The Link - February 2024
Our February issue features the latest news and updates on pediatric care from Children's Mercy clinicians.
Caring About Creatinine: Acute Kidney Injury Follow-Up in the Pediatrician’s Office: Evidence Based Strategies
Pediatric acute kidney injury (AKI) in the hospital has significant implications for the development of chronic kidney disease (CKD) and hypertension in the future. Outpatient providers can play an essential role in identifying these patients earlier in their CKD and hypertension courses, mitigating long-term sequelae of these processes.
Measles and (Immune) Memory Loss: Outbreaks, Alerts & Hot Topics
This column is called “Outbreaks, Alerts and Hot Topics.” While we have had at least one local case of measles and 20 United States cases reported so far this year, this year’s numbers pale in comparison to 2019 (measles by year) or even to 2022 (Measles in The Link January 2023). So, by comparison, we have not a large outbreak so far. The “new” information on measles that I want to discuss came out in Science and in Science Immunology in 2019, so perhaps it’s not exactly a hot topic. So, let’s call this an alert, or a warning. I am alerting you that measles is a bad infection, that we now know at least some of why it is bad, and that we should be trying to vaccinate everyone we can against measles infection. And I hope we can find ways to share this understanding of measles with our vaccine-hesitant families in a way that motivates them.
Vaccine Update: Recent Measles Cases Highlight the National and Global Rise of this Highly Contagious Disease
An old foe is rearing its head: cases of measles are on the rise. The Centers for Disease Control and Prevention (CDC) reports that 56 cases of measles were confirmed in the United States in 2023 in 20 different jurisdictions.1 As of Jan. 17, 2024, 12 cases had already been identified in the following states: Delaware, Georgia, Missouri, New Jersey, Pennsylvania, Virginia and Washington. Specifically in Pennsylvania, the index case contracted measles while traveling abroad and was then hospitalized and returned to child care before a diagnosis was made. So far this one case in Philadelphia has accounted for a total of eight cases, five of them children. This reality highlights the need to be vigilant when evaluating a child with non-specific symptoms of fever, upper respiratory tract infection symptoms and rash. The typical presentation of measles is fever, cough, coryza and conjunctivitis followed by a maculopapular rash that starts on the face and spreads in a cephalocaudal and centrifugal pattern. During the prodrome period, an enanthema called Koplik spots may be present and appear as erythematous, white or gray specks on the buccal mucosa. The incubation period is generally eight to 12 days from exposure to onset of symptoms. Testing is done by sending serum measles IgG and IgM levels and a throat or retropharyngeal swab for PCR testing that is performed by the state health department lab, if the patient meets criteria for testing. Any suspected case of measles should be reported to the local health department as soon as possible.
Managing the Child with Pharyngitis: Wise Use of Antibiotics
With pharyngitis being one of the most common diagnoses seen in ambulatory pediatrics, you’d think its management is straightforward. With the variability in clinical guidelines, difficulty differentiating viral from bacterial pharyngitis, and the never-ending concerns of complications of Streptococcus pyogenes (group A streptococcus [GAS]) infections, this diagnosis becomes much more complex than originally thought. Children’s Mercy Evidence-Based Practice recently reviewed the literature to help support you in managing children presenting with sore throat.