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Kawasaki disease
Published in Samar Razaq, Difficult Cases in Primary Care, 2021
Day 1 Twelve-hour history of fever. Difficult to control with antipyretics. Reduced oral intake. O/e [on examination] appears well. Temperature 38.5°C. No rashes. No meningism. ENT [ear, nose and throat] and chest examination normal. Abdomen soft and non-tender.? Start of viral infection. Advised to observe, push fluids and review if any concerns.
Neuroinfectious Diseases
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Jeremy D. Young, Jesica A. Herrick, Scott Borgetti
Physical examination for meningismus can be performed in several ways. Nuchal rigidity can usually be elicited with a simple chin-to-chest maneuver, with the patient displaying resistance to passive flexion of the neck.
Neck
Published in A. Sahib El-Radhi, Paediatric Symptom and Sign Sorter, 2019
This symptom is extremely important because of the possibility of meningitis and other serious bacterial infections such as pneumonia. It is a common complaint in paediatrics for both emergency and primary care services. The term refers to abnormal position of the neck or restricted range of movement, usually associated with pain during passive and active movement. Of the many causes of stiff neck, the two main and important causes are meningitis and torticollis (wry neck), which is characterised by tilting and rotation of the head to one side, with restricted rotation towards the opposite side. In infants, it is usually caused by a shortening sternomastoid muscle after the formation of swelling (called sternomastoid tumour); another possible cause is cervical spine abnormality. Meningism is the other important cause and always requires emergency evaluation. It is characterised by the presence of signs of neck stiffness in flexion position. The most common cause of meningism is meningeal irritation (meningitis or cerebral haemorrhage). In contrast to torticollis, a child with meningism is usually ill-looking with fever. Cerebrospinal fluid examination is usually required to exclude meningitis.
The clinical course and short-term health outcomes of multisystem inflammatory syndrome in children in the single pediatric rheumatology center
Published in Postgraduate Medicine, 2021
Betül Sözeri, Şengül Çağlayan, Vildan Atasayan, Kadir Ulu, Taner Coşkuner, Özge Pelin Akbay, Canan Hasbal Akkuş, Gürkan Atay, Enes Salı, Mehmet Karacan, Taliha Öner, Seher Erdoğan, Ferhat Demir
The coronavirus 2019 (COVID-19) outbreak has caused major changes in daily life and routine activities in societies all over the world. Fortunately, SARS-CoV-2 often causes mild illness in children. Multisystem inflammatory syndrome in children (MIS-C) and MIS-N in the newborn is a rare but severe condition resulting in excessive response of the immune system after SARS-CoV-2 infection. Overall, MIS-C is a rare complication of SARS-CoV-2. In the multicenter study, COVID-19 reported an incidence of MIS-C of 0.14% in children with infection [1]. Although MIS-C occurs in a wide age spectrum from infancy to young adulthood, it is typically reported at school age [2–6]. MIS-C is a life-threatening condition that is characterized by severe inflammation of one or more parts of the body, particularly the lungs, heart, and gastrointestinal tract. It begins several weeks after exposure to SARS-CoV-2. Then patients with MIS-C have symptoms of persistent fever, often accompanied by gastrointestinal symptoms (abdominal pain, vomiting, diarrhea), mucocutaneous changes (rash, conjunctivitis), and cardiac changes (myocarditis, left ventricular dysfunction). Rarely, neurological symptoms (headache, meningismus) have been reported in patients [2–7]. MIS-C signs and symptoms that occur in children may overlap with other time-sensitive diagnoses, such as sepsis, toxic shock syndrome, Kawasaki disease (KD), macrophage activation syndrome, appendicitis, or meningitis. MIS-C patients had a negative PCR for SARS-CoV-2, while they had positive antibody test results [4,8,9].
The diagnostic value of computed tomography in delayed complications after cochlear implantation
Published in Acta Oto-Laryngologica, 2021
Philipp Wolber, Sami Shabli, Andreas Anagiotos, Kathrin Moellenhoff, David Schwarz, Ruth Lang-Roth
The remaining 56 patients that were treated conservatively presented with cephalgia (n = 15 out of 70; 21.4%), scalp hematoma/seroma (n = 10; 14.3%), vertigo (n = 9; 12.9%), device malfunction (n = 9; 12.9%), local infection (n = 4; 5.7%), trauma (n = 4; 5.7%), tinnitus (n = 3; 4.3%), facial palsy (n = 1; 1.4%) and meningism (n = 1; 1.4%). The patient with facial palsy was subsequently tested seropositive for an acute herpes simplex virus type 1 infection and was treated with intravenous corticosteroids and aciclovir with full recovery. The presence of meningitis in the patient with clinical signs of meningism was ruled out by lumbar puncture. Table 2 shows the relationship between reason for tCT, performance of surgery and abnormal tCT finding. Figure 1 shows the relationship between reason for tCT and abnormal finding.
Extrapulmonary tuberculosis in the setting of HIV hyperendemicity at a tertiary hospital in Durban, South Africa
Published in Southern African Journal of Infectious Diseases, 2018
S Gounden, R Perumal, NP Magula
On analysis of symptoms with which patients presented, constitutional symptoms were the most frequent (Table 3). Unintentional weight loss and fever were the predominant symptoms regardless of site of disease. Night sweats were present in almost half of the cases regardless of the system affected, except for the patients with bone involvement. Although weight loss and fever were the most frequent complaints, these was not associated with any specific disease site. Only a few symptoms were specific for the system affected. Lymph node enlargement was only reported with TB lymphadenitis, as were joint symptoms limited to bone involvement. Respiratory symptoms like cough, dyspnoea and chest pain were predominant in pulmonary and pleural involvement but also in TB of other sites except bone involvement. Headache, photophobia and confusion were significant symptoms in TB meningitis (p < 0.05). In patients with abdominal involvement, weight loss was significantly more frequent (p < 0.05). As expected, other gastrointestinal symptoms like abdominal pain, diarrhoea and vomiting were more common in patients with abdominal TB (p < 0.05). Clinical signs showed a greater degree of association with the site of EPTB (Table 4). Significantly, all cases of TB involving the lymphatic system had lymphadenopathy. Similarly, all cases of meningeal involvement had meningism. Peritonitis, ascites and hepatomegaly were significantly more common in cases of abdominal tuberculosis.