Most cases occur in older children and adults Patient Dengue Fever Age group 6 year old male Epidemics were common in temperate areas of the Americas, Europe, Australia, and Asia. Most cases occur in older children and adults Incidence is equal in males and females Etiology 4 distinct antigenic types of dengue virus, members of the family Flaviviridae Transmission Vector borne (Aedes aegypti) Signs & Symptoms Fever (T=39⁰C), vomiting, abdominal pain, malaise, anorexia, weight loss, headache, productive cough, colds Fever, pharyngeal inflammation and mild cough, frontal or retro-orbital pain, backache, generalized papular rash that blanches under pressure, nausea, vomiting, lymphadenopathy, anorexia PE findings Ill- looking, febrile Well hydrated Well nourished Flushed skin Globular abdomen, soft Normoactive bowel sounds Epigastric tenderness No masses Fever, lymphadenopathy, rash, hepatomegaly, conjunctival injection, hemorrhagic findings, signs of shock Laboratory Neutropenia, predominantly segmenters Pancytopenia, neutropenia, thrombocytopenia, hemoconcentration >20% increase in hematocrit, 4x increase in IgG and IgM Signs and symptoms are more apparent in the adolescent age group Hemorrhagic findings (petechiae, purpura, bleeding gums, epistaxis, menorrhagia, positive tourniquet test, hematuria) Hypotension Bradycardia (paradoxical) or tachycardia associated with hypovolemic shock Hepatomegaly Hypothermia Narrow pulse pressure (<20 mm Hg) Signs of decreased peripheral perfusion Causes

Occurs world wide in all age groups Patient Hepatitis A Age group 6 year old male Occurs world wide in all age groups 30–40% of the adult population has evidence of previous HAV infection Highly endemic in developing countries Etiology HAV RNA virus Transmission Fecal oral route, contaminated food and water Signs & Symptoms Fever (T=39⁰C), vomiting, abdominal pain, malaise, anorexia, weight loss, headache, productive cough, colds Acute febrile illness with an abrupt onset of anorexia, nausea, malaise, vomiting, and jaundice, right upper quadrant pain PE findings Ill- looking, febrile Well hydrated Well nourished Flushed skin Globular abdomen, soft Normoactive bowel sounds Epigastric tenderness No masses General appearance is that of mild-to-moderate illness Hepatosplenomegaly (10-20%) Jaundice RUQ tenderness Laboratory Neutropenia, predominantly segmenters Anti-HAV IgM Liver enzymes may be elevated (ALT, AST, bilirubin, ALP, 5′-nucleotidase, and GGT) Increases in ALT and AST levels are seen most consistently, and the values are usually 4-100 times the normal levels. Elevations in ALT and AST levels may precede the onset of symptoms by a week or more and usually peak within 3-10 days after onset of clinical illness. Serum bilirubin levels, although elevated, usually remain below 10 mg/dL and peak after 1-2 weeks of illness.

Urinary Tract Infection Age group 6 year old male Patient Urinary Tract Infection Age group 6 year old male Prevalence and incidence of UTIs varies based on age, sex, and gender. Overall, UTIs are estimated to affect 2.4-2.8% of all children every year. During the first year of life, males have an incidence of UTIs of 2.7% compared with 0.7% for girls. For children older than 1 year, females have a 1-2% incidence of UTIs and males have a 0.1-0.2% incidence of UTIs Etiology E.coli, gram negative rods, bacterial flora, anaerobes Transmission Hematogenous seeding Fecal-urethral route Sexual contact Signs & Symptoms Fever (T=39⁰C), vomiting, abdominal pain, malaise, anorexia, weight loss, headache, productive cough, colds Vomitng, abdominal pain, fever, flank pain, urinary symptoms (dysuria, urgency, frequency), Strong-smelling urine PE findings Ill- looking, febrile Well hydrated Well nourished Flushed skin Globular abdomen, soft Normoactive bowel sounds Epigastric tenderness No masses General appearance is that of mild-to-moderate illness Costovertebral angle tenderness Abdominal tenderness to palpation Suprapubic tenderness to palpation Palpable bladder Dribbling, poor stream, or straining to void Laboratory Neutropenia, predominantly segmenters Urinalysis may show hematuria, pyuria, casts, crystals CBC lymphocytosis with neutrophilic predominance Urine culture Blood culture