for ulcerative colitis,69

Colic, 365Colitis

in cow’s milk allergy, 64Collagen synthesis disordersEhlers-Danlos syndrome, 306Colloid

in toxic shock syndrome, 437Coloanal anastomosisfor Hirschsprung disease, 52Colon, retention of

in short gut syndrome, 66Colon cancer

risk for, 69Colonoscopyfor juvenile colonic polyps, 58for ulcerative colitis diagnosis, 69Colostrum, hyperimmune bovinefor cryptosporidiosis, 478Coma

stage IV, 109Common variable immunodeficiency(CVID), 163

Complement defects, 161

Complex regional pain syndrome See

Reflex sympathetic dystrophy

Concussion, 331 See also Head

injury

depot testosterone for, 189

Constitutional growth delay

growth hormone for, 173

Continuous positive airway pressure

(CPAP)

for apnea of prematurity, 343

for hyaline membrane

for Wilson disease, 85

Cord blood transplant

in rheumatic fever, 37for chorioretinitis

in toxoplasmosis, 472for Crohn disease, 68for dermatomyositis, 301for Diamond-Blackfan anemia,131

for enteropathic arthritis, 299for erythema nodosum, 259for Henoch-Schönlein purpura,104

for hypervitaminosis D, 183for infectious mononucleosis,454

for interstitial nephritis, 95for juvenile rheumatoid arthritis,297

for lead poisoning, 415for MS, 122

for otitis media with persistenteffusion, 288

periocularfor toxocara uveitis, 274plus rifampin, 19for polyarteritis nodosa, 302for reflex sympathetic dystrophy,304

in rheumatic fever, 37for Sydenham chorea, 119for systemic lupus erythematosus,300

topicalfor atopic dermatitis/eczema,254

for seborrheic dermatitis, 255for toxic shock syndrome, 437for ulcerative colitis, 69for vasogenic intracranialhypertension, 393for visceral larva migransinflammation, 475for whooping cough, 442

Corynebacterium diphtheriae See

DiphtheriaCow’s milk allergy, 64Coxa magna

in transient synovitis of hip, 323

Cyclic antidepressant toxicity, 411

Cyclic vomiting syndrome, 113

Cyclophosphamide

for acquired hemolytic anemia, 139

for acute lymphoblastic leukemia,

149

for idiopathic nephrotic syndrome,

96

for polyarteritis nodosa, 302

for systemic lupus erythematosus,

300

Cyclophosphamide, vincristine,procarbazine, prednisone(COPP)

for Hodgkin disease, 153Cyclosporine

for acquired hemolytic anemia,139

for autoimmune hepatitis,82

for dermatomyositis, 301for KID syndrome, 261Cyclosporine Afor idiopathic nephrotic syndrome,96

for proteinuria, 248Cyst

infected congenital, 9lung, 12

Cystectomyfor choledochal cysts, 75Cysticercosis

Taenia solium in, 476

Cystic fibrosis (CF), 6, 12exocrine pancreatic insufficiency

in, 90mannose binding lectin defect in,161

Cystic hygroma, 265

Cystitis See also Urinary tract

infection (UTI)uncomplicated, 103Cysts

breast, 361choledochal, 75

in milia, 262Cytomegalovirus (CMV)pneumonia and, 8Cytophosphamidefor Ewing sarcoma, 158

D

Daclizumab, adjunctive

for graft-versus-host disease,

169Dacryocystitis, 273Dactinomycinfor Ewing sarcoma, 158Dactylitis

in sickle cell disease, 137Danazol

for C1 esterase inhibitordeficiency, 161

Index 501

Dantrolene

for neuroleptic malignant

syndrome, 418

Date rape drug, 422

Debrancher enzyme deficiency, 203

Decongestants, for rhinosinusitis, 287

Deep vein thrombosis (DVT)

lower extremity, 10

from pulmonary embolism, 10

Deer fly bite

for factor VIII deficiency, 143

for factor XI deficiency, 143

for von Willebrand disease,

143

Desmopressin acetate (DDAVP)

