Kim Harley PhD
- Associate Adjunct Professor, Maternal, Child and Adolescent Health
https://publichealth.berkeley.edu/people/kim-harley/
Two common bacterial skin infections are: medicine 035 buy strattera 10 mg on-line, and medicine 8 soundcloud buy discount strattera 40mg on line. Bullous impetigo treatment tinea versicolor purchase strattera 25mg without a prescription, a deep-seated infection characterized by large symptoms ulcer purchase 18mg strattera with visa, fluid-filled blisters, is caused by the bacteria. The major sites of infection are the, and. The most common types of this cancer are: and and diagnosis is made by. A major risk factor for malignant melanoma for young women under 30 years of age is use of a tanning bed times/year. Discuss the clinical manifestations and medical and nursing management for a patient with genital herpes. On the basis of the knowledge of acne vulgaris, the nurse knows that the skin disorder is characterized by five types of lesions:, and. Acne, most prevalent at puberty, is the direct result of oversecretion of the glands. Based on assessment data, identify two collaborative problems: and. One day last October he noticed that the margins of the mole were elevated and palpable and the color had become darker. Since his father had malignant melanoma when he was 32 years old, Steve decided to see a physician. Steve knows that malignant melanoma is currently responsible for 3% of all cancer deaths. Based on statis tical predictions, the number of deaths in 10 years will be approximately: a. Three criteria to support total body digital photography for assessment are:, and. The most common form of melanoma is, which is most commonly found on the and. On examination, the physician notes a circular lesion with irregular outer edges and a pinkish hue in the center. The physician advises Steve that with lymph node involvement he only has a % chance of surviving 5 years. With partial-thickness (second-degree) burns, skin regeneration begins to take place: a. As fluid is reabsorbed after injury, renal function maintains a diuresis for up to: a. Fluid shifts during the first week of the acute phase of a burn injury that cause massive cell destruction result in: a. An unexpected laboratory value during the fluid remobilization phase of a major burn is a: a. A serious gastrointestinal disturbance that frequently occurs with a major burn is: a. As the first priority of care, a patient with a burn injury will initially need: a. Eyes that have been irritated or burned with a chemical should be flushed with cool, clean water: a. Decreased urinary output during the first 48 hours of a major burn is secondary to all of the following except: a. The resuscitation formula for replacing fluid lost during the first 24 to 48 hours recommends the administration of: a. A sample consensus formula for fluid replacement recommends that a balanced salt solution be adminis tered in the first 24 hours of a burn in the range of 2 to 4 mL/kg/% of burn with 50% of the total given in the first 8 hours postburn. A 176-lb (80-kg) man with a 30% burn should receive a minimum of how much fluid replacement in the first 8 hours Fluid and electrolyte changes in the emergent phase of burn injury include all of the following except: a. During the acute phase of burn injury, the nurse knows to assess for signs of potassium shifting: a. One parameter of adequate fluid replacement is an hourly urinary output in the range of: a. During the fluid remobilization phase, the nurse knows to expect all of the following except: a. Leukopenia within 48 hours is a side effect associated with the topical antibacterial agent: a. The nurse knows that the topical antibacterial agent that does not penetrate eschar is: a. The nurse knows to monitor sodium and potassium levels (drug is hypotonic) when a burn patient is being treated with: a. After an occlusive dressing is applied to a burned foot, the foot should be placed in the position of: a. Biologic dressings that use skin from living or recently deceased humans are known as: a. The nurse knows that the physician will most likely prescribe the analgesic of choice for treatment of acute burn pain which is: a. To meet his early nutritional demands for protein, a 198-lb (90-kg) burned patient will need to ingest a minimum of how much of protein every 24 hours Early indicators of late-stage septic shock include all of the following except: a. The two age groups that have increased morbidity and mortality from burn injuries are: and. The overall mortality rate (all ages and total body surface area for burn injuries) is:. The severity of burn injury and likelihood of survival is dependent on seven factors. Name four:, and. Burn injuries are classified according to: and. List two pulmonary complications that occur secondary to inhalation injuries: and. The leading cause of death in thermally injured patients is:. The resuscitation goal of fluid replacement therapy, postburn injury, is a urinary output of:. The three major bacteria responsible for infection in burn centers are:, and. Three commonly used topical antibacterials for skin care are:, and. List four signs of sepsis, postburn:, and. Explain why the survival rate for burn victims has increased significantly over the last 10 years. Explain the pathophysiology of a burn injury specific to the following system alterations: cardiovascular, fluid and electrolyte, pulmonary, renal, and gastrointestinal. Describe general emergency procedures that a nurse should employ at the burn scene. Discuss general nursing actions for six nursing diagnoses for care of a patient during the emergent phase of burn injury. Distinguish between the purposes and nursing implications for biologic dressings (homografts and heterografts) and biosynthetic and synthetic dressings. Describe the appearance of hypertrophic and keloid scars and measures to prevent their formation. Discuss why congestive heart failure is a potential complication of an acute burn. For each nursing diagnosis, list goals, nursing actions, rationale, and expected outcomes. Aimee, a 9-month-old child, climbed onto a stove where an electric range was on high.
