Discussion #1 Subjective CC: Fever Ranging From 0.7 For 7 Da ✓ Solved

Discussion #1 Subjective CC: "fever ranging from .7 for 7 days"

SUBJECTIVE CC: seven-day history of fever ranging from 101 to 104.7 degrees Fahrenheit.

HPI: An eighteen-month-old child, well-known to your practice, presents to the ER with a seven-day history of fever ranging from 101 to 104.7 degrees Fahrenheit.

ROS: Eyes- sclera positive for injected conjunctiva, lips magenta, red macula, extremities- palmar erythema, groin/genitalia positive for excoriating rash.

MEDICAL HISTORY: none, 18 month- old, no other history provided.

OBJECTIVE VITALS: Temperature: 101.5 degrees Fahrenheit, Heart rate: 120 beats/minute, Respiratory rate: 20 breaths/minute, Blood pressure: 90/40.

PHYSICAL EXAM: Injected conjunctiva; Palmar redness; Magenta-colored lips; Red macula; Excoriating rashes in the diaper area.

LABS & DIAGNOSTIC RESULTS: Urine and blood cultures (negative), CBC and CMP done in ER. Additional testing recommended to include CRP and ESR.

ASSESSMENT PRIMARY DIAGNOSIS: Kawasaki Disease M30.3 - a severe and systemic form of vasculitis with persistent fever over 4 days, bilateral injection of conjunctiva, progressive skin rash, oral mucosa swelling and erythema with rashes on hands and feet.

DIFFERENTIAL DIAGNOSIS: Streptococcal scarlet fever A38.9; Viral infection B34.9; and others as discussed.

PLAN TREATMENT: Intravenous immunoglobulin (IVIG), intravenous prednisolone (PSL), and in some cases, high-dose aspirin if indicated for cardiac changes.

EDUCATION: Teaching of post-treatment care to the parents, emphasizing diet full of nutrients and proper rest after treatment is important.

ANTICIPATORY GUIDANCE: Careful follow-up for cardiac complications related to Kawasaki disease and any secondary infections such as pneumonia, cellulitis, or endocarditis.

Paper For Above Instructions

Kawasaki disease (KD) is a critical childhood illness that requires immediate attention due to its potential to cause serious complications, particularly affecting the heart. In the presentation of our eighteen-month-old patient whose history indicates a fever ranging from 101 to 104.7 degrees Fahrenheit for seven days, we recognize several classic symptoms of KD which include persistent fever, conjunctival injection, and rashes among others.

Understanding Kawasaki Disease

Kawasaki disease is known for causing inflammation in the walls of blood vessels throughout the body, leading to vasculitis. Although its exact cause remains unidentified, it primarily affects children under the age of five. The disease is more prevalent in boys and children of Asian descent, increasing the likelihood of coronary artery aneurysms if not treated promptly (Tanaka et al., 2020).

Clinical Presentation

The initial presentation of our patient involved a prolonged fever lasting seven days. Notably, she exhibited conjunctival injection (red eyes) and a magenta color to her lips—both recognized indicators of KD. The presence of an excoriating rash in the diaper area further reinforces the suspicion of this condition. Parents are often the first to notice these symptoms, which may lead them to seek urgent medical care, as was the case here when the child was taken to the ER on the fourth day of fever (Lee, Rhim, & Kang, 2015).

Diagnostic Tests

Laboratory tests play an indispensable role in the diagnosis of Kawasaki disease. Negative blood and urine cultures in this case help in ruling out common infectious processes. Elevated inflammatory markers such as C-reactive protein (CRP) and Erythrocyte Sedimentation Rate (ESR) often accompany KD (Pagana & Pagana, 2018). The Clinical Practice Guidelines for KD state that diagnostic criteria include a fever lasting five days or longer with at least four of the five principal clinical manifestations: polymorphous rash, conjunctivitis, oral mucosal changes, cervical lymphadenopathy, and changes in extremities (Tanaka et al., 2020).

Differential Diagnosis

While the presence of these alarming symptoms point directly to Kawasaki disease, it is crucial to assess for other possible causes. Differential diagnoses include Group A streptococcal infections resulting in scarlet fever and various viral infections, which also manifest with fevers and rashes. Each potential condition has distinct treatments, necessitating a careful and nuanced approach by the healthcare provider (Li et al., 2020; Castro & Ramos-e-Silva, 2020).

Management and Treatment Strategy

Management of Kawasaki disease involves potent therapies to mitigate inflammation and prevent cardiac complications. The first-line treatment is intravenous immunoglobulin (IVIG), which is administered ideally within the first ten days of illness to reduce the risk of coronary artery abnormalities. High-dose aspirin may also be utilized in this context, albeit with caution due to the association with Reye’s syndrome in children (Zhong et al., 2020). Close monitoring of cardiac function is warranted, as complications can arise weeks to months after the initial illness, requiring ongoing surveillance.

Parental and Family Education

Education of parents is paramount, focusing on the need for regular follow-up appointments after treatment, adherence to a heart-healthy lifestyle, and recognizing alarming signs such as decreased output, lethargy, or rash progression (Healthy Children, 2020). Additionally, the postponement of live vaccines for at least eleven months post-IVIG is an important part of the care plan to ensure vaccine efficacy.

Conclusion

In conclusion, Kawasaki disease is a serious pediatric condition that necessitates prompt recognition and intervention to prevent long-term complications. Healthcare providers must maintain a high index of suspicion in cases of prolonged fever accompanied by characteristic clinical signs. Timely and appropriate management, along with strong parental education and follow-up care, is crucial to the optimal outcomes for affected children.

References

• Castro, R., & Ramos-e-Silva, M. (2020). Viral infections in children: Clinical presentation and challenges. Journal of Pediatrics, 193, 10-22.
• Healthy Children. (2020). Kawasaki Disease: Caring for your child. Retrieved from https://www.healthychildren.org/.
• Lee, C., Rhim, J. W., & Kang, H. S. (2015). Laboratory parameters for the diagnosis of Kawasaki disease. Pediatric Infectious Disease Journal, 34(10), 1157-1160.
• Li, Y., et al. (2020). Group A Streptococcus: A comprehensive review. Current Infection Reports, 22(2), 14.
• Pagana, K. D., & Pagana, T. J. (2018). Mosby's Diagnostic and Laboratory Test Reference. Elsevier.
• Pilania, R., Bhattarai, A., & Singh, S. (2018). Managing Kawasaki disease: A review of recent findings. Cardiology in the Young, 28(4), 456-461.
• Tanaka, R., et al. (2020). Update on Kawasaki Disease: Clinical and epidemiological insights. Frontiers in Pediatrics, 8, 241.
• Zhong, Y., et al. (2020). The implications of IVIG treatment in Kawasaki Disease: A systematic review. Archives of Disease in Childhood, 105(4), 325-333.