ABSTRACT
Streptococcus pyogenes (group A beta-hemolytic Streptococcus, GABHS) causes a range of human infections, including necrotizing fasciitis and toxic shock syndrome, because it produces exotoxins that damage host cells, facilitate immune evasion, and serve as T cell superantigens. GABHS conjunctivitis is rare. We report a case of membranous conjunctivitis in a 3-year-old child who was treated with a combination of targeted bactericidal antimicrobials, toxin-synthesis inhibition, and amniotic membrane transplantation.
Subject(s)
Amnion , Anti-Bacterial Agents , Keratoconjunctivitis , Streptococcal Infections , Streptococcus pyogenes , Humans , Amnion/transplantation , Streptococcus pyogenes/isolation & purification , Streptococcal Infections/microbiology , Streptococcal Infections/diagnosis , Streptococcal Infections/drug therapy , Child, Preschool , Anti-Bacterial Agents/therapeutic use , Keratoconjunctivitis/microbiology , Keratoconjunctivitis/drug therapy , Keratoconjunctivitis/diagnosis , Keratoconjunctivitis/surgery , Combined Modality Therapy , Eye Infections, Bacterial/microbiology , Eye Infections, Bacterial/drug therapy , Eye Infections, Bacterial/diagnosis , Male , Drug Therapy, Combination , Conjunctivitis, Bacterial/microbiology , Conjunctivitis, Bacterial/drug therapy , Conjunctivitis, Bacterial/diagnosis , FemaleABSTRACT
The use of procalcitonin (PCT) has grown over the past decade with increasing reliance on the test to rule out bacterial infection. We retrospectively reviewed the medical records of children <18 years old hospitalized at a tertiary care children's hospital from 2017 to 2019 who had PCT testing performed during their admission. Of 4135 PCT levels collected on 1530 children, 982 (23.7%) were diagnostically low and 1993 (48.1%) were diagnostically elevated. Pediatric intensive care, with 6% of total hospital patients, obtained 41.4% of tests. Thirty-one (2%) patients had an average of 27 PCT levels per patient, accounting for 20% of all tests. Many children had symptoms for which testing is not indicated (eg, skin complaints). The differences in PCT testing by service, inappropriate patterns of repeat testing, and testing performed in patients for whom it is not indicated may identify targets for diagnostic stewardship.
ABSTRACT
INTRODUCTION: The COVID-19 pandemic has not only exacerbated traditional cognitive biases but also created new cognitive biases specific to the pandemic that contribute to diagnostic errors. Cases of suspected multisystem inflammatory syndrome in children (MIS-C)-one of the more clinically significant manifestations of COVID-19 in children-need to be reported and reviewed by clinicians as they have varied presentations and lack definitive confirmatory testing, presenting challenges to effective diagnosis. CASE PRESENTATION: We present 3 cases of pediatric patients initially diagnosed with COVID-19/MIS-C who were ultimately found to have alternative diagnoses. DISCUSSION: For each case, we describe conventional and COVID-19-related cognitive biases to enhance awareness of their role in diagnostics and promote strategies to support diagnostic accuracy and timeliness. CONCLUSION: With rapidly changing knowledge about COVID-19 and MIS-C, providers must remain diligent to counteract heuristic thinking and provide timely and accurate diagnostic evaluations.
