Pediatric emergency medicine trisk 2298 2298
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a leukocytosis with a neutrophilic predominance, and blood cultures (aerobic and anaerobic) should be obtained, as
bacteremia is present in a majority of cases. Fasciitis is a medical and surgical emergency. Debridement is needed
in many instances to prevent spread to adjacent tissues. Antimicrobial therapy should be targeted toward GAS, S.
aureus, and anaerobes, especially with fasciitis of the head and neck (or any area with evidence of gas production
in the tissues). Multidrug empiric therapy with penicillin (which is more bactericidal for GAS than clindamycin or
vancomycin), clindamycin (for anaerobic coverage), and vancomycin (for MRSA) should be initiated. Contact
precautions should be used.
INFECTIONS IN RETURNED TRAVELERS
Introduction
Over the last 20 years, there has been an enhancement of medical provider networks designed to improve
surveillance and medical care for international travelers. More than 80% of U.S. citizens visiting pretravel clinics
are traveling to resource-poor countries, with Africa being the most commonly visited region. Approximately 38
million residents of the United States traveled internationally in 2017, with approximately 9% reporting travelassociated illnesses. While most are mild, self-limited conditions, such as traveler’s diarrhea, a proportion of these
individuals will present to the ED after returning home. Pediatric travelers may be classified into several groups:
children returning from international travel; children returning from visiting friends and relatives (VFRs) in the
child or parents’ country of origin; international adoptees; and recently emigrated children. These groups may have
distinct risk factors for infection and certain groups (VFRs) historically have been at higher risk for travelassociated infections because their families infrequently seek medical attention prior to international travel.
It is critical for the emergency medicine provider to ask families not only about locations to which the child has
traveled ( Table 94.18 ) for infections common in specific regions, but what regions (e.g., urban vs. rural) the child
visited and what activities were undertaken. Knowing when a child returned home can help determine the possible
incubation period, narrowing the differential diagnosis to certain pathogens. The incubation period and symptoms
of most common diseases in the returned traveler are summarized in Table 94.19 , and the diagnosis and treatment
of these diseases are presented in Table 94.20 . These diseases are categorized in one of three ways: diseases
endemic in both industrialized and developing nations; vaccine-preventable illnesses more common
internationally; and diseases endemic only outside industrialized nations.
