Course Management of Prevalent Infections in Children Following a Disaster

Case 1.

The child is ill-appearing, febrile, tachycardic, and tachypneic with a physical exam remarkable for scattered petechiae on the abdomen and lower extremities. The primary concern is whether this child is in shock. Tachycardia and decreased capillary refill are consistent with compensated shock.

Since the child is febrile and has a history of an upper respiratory disease, the most likely etiology of the shock is sepsis. The fever and the presence of petechiae suggest a severe bacterial infection, most likely meningococcemia. While many other conditions such as viral infection—influenza, enterovirus, adenovirus, infectious mononucleosis, or group A Streptococcus infection—can present with fever and petechiae, meningococcal infection is rapidly progressive and life-threatening.

Initial management begins with 100% oxygen. An IV line was placed and a blood sample was sent for complete blood count, serum electrolytes, coagulation studies, and culture. Rapid blood glucose determination was 120 mg/dL. As the child was tachypneic and had signs of shock, the lumbar puncture was deferred and IV antibiotics were administered immediately. An IV bolus of normal saline was given because of poor oral intake and decreased urine output, with no signs of cardiac or pulmonary disease.

His initial laboratory tests showed a white blood cell count of 21,000. Serum bicarbonate was 11, prothrombin time 15 seconds, and partial thromboplastin time 28 seconds.

Over the next several hours the child developed purpura, had increasing respiratory distress, and labile blood pressure. He was intubated and ventilated. His blood culture grew N. meningitidis.