Maintain a permanent record of evaluation for each resident symptoms you may be pregnant discount 40 mg strattera overnight delivery, which is accessible to the resident and other authorized personnel; 5 symptoms 5 weeks pregnant quality 40 mg strattera. Residents are provided with a summary of their performance after their semi annual review meeting with the Program Director treatment example cheap strattera master card. These evaluations are compiled and used to improve the quality of the educational experience treatment hepatitis c order strattera now. Milestones for non-clinical core competencies are applicable to every resident on every rotation. Scholarly activity resulting in implementation of initiatives to improve patient quality and safety of care! At any given time, one urology surgery resident will represent the department on the following committee: a. Render a written annual program evaluation, which shall be submitted to the chairman and program director and be reviewed and discussed by the faculty at a departmental meeting. Except as permit ted under the United States Copyright Act of 1976, no part of this publication may be reproduced or distributed in any form or by any means, or stored in a database or retrieval system, without the prior written permission of the publisher. Rather than put a trademark symbol after every occurrence of a trademarked name, we use names in an editorial fashion only, and to the benefit of the trademark owner, with no intention of infringement of the trademark. McGraw-Hill eBooks are available at special quantity discounts to use as premiums and sales promotions, or for use in corporate training pro grams. Your right to use the work may be terminated if you fail to com ply with these terms. McGraw-Hill and its licensors do not warrant or guarantee that the functions contained in the work will meet your requirements or that its operation will be uninterrupted or error free. This limitation of liability shall apply to any claim or cause whatsoever whether such claim or cause arises in contract, tort or otherwise. Ambulatory & Community Pediatrics 216 Amphetamines & Related Drugs 321 Anesthetics, Local 321 Robert M. Immunization 236 Cyclic Antidepressants 325 Digitalis & Other Cardiac Glycosides 325 Matthew F. Normal Childhood Nutrition Ibuprofen 328 & Its Disorders 268 Insect Stings (Bee, Wasp, & Hornet) 328 Nancy F. Emergencies & Injuries 294 Morphine, Propoxyphene) 331 Phenothiazines (Chlorpromazine, Maria J. Critical Care 339 Diseases of the Optic Nerve 419 Diseases of the Orbit 421 Todd C. Respiratory Tract & Mediastinum 471 Dermatitis (Eczema) 388 Common Skin Tumors 390 Gwendolyn S. Cardiovascular Diseases 519 Acute Pancreatitis 644 Chronic Pancreatitis 645 Henry M. Kidney & Urinary Tract 651 Cardiac Transplantation 564 Primary Pulmonary Hypertension 566 Gary M. Gastrointestinal Tract 577 Hematuria & Glomerular Disease 656 Proteinuria & Renal Disease 658 Judith M. Neurologic & Muscular Disorders 673 Disorders of the Peritoneal Cavity 591 Paul G. Rheumatic Diseases 796 Chronic Pain 884 Pediatric Palliative & End-of-Life Care 886 Jennifer B. Hematologic Disorders 804 Primary Considerations 891 Antibody Deficiency Syndromes 895 Daniel R. Endocrine Disorders 911 Common Recognizable Disorders with Variable or Unknown Cause 1013 Philip S. Diabetes Mellitus 949 Adverse Reactions to Drugs & Biologicals 1046 Food Allergy 1050 H. Inborn Errors of Metabolism 956 Prophylactic Antimicrobial Agents 1058 Initial Empiric Antimicrobial Choices for Janet A. Human Immunodeficiency Amebiasis 1197 Virus Infection 1111 Giardiasis 1199 Elizabeth J. Fluid, Electrolyte, & Acid-Base Pseudomonas 1151 Disorders & Therapy 1245 Salmonella Gastroenteritis 1152 Typhoid Fever & Paratyphoid Fever 1154 Douglas M. Pediatric Laboratory Medicine Leptospirosis 1179 & Reference Ranges 1254 Lyme Disease 1180 Georgette Siparsky, PhD, & Frank J. Infections: Parasitic & Mycotic 1183 Challenges in Determining & Interpreting Samuel R. Clayton, PhD Critical Care Instructor, Department of Physical Medicine/Rehabilitation, University of Colorado School of Medicine; the Samuel R. Residents in pediatrics (and other specialties) will appreciate the detailed descriptions of diseases as well as diagnostic and therapeutic procedures. A wealth of tables and figures provides quick access to important information, such as acute and critical care procedures in the delivery room, the office, the emergency room, and the critical care unit; anti-infective agents; drug dosages; immunization schedules; differential diagnosis; and developmental screening tests. New references as well as up-to-date and useful Web sites have been added, permitting the reader to consult original material and to go beyond the confines of the textbook. As editors and practicing pediatricians, we have tried to ensure that each chapter reflects the needs and realities of day-to-day practice. The Gastrointestinal Tract chapter, with contributions from a new author, has been thoroughly revised, particularly the sections on inflammatory bowel disease and gastroesophageal reflux, as well as new sections on cyclic vomiting syndrome and eosinophilic esophagitis. Especially important are updates to the chapters on Infectious Diseases, including information on methicillin-resistant staphylococcus and tropical diseases such as dengue and malaria. The Oral Medicine & Dentistry chapter has a new author and a focus on preventive dentistry. The Cardiovascular chapter has been streamlined and includes a thoroughly updated section on ultrasound and a new section on cardiac transplant and treatment of rejection. The Rehabilitation Medicine & Sports Medicine chapter has been separated into two chapters to clarify and emphasize the unique aspects of each. Child & Adolescent Psychiatric Disorders & Psychosocial Aspects of Pediatrics has been completely revised by two new authors. Significant peripartum practice, however, sick or very immature infants may require events include duration of ruptured membranes, maternal neonatal care for many months. There are three levels of fever, fetal distress, meconium-stained amniotic fluid, type of newborn care. Level 1 refers to basic care of well newborns, delivery (vaginal or cesarean section), anesthesia and analgesia neonatal resuscitation, and stabilization prior to transport. Adding the (2) maternal past obstetric history, and (3) current antepar scores assigned to each neonatal physical and neuromuscular tum and intrapartum obstetric history. Foot social history that might increase the risk for parenting prob length, from the heel to the tip of the longest toe, also lems and child abuse. Family illnesses with genetic implica correlates with gestational age in appropriately grown tions should be sought. The current obstetric history includes the results of If the physical examination indicates a gestational age procedures during the current pregnancy such as ultrasound, within 2 weeks of that predicted by the obstetric dates, the amniocentesis, screening tests (rubella antibody, hepatitis B gestational age is as assigned by the obstetric date. Intrauterine growth curves for weight, length, and head circumference for singleton births in Colorado. Whenever possible, standards for new cal growth restriction implies an event of early pregnancy: born weight and gestational age based on data derived chromosomal abnormality, drug or alcohol use, or congeni from the local or regional population should be used.
