Pediatric Skin Infections: Differentiating When to Worry
Faculty: Jonathan Dyer, MD
Dr. Jonathan Dyer reviewed pediatric skin infections Saturday morning. Rocky Mountain Spotted Fever (RMSF) was explored by Dr. Dyer who mentioned “it is more common than we think”. While rates of diagnosis of RMSF have significantly increased over time, the mortality rate has dramatically decreased. RMSF is more common in adults while children have an increased mortality rate. The classic triad of symptoms for RMSF are fever, headache and rash. Dr. Dyer commented “photophobia tends to be quite prominent” in these patients. Treatment for RMSF is with an oral tetracyclines.
Next, Dr. Dyer discussed the presentation of ehrlichiosis which is caused by the lone star tick and is also known as rocky mountain “spotless” fever in adults. Children present more commonly with a rash. Of note, Dr. Dyer reports significant confusion can be common in adults who present with ehrlichiosis and these neurological affects can linger a long time.
Dr. Dyer reviewed the presentation of meningococcemia meningitis which most often presents in young adults. This condition is a medical emergency and patients need to be treated immediately with antibiotics and sent to the ICU for supportive care. He noted patients with early meningococcemia sometimes complain of leg pain and cold hands and feet prior to presentation with purpura fulminans. Purpura fulminans is the acute onset of progressive skin hemorrhage and necrosis. Patients with meningococcemia will often need long term wound care, debridement and grafting.
Lastly, the dramatic resurgence of syphilis was reviewed by Dr. Dyer. Syphilis cases among newborns have reached a 20 year high in the US. He quoted Sir Osler who reported “the physician who knows syphilis knows medicine.” As the chancre of syphilis is not painful, many individuals are not aware they are infected. It is most commonly sexually transmitted or through vertical transmission from mother to newborn. It is less commonly transmitted through non-penetrative sexual activity. It is now recommended to test pregnant patients at 28-32 weeks in pregnancy in addition to at the beginning of pregnancy. If untreated in pregnancy, there is a 40% infant death rate, with worse prognosis if transmitted earlier in pregnancy. Additional topics explored by Dr. Dyer include herpes zoster, impetigo, hot tub folliculitis, scarlet fever and eczema herpeticum.