for diabetes insipidus, in children,

for attention deficit/hyperactivitydisorder, 369

Dextromethorphan, for seizures

in nonketotic hyperglycinemia,212

Dextrose solutionfor neonatal hypoglycemia, 349for neonatal seizures, 353Diabetes control

for nonalcoholic fatty liverdisease, 83

Diabetes insipidus (DI)central, 174nephrogenic, 174Diabetes mellitustype 1, 197type 2, 198Dialysisfor acute renal failure, 99for alcohol poisoning, 402for chronic renal failure, 100for granulonephritis, 94for hemolytic uremic syndrome,98

for interstitial nephritis, 95for polycystic kidney disease, 93Diamond-Blackfan anemia, 131Diaphragm

eventration of, 14surgical plication of, 14Diaphragmatic hernia, 12Diarrhea

acute infectious, 59chronic, 60

in cryptosporidiosis, 478

from E coli infection, 59

high-volume, 59low-volume, 59osmoticfrom glucose-galactosemalabsorption, 63from rotavirus, 455toddler, 60

from Vibrio cholera infection, 59

Diazepamfor amphetamine poisoning,403

for antihistamine poisoning,404

502 Index

Diazepam (Cont.):

for febrile seizures, 110

for phenothiazine agitation, 418

for cystic fibrosis, 6

for diabetes mellitus, type 1, 198

fructose and sucrose avoidance in,

Digoxin immune Fab

for digitalis toxicity, 421

of hip, 339Disorders of energy metabolism,206

Disorders of the urea cycle, 207Disseminated intravascularcoagulation (DIC), 144

in acquired hemolytic anemia, 139

Diuresisfor acute renal failure, 99for idiopathic nephrotic syndrome,96

Diureticsfor hantavirus infection, 461Diverticula

Meckel, 51Dobutaminefor adrenal crisis, 191Documentation

of child abuse, 387

of child neglect, 389Dog bite, 398Dogs

de-worming for Toxocara, 475

Toxocara canis infection from, 475

Dopaminefor adrenal crisis, 191for cyclic antidepressant toxicity,411

Dopaminergic blockersfor Sydenham chorea, 119Down syndrome (trisomy 21), 25acute myeloid leukemia in,megakaryocytic, 150Hirschsprung disease in, 52mosaic, 225

translocation, 225Doxorubicinfor Ewing sarcoma, 158Doxycycline

for cat scratch disease, 431for chlamydial infection, 447for chloroquine-resistant malaria,471

for ehrlichiosis, 465for gonorrhea, 445for leptospirosis, 436for Lyme arthritis, 438for plague, 440

for resistant strains of malaria, 471

for Rocky Mountain spotted fever,

D-penicillamine copper chelation

for Wilson disease, 85

in chronic mucocutaneouscandidiasis, 167Eczema, 254

Edemaacute intracranial hypertensionfrom, 393

cerebralfrom ketoacidosis, 199cytotoxic, 393

gallbladder, 78pulmonary, 4

in hantavirus cardiopulmonarysyndrome, 461

from Taenia solium larvae death,

476vasogenic, 393Education

of family and child, 376for anxiety disorders, 380for post-traumatic stressdisorder, 382

of parents

in child neglect, 389

of colicky infant, 365for somatoform disorders, 383

Ehlers-Danlos syndrome (EDS), 306

mitral valve prolapse with, 29

Eikenella corrodens infection

from human bites, 398Eisenmenger syndrome, 24Elbow pain, 338

lateral, 338medial, 338posterior, 338Electrolyte replacementfor diabetic ketoacidosis, 199for salt-losing crisis in congenitaladrenal hyperplasia, 192Electrolyte resuscitationfor adrenal crisis, 191