The cariostatic mechanisms of tained to monitor and reinforce good oral health practices chi infra treatment strattera 18 mg with amex. Fluoride affects the dentin and ciency useless id symptoms buy genuine strattera on-line, better health outcomes symptoms nausea order 25mg strattera overnight delivery, and lower costs than enamel of both erupted and unerupted teeth medicine man lyrics strattera 10mg without a prescription. Fluori Caries Prevention dated toothpaste and mouth rinses deliver topical benefits. The gums can be cleaned younger than 6 years of age cannot expectorate reliably, the gently with a moist, soft cloth. Once the teeth begin to erupt, use of fluoridated toothpaste must be monitored by their oral hygiene must be practiced in earnest. A small, soft parents and the recommendation to use only a pea-sized toothbrush designed for infants should be used. Prior to viduals with orthodontic appliances, reduced salivary func age 8 years parents need to be involved daily in brushing and tion, or gastroesophageal reflux disease, or those who are flossing. Brushing with fluoride-containing toothpaste at unable to clean their teeth properly, are at dietary risk, have least twice daily and regular flossing will help to reduce the mothers or siblings with caries, or have active caries should count of cariogenic bacteria in the oral flora. A second step be considered for additional topical fluoride therapy to is to decrease the amount of substrate available to the supplement oral hygiene measures. The primary care physician plays an invalu begins as inflammation of the gingival tissue adjacent to a able role in disseminating this information and reinforcing tooth. Generally, this condition responds well to removal of bacterial deposits and improved oral hygiene. Patients with localized aggressive peri odontitis typically have severe alveolar bone loss around permanent first molars and incisors, whereas the generalized form involves other teeth as well. Familial aggregation and functional defects such as anoma lies of neutrophil chemotaxis, phagocytosis, and bacterial activity increase the risk of periodontitis. They are also a lead nomycetemcomitans in combination with Bacteroides-like ing cause of condylar fracture in the pediatric population. An association between Condylar fracture should be suspected if pain or deviation maternal periodontal disease and preterm birth has been occurs when the jaw is opened. It is currently unclear whether this association Tooth-related trauma affects any or all of the dental hard involves causation or it is a marker for another etiology. The range of luxation injuries includes concussion; root debridement plus antibiotic therapy. Isolated chronic subluxation; intrusive, extrusive, and lateral luxation; and avul periodontitis is rare in children and adolescents but may sion. Pulp vitality should be Necrotizing periodontal disease is characterized by interprox periodically assessed. The condition usually responds the peak age for injuries to primary teeth is toddlerhood. Lacerations should be cleansed, inspected for foreign bodies, and sutured if Enamel only Exposed pulp (uncomplicated) (complicated) necessary. Occasionally, radiographs of the tongue, lips, or cheeks are needed to detect tooth fragments or other foreign Enamel and dentin bodies. All patients with facial trauma should to be evaluated (uncomplicated) for jaw fractures. Parents should be advised of any combined with antibiotics is the usual treatment. Severe luxations in any direction are treated drainage, and removal of the source of infection. The latter should be left for physiologic resorption if its retrieval would result in potential damage to the the antibiotics of choice for odontogenic infection are permanent tooth. Several patient groups require prophylactic antibiotic coverage prior to invasive dental Permanent Teeth manipulation. These include children with artificial heart valves, previous infectious endocarditis, certain congenital Because the prognosis for viability worsens rapidly as time heart conditions, immunodeficiency, or central venous cath outside the mouth increases, avulsed permanent teeth eters. Revised guidelines for infective endocarditis prophy should be replanted at or near the site of injury following laxis were published by the American Heart Association in gentle rinsing with clean water. Root canal treatment is necessary in the majority of and potential sources of infection before the child becomes injuries. Factors to consider during treatment planning are neutropenic as a consequence of chemotherapy. Younger root development (open or closed apex) and the extent of patients have more oral problems than adults. Pulp necrosis; surface, inflammatory, and infection include abscessed teeth, extensive caries, teeth that replacement resorption; or ankylosis may occur at any time will soon exfoliate, ragged or broken teeth, uneven fillings, during the healing process and determine the long-term and orthodontic appliances. All luxated and replanted teeth need to be followed before the initiation of cancer therapy, a dental treatment regularly by a dentist. Preventive strategies include reduction of refined sug ars, fluoride therapy, lip care, and patient education. Oral pain may be severe and often leads to pain usually responds to acetaminophen or ibuprofen. Top inadequate food and fluid intake, infections in the oral ical medications are of limited value. Meticulous oral A localized small swelling confined to the gingival tissue hygiene reduces the risk of severe mucositis. This the pediatric oncology patient should be monitored gumboil or parulis represents infection that has spread throughout therapy to screen for infection, manage oral outward from the root of the tooth through the bone and bleeding, and control oral pain. Childhood caries is an infectious disease transmitted by Children receiving hematopoietic cell transplantation bacteria from the mother to the child. During have high levels of S mutans are at greater risk for acquiring the neutropenic phase of pretransplant conditioning, muco the organism. Dental treatment of their mothers or primary sitis, xerostomia, oral pain, oral bleeding, and opportunistic caregivers can delay or prevent the inoculation of the infant. Long-term dental follow-up treatment of expectant mothers does not improve the inci includes management of salivary dysfunction and craniofa dence of preterm delivery or significantly improve birth cial growth abnormalities from total body radiation and weight. The risk of preterm birth is elevated if a mother treatment of oral graft-versus-host disease. Secondhand or pas familiar with young children and their growth and develop sive smoke increases the risk of caries in children. Oral and maxillofacial growth disturbances can occur association is independent of age, family income, geographic after therapy. Late effects of therapy include such morpho region, and frequency of dental visits. It is important to logic changes as microdontia, hypocalcification, short and advise expectant mothers about these risk factors.
