2. 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

3. 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 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.

4. 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 % 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 % 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