0071643192.pdf

PEDIATRICS

Streptococcal toxic shock syndrome (STSS)

■ Typically due to infectionwith exotoxin-producing strain of group A strep-

tococcus (GAS).

DIAGNOSIS

■ Based on established clinical criteria (see Table 1.17)

TREATMENT

■ Treatment strategy is the same as for patients with sepsis.

■ Major difference is antibiotic usage to cover MRSA as well as group A

streptococcus.

■ Nafcillin, clindamycin, and vancomycin concomitantly

ROCKYMOUNTAINSPOTTEDFEVER(RMSF)

■ Rickettsial infection caused by the Gram-negative, obligate intracellular

Rickettsia rickettsii

■ Transmitted via tick bite

■ RMSF occurs throughout the United States (not only in the Rocky

Mountain area).

■ Peak season: April–October

■ Peak incidence: 5–9 years of age

SYMPTOMS/EXAM

■ Typical onset of symptoms: 1 week after tick exposure

■ Severe headache

■ Exanthem: Appears 3–5 days after onset of other symptoms. Initially, pre-

sents as blanching, erythematous macules located on the wrists and ankles.

Rash spreads to palms, soles, and torso. Rash then typically becomes non-

blanching purpura or petechiae (see Figure 5.14).

■ May develop hypotension, CNS involvement, abdominal pain, renal failure,

and ARDS

DIFFERENTIAL

Extensive, including:

■ Meningococcal disease

■ Ehrlichiosis

■ 2° syphilis

■ Henoch-Schönlein purpura

■ Kawasaki disease

■ Drug reactions

■ Toxic shock syndrome

■ Viral infections (enterovirus, influenza)

DIAGNOSIS

Clinical suspicion, confirmed by antibody testing

RMSF Triad (present in 60% of

cases):

1. Fever


2. Rash


3. Headache

Treatment of RMSF should be

based on clinical suspicion.

Do not exclude the diagnosis

of RMSF because of lack of

rash or tick exposure.