Tomato Red Cheeks - Case Study Example

Study Case Study of a 16 year old Patient presents with “Tomato Red Cheeks” February 12, 2013 Abstract This paper will provide a diagnosis, assessment, treatment and management of three diseases that can affect a 16-year-old female. It will show the signs and symptoms of these diseases. The three diseases that is affecting this teenage child is one of the following Fifth Disease, Mononucleosis, and Kawasaki’s Disease. With these differential diagnoses and the research that is available we will be able to delineate the better treatment that is needed and this will help the prevention of the others that will help educate them. This will also help us to screen for probable problems that could arise for each of these diseases. For each of these diseases a physical examination will have to be done to achieve a proper diagnosis of each. Keywords Fifth Disease, Kawasaki’s Disease, Mononucleosis, diagnosis, treatment, management, assessment, differential diagnosis Introduction A 16-year-old female presented with her mother at the doctor’s office. The patient states that the following subjective symptoms that are bothering her are that she feels extremely tired and fatigued. She has a lack of appetite. She appears to have ‘tomato red cheeks’ as if someone slapped her. She also states that she has had a fever for the past 24 hours. This is according to the mother for she sais that she gave her daughter Tylenol for the fever it was effective for a short while, but fever comes back. They also share that they just moved to California three months ago. The patient also states that she began working for a preschool as a teacher’s helper and that no child is present with any rashes. Patient also states that she has had her period (menses) one week ago. Her mother asks a question about her own health for she happens to be five months pregnant. On further examination the objective symptoms that the patient presents are as follows: Vitals---- Temperature 101.4 Blood Pressure 100/68/48 Pulse 84 Respirations 20 Oxygen saturation 99% Weight 103 pounds Height 63 inches Patient is alert, cooperative, and exhibits no apparent distress. Physical Examination HEENT: Significant- bright erythematous cheeks bi-laterally and slight erythema of oropharnyx without tonsillar enlargement. NECK: Supples without lymphodenopathy RESPIRATORY: Lungs are clear anterior and posterior CARDIOVASCULAR: WNL with no murmur or rub GASTROINTESTINAL: Soft and non-tender without organamegaly; Patient also denies no nausea, vomiting or diarrhea. MUSCLOSKELETAL: WNL with erythematous of the hands and feet; papular lesions were exhibited; no bruises or other rashes present. NEUROLOGICAL: WNL, but does complain of pruritis (itching) of the hands and feet bilaterally and no non-specific rashes were present. The three differential diagnoses that this patient could be suffering from are Mononucleosis, Fifth Disease, and Kawasaki’s Disease. This 16 year old female is exhibiting prodromal symptoms (symptoms that occur before the actual onset of the disease) of these three diseases. Three Differential Diagnoses for this Patient Mononucleosis Diagnosis- Characterized by malaise, anorexia, chills and fever which is a prodromal symptom, pharyngitis and lymphadenopathy. Occasionally the disorder comes on abruptly with high fever. Seek help when severe pharyngitis lasts for five to seven days. Only 90% of patients suffer from lymphadenopathy even though the patient shows no signs at this moment. Rashes that appear look like Rubella when it may appear. Screening- Most persons during adolescence and young adulthood and in the upper socioeconomic classes in developed countries. Relatively asymptomatic when it occurs during childhood and confers complete immunity to the virus. It has been known as the ‘Kissing Disease’. You should check the EBX seropositive blood results even if it is not a highly contagious disease. Prevention and Management- Treatment is with medication like amoxicillian and ampicillian and you will have to be careful for these medications can also cause rashes. The patient must be observed for organomegaly. If it is symptomatic and supportive and it will include bed rest and analgesics to relieve the fever, complaints of headache pain, sore throat and if it becomes more serious cocorticosteroids will be needed for pharynotonsillitis. (PubMed, 2012) Kawasaki’s Disease Diagnosis- This disease is confirmed by the presence of a fever that lasts for five or more days without another more reasonable explanation and by at least four of the following: rash, redness and swelling of hands and feet, fever, strawberry coloring. This disease occurs in three phases. Screening- The cause is unknown but it is characterized by a vascularitis and occurs as an immunologic origin. It could also be caused by a virus or it is an immune response or it is a common infectious agent. Prevention and Management- This disease is helped by taking aspirin and antipyretic medications for the fever and the itching. In more serious conditions Intravenous gamma globulin with anticoagulant therapy will be needed for children with multiple or large coronary aneurysms. There are restrictions in activities like competitive sports and it would depend on the level of the problem that is presented. (Holman, 2003) Fifth Disease-(Erythema Infectioseum) Diagnosis- Erythema on the face and chiefly on the cheeks like they were “slapped cheeks” and this appearance disappears one to four days . About one day after a rash appears on the face there are macropapular red spots appear systematically distributed on upper and lower extremities and the rash progresses from the proximal to the distal surfaces and may last a week or more. The rash subsides but reappears if the skin is irritated or traumatized. The patient may have swollen joints. Screening- This disease is known as another name Human Parvovirus B19 (HPV) and the infected persons do not know how it is transmitted and it is possibly a respiratory problem and with the secretions that contain blood. It has an incubation period of 4 to 14 days and as long as 20 days. There is a period of communicably and it is uncertain but before the onset of most symptoms in most children for about one week. Prevention and Management- The medications that are used could be antipyretics, analgesics, and anti-inflammatory drugs. In more serious cases possible blood transfusions if patients also have transient aplastic anemia. This disease could lead to self-limited arthritis and this could become chronic. It may also result in fetal death if the patient is a mother who is infected during pregnancy, but no evidence of congenital anomalies like an aplastic crisis in children with hemolytic disease or immunodeficiency. Myocarditis is rare. The isolation of the child is not necessary and universal precautions are used. Pregnant women should not care for patients with the aplastic crisis. You should explain how low the risk of fetal death to those in contact with affected children. (CDC, 2012) Conclusion The diagnosis that I would give the patient is the one named Fifth Disease. The reason is for the signs of the “tomato red cheeks”; the complaints of the headache; and the fever. Also, it fits with the problem she stated with the problem of her hands and feet. Even if she denies that she is having no nausea, vomiting or diarrhea she might be afraid to share this information for fear that it could be something more serious. Her mother should be more careful when around her daughter and should also use universal precautions when around her daughter. References CDC (2012). 24/7: Saving Lives Protecting People; Fifth edition Holman, R.C.; Curns,A.T.;Balay, Q.L.; Schonberger, L.D. (2003). Pediatrics; Kawasaki’s Syndrome; pp.495-501 Mayo Clinic (2011). Fifth Disease. Mayo Clinic.com PubMed Health (2012). Mononucleosis, ncbi.nlm.nih.gov/A.D.A.M. Medical Read More