Pediatric Patient and Journal

Infectious Conditions in a Pediatric Patient

What will be your differential diagnoses for this patient?

Chickenpox

Measles

Rubella

Scarlet fever

Erythema infectiosum (5th disease) -- human parvovirus

Exanthema subitum or Roseola infantum

Non-polio entero-viruses (e.g., echovirus, coxsackievirus) (Long, 2016; de Graaf et al., 2016; Long, Pickering & Prober, 2012)

What specific physical exam findings support these differential diagnoses?

Chickenpox:

• Palmar redness

• Excoriating diaper-area rashes

Measles:

• Injected conjunctiva

• Excoriating diaper-area rashes

Rubella:

• Excoriating diaper-area rashes

Scarlet fever:

• Magenta-colored lips

• Palmar redness

• Excoriating diaper-area rashes

Erythema infectiosum (5th disease) -- human parvovirus

• Excoriating diaper-area rashes

Exanthema subitum or Roseola infantum

• Excoriating diaper-area rashes

Non-polio entero-viruses (e.g., echovirus, coxsackievirus):

• Excoriating diaper-area rashes

• Red macula

• Magenta-colored lips

• Palmar redness

Of the differential diagnoses you listed, which would be the most concerning?

Non-polio enteroviruses

What additional diagnostic tests will you recommend? Why?

PCR (Polymerase chain reaction) testing, cell cultures obtained from the patient's cerebrospinal fluid, stool, or blood, and additional immunologic examinations (de Graaf et al., 2016; Thong et al., 2017).

PCR -- This is the most dependable enterovirus diagnosis test which recognizes the virus's genetic matter and is offered by specialized labs. It is commonly employed in times of virus outbreaks (e.g., the 2014 American EV-D68 epidemic) (Zhuge et al., 2015). Its alternative, cell cultures, are not as sensitive, and are incapable of spotting all enteroviruses. As such examinations aim at amplifying and detecting RNA/DNA segments highly specific to particular genetic organisms or sequences, applying them in non-polio enterovirus diagnoses will prove highly valuable. PCR tests aim at detecting a shared genetic area within enteroviral subtypes. Test results are provided within a day. This makes identification more precise (97%), time-efficient and sensitive (95%) (Zhuge et al., 2015).

Cell culture (using the patient's stool, saliva, blood, and spinal fluid) -- This approach, as well as that of conducting immunological examinations of the patient's cerebrospinal fluid, blood or stool, is not as successful in detecting enteroviruses, which may be present within the patient's cerebrospinal fluid, stool, pharynx, and blood.

Serologic testing -- This technique employs a number of titers for the identification of a trend of increasing levels of antibody between two and four weeks. A single enteroviral antibody level may be found among healthy individuals. Thus, serology observation is vital to identifying a growth in levels by four times.

What would be your focus for caregiver education?

The emphasis of caregiver education in case of patients diagnosed with enterviral ailments would be supportive approaches and illness management which entail pericardial pain, heart failure, pericardial effusion, and arrhythmias management. Bed rest has been established as imperative, as exercise may cause a rise in myocardial necrosis level. IVIG (intravenous immunoglobulin) treatment has revealed a certain amount of advantage within small-scale case-control research works. Still, a majority of reports are not statistically significant. Thus, there is a need for randomized trials (Thong et al., 2017; de Graaf et al., 2016). Among the class of medicines which prove helpful in treating immunosuppressed myocarditis patients are capsid-binding inhibitors. Corticosteroids prove less beneficial (or sometimes not beneficial at all) and immunosuppressive treatment is contraindicated in acute viral myocarditis as they prove to lead to clinical deterioration.