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I  would examine the child for a focus and decide how ill the child
appeared.  Consider lab work, CBC, blood culture, etc.  Each case is
different.  Our institution has had 4 positive blood cultures for Group A
Strept recently.  Kind of raises one's concerns.
 
Chris Ritchey, M.D. , F.A.A.P.
Emergency Department
Cook Children's Medical Center
801 7th Ave.
Fort Worth, Texas
                76104
Voice- 817-885-4095
Fax -   817-885-3957
E-mail  [log in to unmask]
 
 
 
-----Original Message-----
From:   Pediatric Emergency Medicine Discussion List
[mailto:[log in to unmask]] On Behalf Of Eran Kozer
Sent:   Saturday, April 11, 1998 11:51 PM
To:     Multiple recipients of list PED-EM-L
Subject:        Varicella and Invasive Streptococcal infection
 
April 12, 1998
 
Varicella and Invasive Streptococcal infection.
 
A qustion for the group.
 
How would you treat a well appearing 3 years old child with
Varicella who still has a fever (39 C) on the 4th day of his
illness?
The committee on infectious diseases in its statement on
"Invasive Streptococcal infections" (Pediatrics January
1998) states that in such a case the possibility of invasive
Streptococcal infection should be considered. However the
diagnosis of invasive Streptococcal infection is not an easy
one . Cellulitis  and leukocytosis are not always present
and these patients are seen by many Physicians before an
accurate diagnosis is  made (Doctor A. et al. Pediatrics
1995) .
So, would you admit  such a child for perentral antibiotic
treatment?
 
Eran Kozer
Pediatric Division
Assaf Harofeh Medical Center
Zerifin, Israel
 
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