Pediatric emergency medicine trisk 2323 2323
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daily, 4 to 11 years: 200 mg twice daily, ≥12 years: 500 mg twice daily). Longer
treatment courses may be needed in HIV-infected children and other
immunocompromised hosts. Standard and contact precautions should be used for
the incontinent child.
Gram-negative Enterics: Vibrio, E. coli, Campylobacter,
Shigella
Several gram-negative enteric pathogens are more common in developing
nations than in industrialized countries. These include Vibrio cholera,
enterotoxigenic, enteropathic, enteroinvasive, and enteroaggregative E. coli, and
Campylobacter ( e-Table 94.22 ). Cholera is characterized by painless watery
diarrhea, and persons most at risk are those with low gastric acidity. It can be
easily spread in congregate settings, and is a major cause of diarrhea in camps
for displaced persons. The character of diarrhea varies based on E. coli type, and
some types produce a Shiga-like toxin. Campylobacter is also a cause of
dysentery (bloody stools with fecal leukocytes) in the United States, but is more
common internationally. The most at-risk group for Shigella domestically is the
child in daycare. In addition to the acute symptoms (which are more severe in
immunocompromised hosts), patients with Campylobacter can also have
postinfectious sequelae with Guillain–Barré syndrome, including the Miller
Fisher variant (ataxia out of proportion to sensory loss, areflexia, and
ophthalmoplegia). All three pathogens can be cultured on routine stool culture
media. The mainstay of therapy is rehydration. Adjunctive antibiotic treatment is
recommended to decrease symptom duration, decrease fecal shedding, and
decrease secondary transmission. Standard and contact precautions are
recommended.
Schistosomiasis
Schistosomiasis is caused by mammalian blood trematodes (flukes) in the
Schistosoma genus. Freshwater snails transmit the infection through penetration
of intact skin. Schistosomiasis is endemic in more than 75 countries worldwide
including in Africa, the Middle East, China, Southeast Asia, Brazil, Venezuela,
and the Caribbean. Adult worms can live as long as 30 years, causing disease
decades after patients have left an endemic area. The clinical manifestations of
the most common syndromes caused by schistosomes are summarized in
eTable 94.23 . The severity of chronic illness is associated with worm burden.
Those with low to moderate burden may never develop significant illness, while
those with significant worm burden may develop mucoid bloody diarrhea and
