A 4-year-old boy is brought to the office due to high fever, nasal discharge, and cough for 3 days. His family recently returned from a vacation in Mexico. Physical examination shows an ill-appearing, febrile child. The patient has bilateral conjunctival injection and several small white spots with an erythematous base on his buccal mucosa. A review of the medical record shows parental refusal of preventive health services in favor of a "natural" approach to the child's health. Over the next several days, which of the following is most likely to develop?

Question

A 4-year-old boy is brought to the office due to high fever, nasal discharge, and cough for 3 days.  His family recently returned from a vacation in Mexico.  Physical examination shows an ill-appearing, febrile child.  The patient has bilateral conjunctival injection and several small white spots with an erythematous base on his buccal mucosa.  A review of the medical record shows parental refusal of preventive health services in favor of a "natural" approach to the child's health.  Over the next several days, which of the following is most likely to develop?

Quizplus · Accepted Answer

11ec160b_3843_a02f_9249_d79259642f17_MD0001_00 Measles virus, or rubeola, is an enveloped, nonsegmented, negative-sense RNA virus of the Paramyxoviridae family. This highly contagious infection is transmitted by airborne or person-to-person contact. Classically, measles presents with a prodrome of fever, cough, rhinorrhea, and conjunctivitis. Koplik spots on the buccal mucosa are a pathognomonic finding and consist of small white, blue, or gray specks on an erythematous base. These symptoms precede a maculopapular exanthem that starts on the face and spreads down the trunk and extremities. The parents' refusal of preventive medicine also supports a diagnosis of measles as the child likely did not receive the recommended combined measles, mumps, and rubella (MMR) vaccine. This live, attenuated vaccine is safe; serious side effects are extremely rare. (Choice A) Hepatitis A spreads through the fecal-oral route and is generally an acute and self-limited disease. Hepatitis B is transmitted via bodily fluids and causes acute and chronic disease. These viruses cause elevated liver enzymes and hyperbilirubinemia (jaundice). (Choice C) Mumps is a member of the Paramyxoviridae family and spreads by respiratory droplets or person-to-person contact. Infection classically causes parotitis, orchitis, and aseptic meningitis. (Choice D) Pertussis is caused by the gram-negative bacteria Bordetella pertussis and spread by respiratory droplets. It is highly contagious and presents with paroxysms of cough and an inspiratory "whoop" sound in children. (Choice E) Epiglottitis is linked with Haemophilus influenzae type b, a gram-negative, encapsulated bacteria spread by respiratory droplets. Patients often present with tripod positioning in an attempt to increase airflow due to life-threatening airway obstruction. (Choice F) A diffuse vesicular rash of different stages is typical of chickenpox, or varicella-zoster virus (VZV) infection. VZV is a double-stranded, enveloped, DNA virus that is part of the Herpesviridae family. Transmission occurs via respiratory droplets or direct contact. (Choice G) Rotavirus, a double-stranded RNA virus of the Reoviridae family, causes profuse watery diarrhea in infants, potentially leading to dehydration and death. Educational objective: Measles presents with fever, cough, rhinorrhea, and conjunctivitis followed by a maculopapular rash that starts on the face and spreads downwards. Koplik spots are pathognomonic for measles and characterized by tiny white or blue-gray lesions on the buccal mucosa. __________ References: Predictive power of Koplik's spots for the diagnosis of measles. (http://www.ncbi.nlm.nih.gov/pubmed/22421609) Use of combination measles, mumps, rubella, and varicella vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP). (http://www.ncbi.nlm.nih.gov/pubmed/20448530) Measles. (http://www.ncbi.nlm.nih.gov/pubmed/21855993)

A 4-Year-Old Boy Is Brought to the Office Due to High