Increase growth and intellectual function in children in desipramine serum levels associated with of drug addicts medicine vocabulary order strattera australia. Buprenorphine mainte in methadone treatment using survival analy nance treatment of opiate dependence: A sis medicine 4 times a day strattera 10mg overnight delivery. Substance Use & quantitation of urinary buprenorphine and Misuse 34(9):1299n1324 mueller sports medicine purchase strattera with amex, 1999 medicine head generic 10mg strattera with visa. Journal of methadone treatment: Lessons learned, Chromatography B 692(1):67n77, 1997. Journal of methadone patients: Predictors of outcomes Substance Abuse Treatment 19:291n296, in a psychosocial clinical trial. The effectiveness of in-jail tion to establishment: Problem in community methadone maintenance. Australian and Pharmacology & Therapeutics New Zealand Journal of Obstetrics and 62(5):569n571, 1997. The impact of methadone ribavirin compared with interferon alfa-2b induction on cardiac conduction in opiate plus ribavirin for initial treatment of chronic users (letter to the editor). Drug and Alcohol versus no opioid replacement therapy for opi Dependence 61:195n206, 2001. Determinants nance treatment: A 152-week follow-up using of relapse: Implications for the maintenance higher-dose methadone. Efficacy of coercion in of recovery training and self-help for opioid substance abuse treatment. Quantitative urine drug monitor Placement Criteria for the Treatment of ing in methadone programs: Potential clinical Substance-Related Disorders, 2d ed. Historical Review of Criteria for the Treatment of Substance Opium/Heroin Production, n. Update: Clinically significant Problemnservice imatchingi in addiction cytochrome P450 drug interactions. Does clinical case Motivational Interviewing: Preparing People management improve outpatient addiction for Change, 2d ed. Journal of Exchange, Center for Substance Abuse 264 Appendix A Treatment, November 2000. A gas chromatographic iThere is a balm in Gileadi: Religion and positive ion chemical ionization-mass spectro substance abuse treatment. Phases of ment of necrotising fasciitis caused by Group treatment: A practical approach to A Streptococcus. Journal of Pain and Symptom Addiction: Close to Home [5-part television Management 14(5):261n263, 1997. Department of Health and Human new light on the state of drug abuse treatment Services, 2005. National Center on Addiction and Substance Dual diagnosis: A review of etiological theo Abuse. Effective Developing and Implementing a W orkplace medical treatment of opiate addiction. Integrating Behavioral Absence of antibody to human immunodefi Therapies W ith Medication in the Treatment ciency virus in long-term, socially rehabilitat of Drug Dependence. Natural killer cell activity Pharmacologic treatment of heroin and lymphocyte subsets in parenteral heroin dependent patients. Annals of Internal abusers and long-term methadone mainte Medicine 133(1):40n54, 2000. Metabolism of and Experimental Therapeutics methadone and levo-alpha-acetylmethadol 250(2):606n610, 1989. Imipramine treatment of opiate Pharmacology and Experimental dependent patients with depressive disorders: Therapeutics 298(3):1021n1032, 2001. Does therapeutic threshold of Disulfiram treatment for cocaine dependence methadone concentration in plasma exist New York: American Association for atic desensitization for heroin addicts in the Treatment of Opioid Dependence, 2002. Induction simulationomoderate to Successful pain management for the recover high tolerance [slide presentation]. Journal of Analytical Toxicology agement and cognitive-behavioral approaches 23(5):313n322, 1999a. Archives of General Psychiatry Addiction and Substance Abuse at Columbia 57(4):395n404, 2000. Anger Transtheoretical therapy: Toward a more Management for Substance Abuse and integrative model of change. Psychotherapy: Mental Health Clients: A Cognitive Theory, Research and Practice Behavioral Therapy Manual. Pathologie-Biologie (Paris) use of buprenorphine-benzodiazepine combi 50(9):568n575, 2002. Journal of Psychoactive Drugs American Journal of Public Health 27(2):151n159, 1995. Maternal-infant azepine dependence among heroin users in transmission of hepatitis C virus infection. Archives Methadone Treatment for Opioid of General Psychiatry 43(8):739n745, 1986. Journal of Substance Abuse Treatment Medical Journal of Australia 173:484n488, 19(1):7n14, 2000a. Importance of identifying