Pediatric emergency medicine trisk 2313 2313
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likely to result in neutropenia. Thrombocytopenia can be found with both diseases although severe
thrombocytopenia is more common in dengue. Fluid resuscitation may be needed due to dehydration from reduced
intake and increased insensible losses. Most children recover fully over a period of weeks but approximately 5% to
10% experience chronic joint symptoms. Severe complications include meningoencephalitis, cardiopulmonary
compromise, acute renal failure, and death; these are more common in patients with comorbidities and the elderly.
The primary diagnostic tool used is serology. PCR can be performed at state labs and the CDC. ELISA tests
identify IgM (approximately 7 days after infection, and IgM remains elevated for up to 3 months) antibodies.
Management: Treatment is supportive. Repeat episodes are more likely to be severe. NSAIDs or corticosteroids
may help to relive arthralgia. Standard isolation precautions should be used. The risk of human infection may be
reduced by utilization of insect repellant (no more than 30% DEET recommended for children >2 months),
wearing long pants and long sleeve shirts, and staying in screened or air-conditioned dwellings during peak
feeding times. Bed nets are ineffective since this mosquito genus is a daytime feeder. Standard precautions are
recommended.
Zika
CLINICAL PEARLS AND PITFALLS
Zika is endemic in the Americas and the Western Pacific.
While symptoms can mimic those of Chikungunya, symptom severity and duration are less intense
and over 80% of individuals are asymptomatic.
Transmission can occur via mosquito bite, blood transfusion, and sexual contact.
Current Evidence
The main vectors are Aedes species mosquitoes, which are daytime biters; as such, bednets are ineffective in
preventing Zika infection. While there was no documented Zika transmission in the United States in 2018, 56
countries have reported outbreaks in the last 5 years, most from the Caribbean, Mexico, Central and South
America, and the Western Pacific islands.
Goals of Treatment
The symptoms of Zika infection can mimic those of other pathogens more common in industrialized and
developing nations. Prompt recognition can guide reproductive decision making and allow emphasis on further
mosquito bite prevention to decrease local transmission.
Clinical Considerations
Clinical recognition: The incubation period is 3 to 14 days. Up to 80% of persons have asymptomatic infection.
Symptoms are mild, usually resolving in less than 1 week, and can include fever, arthralgia, conjunctival injection,
and a nonpetechial rash. Guillain-Barré syndrome has been reported. Infants with congenital Zika infection can
have microcephaly, microphthalmia or cataracts, contractures, tonal abnormalities, and intellectual disability.
Triage Considerations
Clinical assessment: The differential diagnosis includes dengue and Chikungunya (both transmitted by the same
mosquito vector), as well as measles, adenovirus, and Kawasaki disease. For nonvertically acquired infection, the
diagnosis is based on RT-PCR obtained within 14 days of illness onset. Even in patients with mild symptoms, PCR
confirmation may help guide conversations about contraception after infection. In congenital infection, RT-PCR in
serum and urine and serum IgM can confirm the diagnosis.
Management: Treatment is supportive. NSAIDs should be avoided until dengue can be ruled out. Standard
precautions are recommended, and affected children should avoid insect bites to decrease the risk of local
transmission.
Diarrheal Diseases
CLINICAL PEARLS
