PAINE #PANCE Pearl – Pediatrics



Question

A 3-week old baby girl is sent to your emergency department after being seen by their pediatrician for irritability, poor feeding, and a seizure just prior to arrival at the pediatrician’s office. Vital signs are BP-103/73, HR-137, RR-25, O2-100% on room air, and Temp-39.2oC (102.5oF). Physical examination reveals a lethargic infant with decreased motor tone and a full, bulging frontal fontanelle. What is the most important diagnostic study to obtain and what is the empiric treatment of choice while awaiting results?



Answer

  1. A full or bulging fontenelle is suggestive of meningeal edema and swelling are concerning for meningitis. Couple this with the lethargy and poor motor tone and this infant bought herself a lumbar puncture.
  2. Now….because of her age (<30 days old), you have to cover for a specific set of pathogens due to a developing immune system. Classically, neonatal sepsis bugs include group B streptococcus (GBS), Escherichia coli, and Listeria monocytogenes. Empiric antibiotic coverage (until gram stain results) is:
    1. Ampicilin (GBS)
    2. Gentamycin (gram negative coverage)
    3. Cefotaxime (wider gram negative coverage)
2004 – IDSA Guidelines

Ep-PAINE-nym



Roth’s Spots

Other know aliasesLitten’s spots

Definitionexudative, edematous hemorrhagic lesions of the retina with pale, white centers that can be composed of coagulated fibrin, platelets, infectious organisms, or neoplastic cells

Clinical Significanceone of the classic physical examination findings in bacterial endocarditis seen on fundoscopy. Further research and analysis has shown these can be present in leukemia, diabetes, and hypertensive retinopathy

Historynamed after Mortiz Roth (1839-1914), who was a Swiss pathologist and recieved his medical doctorate from University of Basel in 1864. He practiced all around Switzerland before returning to Basel as professor extraordinary of pathology in 1872, when he published his now eponymous findings in an article entitled “Uber Netzhauteffecstionen bei wundfiebren [Retinal Manifestations of wound fever]”. Dr. Roth, though, never described the classic appearance of the retinal red spot with a white center. Dr. Moritz Litten described this finding 6 years later and would coin the term we still use today.


References

  • Firkin BG and Whitwirth JA.  Dictionary of Medical Eponyms. 2nd ed.  New York, NY; Parthenon Publishing Group. 1996.
  • Bartolucci S, Forbis P.  Stedman’s Medical Eponyms.  2nd ed.  Baltimore, MD; LWW.  2005.
  • Yee AJ, Pfiffner P. (2012).  Medical Eponyms (Version 1.4.2) [Mobile Application Software].  Retrieved http://itunes.apple.com.
  • Whonamedit – dictionary of medical eponyms. http://www.whonamedit.com
  • Up To Date. www.uptodate.com
  • Roth Spots – StatPearls. [article]
  • Roth M. Uber Netzhauteffecstionen bei wundfiebren [Retinal manifestations of wound fever]. Deutsch A Chir. 1872;1:471–84.
  • Litten M. Ueber akute maligne endocarditis
  • und die dabei vorkommenden retinal veranderungen.
  • Charite-Ann 1878;3:135.

PAINE #PANCE Pearl – Infectious Disease



Question

 

To weave a common theme this week between this post and Wednesday’s eponym:

  1. What are the HACEK bugs?
  2. What disease are they associate with?
  3. Why are they important?


Answer

 

The HACEK pathogens is an acronym for the fastidious, gram-negative bacteria that are implicated in 5-10% of infective endocarditis cases. The bugs are:

  • Haemophilus species
  • Aggregatibacter species
  • Cardiobacterium species
  • Eikenella species
  • Kingella species

 

These pathogens are normal oropharyngeal flora, but can take up to 14 days to grow in the laboratory and are often referred to as
culture-negative” endocarditis cases.  It is important to discuss with your lab if you are worried about HACEK pathogens so they can plate the blood cultures on the appropriate agar plates and keep past the typical 3-5 days if there is no growth.