Disorders and Addictions: Evidence on cocaine and alcohol dependent methadone Epidemiology, Utilization, and Treatment clients. Journal of Pediatrics neglected: Cognitive processing of cues in 101(2):192n196, 1982. Mount Sinai follow-up of a methadone medical mainte Journal of Medicine 67(5n6):388n397, 2000. Mount Sinai the impact of a brief motivational interven Journal of Medicine 67(5n6):412n422, 2000. Principles of pain treatment in Drug and Alcohol Dependence 51(1n2): the addicted patient. A nationwide survey of urinaly seronegative drug users in a methadone main sis practices of methadone maintenance clin tenance program. Contingency management for women in methadone maintenance treatment tobacco smoking in methadone-maintained programs. Drug and Alcohol Dependence drug abuse: A meta-analysis and review of 41:197n207, 1996. A psychoedu voucher-based reinforcement in drug abuse cational approach to methadone maintenance treatment. Motivating Behavior Change Among Journal of Substance Abuse Treatment Illicit-Drug Abusers: Research on 8(3):125n131, 1991. The effect of therapist/patient Cannabinoids, lysergic acid diethylamide, race and sex-matching in individual treat buprenorphine, methadone, barbiturates, ment. Substance Use & Misuse polydrug use among methadone maintenance 35(12n14):1911n1930, 2000. Drug abuse treatment retention and pro 48th Annual Scientific Meeting, the cess effects on follow-up outcomes. Drug and Committee on Problems of Drug Dependence, Alcohol Dependence 47(3):227n235, 1997b. Drug tizing fasciitis in an intravenous drug user and Alcohol Dependence 8(3):189n199, 1981. A Family Like methadone treatment: the case for positive Yours: Breaking the Patterns of Drug Abuse. Community Mental Substance Abuse and Mental Health Services Health Journal 37(6):469n479, 2001. Journal of Pediatrics 89(5):842n846, Developing Treatment Programs for People 1976. W ith Co-Occurring Substance Abuse and Substance Abuse and Mental Health Services Mental Disorders. 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If there is tender erythema but cillin treatment 247 purchase discount strattera on-line, such as methicillin medicine dispenser 25 mg strattera with mastercard, oxacillin symptoms tracker generic strattera 10 mg on-line, nafcillin symptoms meaning discount 10 mg strattera visa, cloxacillin, or not exfoliation, the disease is termed nonstreptococcal scarlet dicloxacillin. The scarlatiniform rash is sandpaper-like, but straw are found worldwide and are now common in certain hospitals berry tongue is not seen, and cultures grow S aureus rather and, increasingly, in community-acquired infections in some than streptococcus. Additional nia in infancy is characterized by abdominal distention, high clinical features include sudden onset; conjunctival suffu fever, respiratory distress, and toxemia. It often occurs with sion; mucosal hyperemia; desquamation of skin on the out predisposing factors or after minor skin infections. Frequent chest radiographs to monitor the pro strual periods in as many as 60% of untreated women who gress of disease are indicated. Recurrences occur in up to 15% of be typical of paralytic ileus, suggestive of an abdominal women given antistaphylococcal antibiotics who stop using catastrophe. Purulent pericarditis occurs by direct Localized and systemic coagulase-negative staphylococcal extension in about 10% of cases, with or without empyema. Coagulase-negative staphylococci are the most poisoning is a result of ingestion of enterotoxin produced by common nosocomial pathogen in hospitalized low-birth staphylococci growing in uncooked and poorly refrigerated weight neonates in the United States. About 25% of all cases of endocarditis are catheter infection, often necessitating removal of the foreign due to S aureus. The great majority of artificial heart valve material and protracted antibiotic therapy. Because blood infections involve either S aureus or coagulase-negative sta cultures are frequently contaminated by this organism, diag phylococci. Infection usually begins in an extracardiac focus, nosis of genuine localized or systemic infection is often often the skin. Blood cultures are frequently positive in systemic the presenting symptoms in staphylococcal endocarditis staphylococcal disease and should always be obtained when are fever, weight loss, weakness, muscle pain or diffuse it is suspected. Similarly, pus from sites of infection should skeletal pain, poor