Pediatric emergency medicine trisk 2305 2305
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Hepatitis viruses
Leishmaniasis
Leptospirosis
Malaria
disseminated
other arboviruses in
intravascular coagulation
the same class)
Serology testing
Serology testing
Acute hepatitis A and B: supportive
Chronic hepatitis C: Ledipasvir, sofosub
specific antiviral agents, +/– ribavirin
Direct visualization of
Visualization of
Consultation with CDC should be perfor
protozoa from bone
protozoa from bone Standard treatment involves pentavalent
marrow aspirate
marrow or splenic
sodium stibogluconate; miltefosine an
aspiration
Serology if other diagnostic
also been used
tests unavailable
Serology not useful for
cutaneous form
Ancillary for visceral form:
marrow suppression,
elevated hepatic
transaminases,
hypoalbuminemia,
hypergammaglobulinemia
PCR, culture, or
PCR is sensitive and
Penicillin or ampicillin for severe diseas
immunohistochemical
continues to be
Doxycycline or amoxicillin for mild dise
staining (culture is
positive even after
also recommended for prophylaxis
sensitive and slow)
initiation of therapy Need to monitor for Jarisch–Herxheimer
Ancillary: can see
Serology (microscopic
initiation of therapy
lymphocytic
agglutination test,
cerebrospinal fluid
MAT)
pleocytosis with elevated If sending blood
protein and opening
cultures, need to
pressure; elevated hepatic
notify laboratory to
transaminases and
hold culture for 2–4
bilirubin; urinalysis
mo
showing pyuria,
proteinuria, and
hematuria; elevated
creatinine, creatine
kinase, and amylase
Thick, thin smear
Thick smear: quantify Check CDC site for regions
level of parasitemia
( />Anemia, thrombocytopenia,
) where parasites retain chloroquine su
hypoglycemia, metabolic Thin smear: allows for
acidosis, elevated
speciation; presence P. falciparum:
creatinine, bilirubin, and
of >1 ring form in a Atovaquone/Proguanil (Malarone) × 3 d
serum transaminases.
erythrocyte suggests Artemether-lumefantrine (Coartem) × 3
Obtain type and screen
P. falciparum, the
Quinine + (clindamycin or doxycycline)
and G6PD level (need to
species responsible Mefloquine (Larium) × 2 doses
know status before
for most deaths
Severe/complicated malaria: quinine + c
treating with primaquine
globally
exchange transfusion considered for c
for the hypnozoite form
high-grade parasitemia
seen in P. vivax and ovale
For vivax/ovale: atovaquone. Proguanil
)
If strongly suspect malaria,
do not withhold treatment
if initial smears negative,
simply repeat smears in
12–24 hrs
