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Basic dermatology in children and adolescents
Published in Joseph S. Sanfilippo, Eduardo Lara-Torre, Veronica Gomez-Lobo, Sanfilippo's Textbook of Pediatric and Adolescent GynecologySecond Edition, 2019
Kalyani Marathe, Kathleen Ellison
It presents as a well-defined plaque, which can vary in appearance from a dry pink plaque to bright red moist erythema with overlying maceration. Affected infants and children may have tenderness, discomfort, and sensitivity of the area, rectal pruritus, blood-streaked stools, and constipation. Guttate psoriasis, classically associated with streptococcal pharyngitis, can be related to PSD. Therefore, a thorough anogenital exam should be performed in infants and children presenting with skin findings of guttate psoriasis (discussed later in this chapter). Diagnosis is made clinically, and a culture or rapid strep test can be used to confirm the diagnosis. The differential diagnosis of PSD includes contact dermatitis, candidiasis, seborrheic dermatitis, pinworm infection, and sexual abuse, so a thorough history and examination are warranted.12 Of note, girls can also become infected with group A vaginal streptococcal vaginitis; this often presents with vulvar erythema and copious watery vaginal discharge.
Acute tonsillitis
Published in S. Musheer Hussain, Paul White, Kim W Ah-See, Patrick Spielmann, Mary-Louise Montague, ENT Head & Neck Emergencies, 2018
In contrast to US guidance and practice elsewhere in Europe, current UK guidance (1999; updated in 2010) does not recommend RSAT (or rapid strep test, RST), although the test is fast (10 minutes) and cheap (£1). The test is 95–100% specific for streptococci (sensitivity 65–80%). The test cannot exclude asymptomatic carriage, but in an individual with acute sore throat and a clinical diagnosis of bacterial tonsillitis, a positive RSAT aids decision-making for antibiotic prescribing.
The Gram Stain Revisited: The Original Rapid Diagnostic Test: Role in Antibiotic Selection and Antibiotic Stewardship Programs (ASPs)
Published in Nancy Khardori, Bench to Bedside, 2018
Cheston B. Cunha, Burke A. Cunha
In ABP, a negative Gram stain, i.e., negative for evidence of bacterial pharyngitis (no abundance of PMNs, cellular debris, etc.). As previously noted, the clinical value of the Gram stain in pharyngitis is to differentiate GAS colonization from GAS pharyngitis is not based on the bacterial component of the Gram stain. Even if GAS demonstrated by rapid strep test or throat culture without a cellular background of infection (abundant PMNs with much cellular debris) such results represent GAS colonization, not infection (Cunha and Cunha, 2017, Bottone 2004, de la Maza et al. 2004, Koneman et al. 1997, Jui et al. 1985, Sharma and Subbukrishnan 1981).
Education, decision support, feedback and a minor reward: a novel antimicrobial Stewardship intervention in a Swedish paediatric emergency setting
Published in Infectious Diseases, 2019
Annika Malmgren, Karin Biswanger, Anders Lundqvist, Theoklis Zaoutis
During the pre-interventional period, no educational efforts regarding the topics relevant to this study were conducted at the department. Starting January 2017, educational sessions were provided to all physicians in the paediatric department, including senior specialists and consultants. Despite our evaluation being concentrated only on junior staff, previous studies have shown that effect of interventions are strengthened when senior staff are brought into the audit process [6]. Nurses working at the PED were also invited to attended the educational outreach, and were asked not to perform rapid strep test on children before the on-site physician had been consulted or seen the patient. This because parental pressure was presumed to be a barrier to judicious antimicrobial use when it comes to explaining why a child with a positive rapid strep test should not be treated.
Urticaria multiforme in a 2-year-old girl
Published in Baylor University Medical Center Proceedings, 2019
Meredith Gavin, Leigha Sharp, Cloyce L. Stetson
A 2-year-old girl presented to the emergency department on day 2 of a pruritic, erythematous rash. The rash had rapidly spread from her face to her legs and trunk and she had developed a fever, with a high of 103°F, within the last 24 hours. Two weeks previously she had been diagnosed by a rapid strep test with streptococcal pharyngitis, and 5 days prior to presentation she had completed a 10-day course of amoxicillin. Large polycyclic annular erythematous wheals, a few with dusky centers but no true targets, were present on the face, trunk, and extremities, affecting 50% total body surface area (Figure 1a). The palms and soles were spared, and there was no ocular or mucosal involvement. After careful history and physical examination, she was diagnosed with urticaria multiforme. She was subsequently treated with systemic antihistamine therapy. Upon evaluation 24 hours later, the rash had greatly regressed with no further sequelae, therefore confirming the diagnosis of urticaria multiforme (Figure 1b).