feeding, pallor, and cardiac decompensa always be aspirated or obtained surgically, examined with tion. Signs include splenomegaly, cardiomegaly, petechiae, Gram stain, and cultured both aerobically and anaerobically. Peripheral septic embolization and Differential Diagnosis uncontrollable cardiac failure are common, even when opti Staphylococcal skin disease takes many forms; therefore, the mal antibiotic therapy is administered, and may be indica differential list is long. Bullous impetigo must be differenti tions for surgical intervention (see later discussion). Staph vomiting, myalgia, prostration, hypotension, and multior ylococcal scalded skin syndrome may resemble scarlet fever, gan dysfunction. It is due to S aureus focal infection, usually Kawasaki disease, Stevens-Johnson syndrome, erythema without bacteremia. A skin biopsy may be described in menstruating adolescents and young women critical in establishing the diagnosis. The addition of rifampin is advo Klebsiella), and both skin and systemic infections occur with cated by some (rifampin should not be used alone to treat virtually all of these organisms. Afebrile, well-appearing patients with small abscesses may Treatment do well with incision and drainage (with or without the A. Results of these tests facili from patients with skin and soft tissue infections. Antibiotics are continued for at intravenous treatment until fever and local symptoms and least another 4 weeks. Longer treatment may be required, par tion (or removal of tampons or foreign bodies), and giving ticularly when radiographs show extensive involvement. In arthritis, where drug cally as a single agent until susceptibilities (when an isolate diffusion into synovial fluid is good, intravenous therapy grows) are known; some strains of S aureus are clindamycin need be given only for a few days, followed by adequate oral resistant. In all instances, oral therapy Intravenous immune globulin has been used as adjunc should be administered with careful attention to compli tive therapy. Some experts believe that corticosteroid therapy ance, either in the hospital or at home. If not, cally until results of cultures and susceptibility tests are therapeutic options are limited and include use of quinupris obtained. Experience is cious as vancomycin for the treatment of resistant gram very limited with daptomycin in pediatric patients. Consul positive pneumonia and soft tissue infections (cure rates: 95% tation with an infectious disease specialist is recommended. The Bacteremia and other serious coagulase-negative staphylo choice of chest tube versus thoracoscopic drainage depends coccal infections are treated initially with vancomycin. If staphylococcal Coagulase-negative staphylococci are uncommonly resistant pneumonia is treated promptly and empyema drained, reso to vancomycin. Skin and soft-tissue infections caused lin-susceptible isolates are often treated with oxacillin or by methicillin-resistant Staphylococcus aureus. Reichert B et al: Severe non-pneumonic necrotising infections in Occasionally, medical treatment fails. Signs of treatment children caused by Panton-Valentine leukocidin producing failure are (1) recurrent fever without apparent treatable Staphylococcus aureus strains. Deficiencies of early and alter nate pathway complement components also are associated with increased susceptibility. Many children with clinical meningococcemia also have Fever, shock, petechial or purpuric skin rash (meningo meningitis, and some have other foci of infection. Purpura, petechiae, and General Considerations occasionally bright pink, tender macules or papules over the extremities and trunk are seen. The rash usually progresses Meningococci (Neisseria meningitidis) may be carried rapidly. Fulminant meningococ asymptomatically for many months in the upper respiratory cemia (Waterhouse-Friderichsen syndrome) progresses rap tract. This syndrome also may be caused septic arthritis, pericarditis, pneumonia, chronic meningo by H influenzae, S pneumoniae, or other bacteria. Chronic coccemia, otitis media, conjunctivitis, and vaginitis also meningococcemia is characterized by periodic bouts of fever, occur. The incidence of invasive diseases in the United States arthralgia or arthritis, and recurrent petechiae. Chronic meningococcemia occurs primarily attack rate for meningococcal meningitis is in the first year of in adults and mimics Henoch-Schonlein purpura.
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