tailieunhanh - Ebook Nelson essentials of pediatrics (7th edition): Part 2

(BQ) Part 2 book "Nelson essentials of pediatrics" presents the following contents: Infectious diseases, the digestive system, the cardiovascular system, the respiratory system, hematology, oncology, nephrology and urology,. and other contents. | Infectious Diseases Matthew P. Kronman and Sherilyn Smith SECTION 16 Chapter 93 ASSESSMENT Overlapping clinical symptoms caused by infectious and noninfectious illnesses make the diagnosis of some diseases difficult. Clinicians are concerned that an untreated minor infection may progress to a life-threatening illness if appropriate treatment is not given. However unnecessary treatment with antimicrobial agents may lead to a serious problem emergence of antimicrobial resistant organisms. Accurate diagnosis of infectious and noninfectious diseases and providing specific treatment only as indicated reduce the unnecessary use of antibiotics. A thorough assessment of the patient including a detailed history complete physical examination and appropriate diagnostic testing is the cornerstone of optimal care. INITIAL DIAGNOSTIC EVALUATION The ability to diagnose specific infections accurately begins with an understanding of the epidemiology risk factors including exposures to sick contacts or environmental risks . zoonosis and age-related susceptibility reflecting the maturity of the immune system. Obtaining a thorough history and physical examination identifies most of these elements Tables 93-1 and 93-2 and guides appropriate use of other diagnostic tests. Unique questions that help identify whether an infection is causing the patient s symptoms include a detailed environmental history including sick contacts travel and animal exposure see Table 93-1 . Certain infections are more common in specific geographic areas. For instance parasitic infections are more common in tropical climates. Diarrhea may be bacterial viral or parasitic in the tropics but in temperate climates parasitic causes of diarrhea other than giardiasis are much less likely. Certain fungal infections have specific geographic distribution coccidioidomycosis in the southwestern United States blastomycosis in the upper Midwest and histoplasmosis in central United States . In other areas fungal .