September Week 2: Enterovirus Infections

1. Pasquinelli L, et al. Enteroviral Infections. Peds in Review. Vol 27, No 2. Feb 2006.
2. Zaoutis T, et al. Enterovirus Infections. Peds in Review. Vol 19, No 6. June 1998.

Case 1
A mom brings in her 5 yo son for a sick visit after he was sent home from school with a fever. He complains of sore throat. On exam, he has oral lesions on the buccal muscosa and tongue, as well as tender erythematous vesicles on his palms, soles, and buttocks.

  • What is your differential diagnosis for oral vesicles? For vesicles on the skin?
  • What is your diagnosis for this patient?
  • Describe the pathogenesis. When is this disease most prevalent?
  • Mom asks you how to prevent her 3 month old from getting the same thing. What do you tell her?

Case 2:

You are seeing an 18 month old in the ER for dehydration. Dad reports she has been very irritable and fussy which they attributed to her fever that has come and gone over the last 2 days. Yesterday she was refusing to drink milk or juice and had 2 episodes of vomiting overnight. On exam you note temp 39.1 rectally, HR 156, RR 32, BP 90/60. She is listless but cries appropriately, her diaper is dry, and she has a capillary refill time of 4 sec. She has mucosal ulcerations surrounded by erythema over tonsils and posterior oropharynx.

  • What is the most likely diagnosis for this child?
  • How will you treat her?

Case 3:
Three days after recovering uneventfully from a transient fever and mild irritability, a 2-year-old boy begins to complain of a severe headache, and fever recurs. He previously has been well and is appropriately immunized. On examination, abnormal findings include a rectal temperature of 39°C, irritability, nuchal rigidity, and a diffuse maculopapular rash. 200 cells/mm3, 70% granulocytes, glucose 65, protein 45.

  • What is this patient’s diagnosis?
  • What organisms are in your differential?
  • Mom is concerned about the long term effects of this infection. What do you tell her?