Pediatric emergency medicine trisk 2303 2303
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Disease
ED-based testing
Definitive diagnosis
Treatment
Amebiasis
Stool (better for colitis) or
serum (better for hepatic
abscess) antigen detection
Serology (better for hepatic
abscess)
Ancillary: leukocytosis,
anemia, elevated ALT;
abdominal imaging to
help differentiate from
pyogenic abscesses,
Echinococcus, and
malignancy
Thick and thin smears with
Giemsa/Wright staining
Anemia, low haptoglobin,
elevated lactate
dehydrogenase, and
reticulocyte count;
thrombocytopenia
common
Serology (acute and
convalescent titers)
Lab should be notified that
Brucella is suspected as
cultures require an
incubation of 4 wks
minimum
Microscopy to detect
eggs in stool or
antigen detection
(stool, serum) or
serology
Noninvasive or asymptomatic disease: p
a luminal agent)
Colitis: metronidazole
Amebic abscess: metronidazole + parom
luminal agent
Serology
Trimethoprim-sulfamethoxazole and rifa
wks
Addition of an aminoglycoside should b
days in case of suspected meningitis, e
osteomyelitis
Campylobacter
Stool culture
Stool culture
Chagas
Giemsa Staining or direct
Giemsa staining
wet mount
Serology testing available
by CDC for chronic cases
Fluid resuscitation
Azithromycin (10 mg/kg) × 3 days
Benznidazole for 60–90 days or
Nifurtimox available through CDC; seek
Chikungunya
Usually a clinical diagnosis:
fever + severe
arthralgia/arthritis +
travel to or residence in
endemic area within 15
days of symptom onset +
virologic evidence
Stool culture with use of
salt-containing media
(TBS)
Ancillary: may see
hypoglycemia,
hypokalemia, and other
electrolyte disturbances
secondary to dehydration
Stool culture for oocysts
Babesiosis
Brucella
Cholera
Cryptosporidium
Visualization of
Mild–moderate: atovaquone + azithromy
trophozoites
quinine for 7–10 days
(Maltese cross)
If parasitemia >10% (especially in asple
Antibody detection by
significant anemia, or hepatorenal or p
indirect
compromise, exchange transfusion sh
immunofluorescence
assays
PCR is preferred in
Supportive, nonsteroidal anti-inflammato
early stages
Small series have noted possible benefit
Serology: IgM usually
chloroquine, but these have not been v
detectable in 2–7
days (lasts <3–4 mo)
Stool culture
Fluid resuscitation
Antibiotics (fluoroquinolones, tetracycli
severity and duration—important to p
spread
Stool culture for
Most do not require therapy
