Pediatric emergency medicine trisk 2320 2320
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period is approximately 2 weeks; children then develop a nonspecific prodrome of myalgia, low-grade fever, and
headache. Subsequently, there is a swelling of the salivary glands (primarily parotid glands). However, multiorgan
involvement (epididymitis, prostatitis, oophoritis, mastitis, myocarditis, hearing impairment, hepatitis, pancreatitis,
thyroiditis, and arthritis) can be seen. Diagnosis is made clinically, with confirmatory laboratory PCR and serology
testing available. Treatment is supportive. The infectious period is from 3 days prior to onset of symptoms to the
4th day of active disease. Standard and droplet precautions are recommended.
Brucella
Brucellosis is a systemic infection caused by the bacteria in the genus Brucella, small gram-negative aerobic
bacilli. Brucella is a zoonotic infection of livestock that is most common in the Mediterranean region, Indian
subcontinent, and Latin America. Brucella can be transmitted via inhalation of aerosols, mucosal or skin contact,
or ingestion of unpasteurized dairy products, raw meat, liver, or bone marrow. Symptoms include fever, night
sweats, malaise, anorexia, headache, abdominal pain, and myalgia. Complications include meningitis, arthritis,
osteomyelitis, and endocarditis. Diagnosis is made by isolation of the organism from the blood and acute and
convalescent titers; the laboratory should be instructed that Brucella is suspected, as cultures need to be incubated
for a minimum of 4 weeks. Treatment of children consists of combination therapy with TMP-SMZ and rifampin
for at least 4 to 6 weeks. Adolescent and adult patients are preferably treated with either doxycycline or TMP-SMZ
and rifampin; an aminoglycoside should be added for the first 14 days of therapy in cases of suspected meningitis,
endocarditis, and osteomyelitis. Rifampin monotherapy is not recommended for concern for selecting for antibiotic
resistance. Standard precautions can be used.