504 Index

Electrolytes

monitor and correct

for neonatal seizures, 353

Electrolyte solutions

for rotavirus diarrhea, 455

Emboli

recurrent pulmonary, 5

Emergencies See also Injuries

acute intracranial hypertension,

393

hyperthermia, 396

Emesis See also Vomiting

for belladonna alkaloid poisoning,

after aortopulmonary shunt, 34

after valve replacement, 28

for congenital heart defects, 39

Endotracheal tube obstruction, 12

End-stage lung disease, 17

End-stage renal failure

in hemolytic uremic syndrome, 98

for bronchiectasis, 5Enzyme replacementfor lysosomal disorders, 219

in Pompe disease, 203Eosinophilic esophagitis, 44Epidermolysis bullosa (EB), 260

autosomal recessive, 260complications of, 260dystrophic, 260junctional, 260Epiglottitis, 293Epilepsyrisk factors for, 110types of, 111Epinephrine inhalationfor croup, 3Epstein-Barr virus (EBV)infectious mononucleosis from,454

in pharyngitis/tonsillitis, 292pneumonia and, 8

Epstein-Barr virus (EBV) infection,168

Equine antitoxin, trivalentfor food-borne botulism,428

Erysipelas, 425Erythema infectiosum, 458Erythema multiforme, 258drug-induced, 258Stevens-Johnson syndrome in,258

Erythema nodosum, 259Erythema toxicum, 263Erythromycinfor cat scratch disease, 431for chlamydial infection, 447for congenital syphilis, 448for diphtheria, 430for diphtheria immunization,430

for psittacosis, 443for relapsing fever, 439for streptococcal impetigo, 267for whooping cough, 442for whooping cough exposure,442

for caustic acid exposure, 408

for caustic base exposure, 409

Esophagus,

caustic burns of, 45

Essential tremor, 119

Estrogen-progesterone therapy, cyclic

for hypogonadism in girls, 187

Estrogen replacement therapy

for hypogonadism in girls, 187

for Turner syndrome, 230

for neonatal jaundice, 350

for sickle cell disease, 137

Exercise, for diabetes mellitus, type

1, 198

Exfoliants, for psoriasis, 257

Exocrine pancreatic insufficiency,

Facial nerve injurybirth-related, 344Facial nerve palsy (Bell’s palsy), 123neonatal, 123

postviral, 123Factor IX, exogenous, 143Factor IX deficiency (hemophilia B),143

Factor VIII, exogenous, 143Factor VIII deficiency (hemophiliaA), 143

Factor V Leiden, 145

in renal vein thrombosis, 97Factor XI deficiency (hemophilia C),143

Fainting, 112precipitants of, 112Familial hypocalciurichypercalcemia, 182Family educationfor schizophrenia, 378Family support

in child neglect, 389Family therapyfor depression in child, 375

Fanconi anemia See Aplastic

anemia, constitutionalFasciitis

necrotizing, progression of, 425Fat necrosis, breast, 361Fat-soluble vitamin supplementationfor exocrine pancreatic

insufficiency, 90Fava beans, hemolysis from, 134Febrile seizures, 110

Fecal fat excretion

in exocrine pancreaticinsufficiency, 90

Fentanyl skin patch toxicity, 417

Fetal alcohol spectrum disorders,

Dengue fever from, 457

West Nile encephalitis from,

chronic oral therapy

for congenital adrenal

hyperplasia, 192

Fluid and electrolyte management

for third-degree burns, 394

Fluid intake

for neonatal jaundice, 350

Fluid management

for rotavirus, 455

Fluid overload, prevention of

in acute renal failure, 99

Fluid replacement

for dengue fever, 457

for diabetic ketoacidosis, 199

for salt-losing crisis in congenital

adrenal hyperplasia, 192

Fluid resuscitation

for adrenal crisis, 191

for salicylate poisoning, 419

for obsessive-compulsivebehavior, 381Folate deficiency

in megaloblastic anemia, 133Folate supplements

for Hb H disease, 135Folic acid supplementsfor megaloblastic anemia, 133prenatal

for neural tube defectprophylaxis, 115for red cell membrane defects, 134Fontan procedure

for tricuspid atresia, 34Food restriction, during pregnancyfor listeriosis, 435

Foot pain, 340Foreign bodiesairway, 4alkaline, 45aspiration of, 8intravasculargingivitis prevention in, 282laryngeal/esophageal, 3lung abscess and, 9removal of

in gas gangrene, 427Foscarnet

for Epstein Barr virus infection,454

Fosphenytoinfor neonatal seizures, 353Foster placement

in child abuse, 387Fractures

birth-related, 344

in child abuse, 387

of femoral neck, 339

in osteogenesis imperfecta, 315tooth, 284