 


References

  1. Sharara SL, Tayyar R, Kanafani ZA, Kanj SS. HACEK endocarditis: a review. Expert review of anti-infective therapy. 2016; 14(6):539-45. [pubmed]
  2. Chambers ST, Murdoch D, Morris A, et al. HACEK infective endocarditis: characteristics and outcomes from a large, multi-national cohort. PloS one. 2013; 8(5):e63181. [pubmed]
  3. Yew HS, Chambers ST, Roberts SA, et al. Association between HACEK bacteraemia and endocarditis. Journal of medical microbiology. 2014; 63(Pt 6):892-5. [pubmed]
  4. Wassef N, Rizkalla E, Shaukat N, Sluka M. HACEK-induced endocarditis. BMJ case reports. 2013; 2013:. [pubmed]

Ep-PAINE-nym



Jones Criteria

 

Other Known Aliasesdiagnostic criteria for acute rheumatic fever

 

Definitionclinical criteria to help diagnose acute rheumatic fever.  There are divided into major and minor criteria as follows:

  • Major
    • Polyarthritis
    • Carditis
    • Subcutaneous nodules
    • Erythema marginatum
    • Sydenham’s chorea
  • Minor
    • Fever
    • Arthralgia
    • Elevated ESR or CRP
    • Leukocytosis
    • 1st degree heart block

Clinical Significancea diagnosis of acute rheumatic fever is either two major or one major and two minor criteria

 

History – Named after T. Duckett Jones (1899-1954), an American cardiologist who received his medical doctorate from the University of Virginia in 1923.  With a keen interest in rheumatic fever and heart disease, he practiced at Massachusetts General Hospital and House of Good Samaritan in Boston for over 20 years.  He became the medical director of the Helen Way Whitney Foundation to pursue his passion for public health, which led to one of the first tweleve appointments to the National Advisory Heart Council in 1948.  He published his seminal paper entitled “The Diagnosis of Rheumatic Fever” in JAMA in 1944 which described these findings.  Dr. Jones unfortunately died as a result of malignant hypertension in 1954 at the age of 55.

First page PDF preview

 


References

  1. Firkin BG and Whitwirth JA.  Dictionary of Medical Eponyms. 2nd ed.  New York, NY; Parthenon Publishing Group. 1996.
  2. Bartolucci S, Forbis P.  Stedman’s Medical Eponyms.  2nd ed.  Baltimore, MD; LWW.  2005.
  3. Yee AJ, Pfiffner P. (2012).  Medical Eponyms (Version 1.4.2) [Mobile Application Software].  Retrieved http://itunes.apple.com.
  4. Whonamedit – dictionary of medical eponyms. http://www.whonamedit.com
  5. Up To Date. www.uptodate.com
  6. White PD.  T. Duckett Jones, 1899-1954.  Circulation.  1955.
  7. Shulman ST. T. Duckett Jones and his criteria for the diagnosis of acute rheumatic fever. Pediatric annals. 1999; 28(1):9-12. [pubmed]
  8. Jones TD.  The Diagnosis of Rheumatic Fever.  JAMA. 1944;126(8):481-484 [article]

Ep-PAINE-nym



Tullio’s Phenomenon

 

Other Known AliasesSound-induced vestibular activation.

Definition – Vertigo, dizziness, nausea, and nystagmus caused by a load noise.

Clinical Significance This pathology is due to a communication between the middle and inner ear classically associated with congenital syphilis.  Recently, it has been associated with superior canal dehiscence syndrome (SCDS).  This can also be elicited with nose-blowing, valsalva, and heavy lifting.

History – Named after Italian biologist Pietro Tullio, Ph.D. (1881-1941), who originally studied this finding in pigeons and published it in 1929. 

Tullio blowing a whistle in the ear of rabbit test subject


References

  1. Firkin BG and Whitwirth JA.  Dictionary of Medical Eponyms. 2nd ed.  New York, NY; Parthenon Publishing Group. 1996.
  2. Bartolucci S, Forbis P.  Stedman’s Medical Eponyms.  2nd ed.  Baltimore, MD; LWW.  2005.
  3. Yee AJ, Pfiffner P. (2012).  Medical Eponyms (Version 1.4.2) [Mobile Application Software].  Retrieved http://itunes.apple.com.
  4. Whonamedit – dictionary of medical eponyms. http://www.whonamedit.com/
  5. Tullio, Pietro: Das Ohr und die Entstehung der Sprache und Schrift. Berlin, Germany: Urban & Schwarzenberg; 1929.
  6. Kaski D, Davies R, Luxon L, Bronstein AM, Rudge P. The Tullio phenomenon: a neurologically neglected presentation. Journal of Neurology. 2012; 259(1):4-21. [pubmed]
  7. Halmagyi GM, Curthoys IS, Colebatch JG, Aw ST. Vestibular responses to sound. Annals of the New York Academy of Sciences. 2005; 1039:54-67. [pubmed]