Olive Chaney ihuman Case Study
History of Present illness (HPI) – Olive Chaney is a 2-year old female brought by her mother to the clinic for evaluation of a rash since today morning. Mother informs that the rash started on her abdomen and spread gradually to her legs and arms. The rash is non-itchy and non-tender and she has not had any treatments for it. She also reports associated symptoms of a cough, fever, and runny nose. The fever started three days ago and were as high as 103 but went away yesterday evening. The cough is non-productive. Before the onset of current symptoms three days ago, she had a cold. Child is up-to-date with immunizations, denies allergies, changes in bowel movements or changes in appetite.
Assessment
- Exanthema subitum (HHV-6/roseola) – also known as sixth disease, roseola accounts for upto 45% of febrile illnesses in children and patients classically present with an acute onset of a high-grade fever that lasts between three to five days (Hattori et al., 2019). During the febrile phase, children may experience an acute febrile seizure due to the virus ability to cross the blood brain barrier and high fever. Children may also experience orbital edema, malaise, cough, URTI, bulging fontanelle, inflamed tympanic membranes, conjunctivitis, and lymphadenopathy (Hattori et al., 2019). Similar to the patient’s presentation, there’s always a pink, non-pruritic maculopapular rash that begins on the trunk before spreading to the extremities, face, and neck. However, children may appear well and active.
- Rubella (German measles) – it occurs typically in children and begins with malaise, a low-grade fever, lymphadenopathy, and a generalized maculopapular rash. While it affects both sexes equally among children, in adults, it affects women more compared to men (Winter & Moss, 2022). Its risk factors include; travel to endemic areas, unvaccinated individuals, immunodeficiency, and exposure to close contacts with rubella. Clinically, patients present with anorexia, a low-grade fever, adenopathy, sore throat, and lymphadenopathy of the suboccipital, post auricular, and anterior cervical nodes (Winter & Moss, 2022). In children, an exanthema with pinpoint pink papules and macules is often the first manifestation but they first appear on the face and spreads rapidly to the trunk and extremities. This rash often lasts for three days before fading in a similar directional pattern that it appeared.
- Viral Upper Respiratory Infection (URI) – is a self-limiting irritation and swelling of the upper airways associated with cough without signs of pneumonia. The most common viral etiology is rhinovirus but other viral etiologies may include adenovirus, influenza virus, respiratory syncytial virus, and enterovirus (Thomas & Bomar, 2018). Risk factors for transmission include close contact in school or daycare and immunosuppression. Patients will often report symptoms such as sneezing, sore throat, nasal congestion, a low-grade fever, runny nose, malaise, and headache (Thomas & Bomar, 2018). Symptoms tend to begin in one to three days post exposure lasting between 7-10 days.
- Measles – – is an acute febrile and highly contagious illness caused by the measles virus. Transmission occurs via respiratory droplets and close contact with an incubation period of 10-14 days (Sindhu et al., 2019). Those at high risk are pregnant women and young children but young children born to mothers with acquired immunity are safeguarded (Sindhu et al., 2019). Patients will report having a generalized maculopapular rash, fever, conjunctivitis, cough, or coryza. Additional pathognomonic features may include koplik spots on the buccal mucosa a day or two just before the rash. However, the rash in measles first appears on the face before spreading to other body parts and symptoms resolve a week after the onset of the rash.
Final Diagnosis: Exanthema subitum (HHV-6/roseola)
Plan
Pharmacology
- OTC tylenol oral suspension
- SIG: take 5ml PO 4 hourly as needed
- Max dose 25ml in 24 hours, not to exceed 75mg a day
Non-pharmacology
- Ensure the child gets plenty of rest
- Increase fluid intake
Diagnostics:
- No diagnostic tests needed in this visit
Consults/Referrals
- No consults/referrals needed in this visit
Patient Education
- Roseola is a self-limiting viral illness hence the rash will resolve by itself within 24-72 hours
- The condition will be managed symptomatically hence the prescribed tylenol for fever. Take all medications as prescribed. Do not exceed the recommended dosage (Muzumdar, Rothe & Grant-Kels, 2019).
- Do not administer any other medications other than that prescribed as directed
- Observe adequate had hygiene to prevent spread of the disease
- Considering the child’s age (2-years old), discuss safety precautions to prevent injuries; do not leave your child unattended close to water bodies such as a swimming pool, keep all medicines away from children’s reach, lock doors to hazardous areas, often check toys for broken parts, keep kitchen appliances out of reach, do not leave the child unattended and alone in any vehicle, keep the child’s seat rear-facing.
Follow Up:
- To return for follow up in 1 week.
- To return immediately if symptoms worsen.
References
Hattori, F., Kawamura, Y., Kozawa, K., Miura, H., Miyake, M., Yoshikawa, A., & Yoshikawa, T. (2019). Clinical characteristics of primary HHV-6B infection in children visiting the emergency room. The Pediatric Infectious Disease Journal, 38(10), e248-e253.
Muzumdar, S., Rothe, M. J., & Grant-Kels, J. M. (2019). The rash with maculopapules and fever in children. Clinics in Dermatology, 37(2), 119-128.
Sindhu, T. G., Geeta, M. G., Krishnakumar, P., Sabitha, S., & Ajina, K. K. (2019). Clinical profile of measles in children with special reference to infants. Tropical doctor, 49(1), 20-23. https://doi.org/10.1177/0049475518804695
Thomas, M., & Bomar, P. A. (2018). Upper respiratory tract infection.
Winter, A. K., & Moss, W. J. (2022). Rubella. The Lancet, 399(10332), 1336-1346.
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