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Eosinophilic Cellulitis

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121. Cutaneous Manifestations of HIV Disease (Follow-up)

. The most common cutaneous infections in children with HIV disease are impetigo and cellulitis caused by Staphylococcus aureus . Other cutaneous manifestations of HIV infection in the pediatric age group are as follows: Recurrent herpetic gingivostomatitis Scabies Severe atopic dermatitis Drug eruptions Leukocytoclastic vasculitis Previous Next: Malignancies (KS) was the first reported malignancy associated with HIV infection and was first documented in 1981 from reports in New York, Los Angeles (...) suggest HIV infection. Bournerias et al reported tinea capitis from Microsporum canis in 2 patients infected with HIV. [ ] Pityriasis versicolor may be persistent and recurrent in patients with HIV infection. Previous Next: Deep Fungal Infections Rarely, cutaneous cryptococcosis may be observed in patients with HIV infection. [ ] Clinical manifestations include the following: Cellulitis Papules Plaques Ulcers Translucent dome-shaped papules with central umbilication, resembling MC Cutaneous

2014 eMedicine.com

122. Id Reaction (Autoeczematization) (Follow-up)

. . Brenner S, Ophir J, Krakowski A. Pediculid. An unusual -id reaction to pediculosis capitis. Dermatologica . 1984. 168(4):189-91. . Chao SC, Lee YP, Lee JY. Eosinophilic cellulitis and panniculitis with generalized vesicular pustular id reaction after a molten aluminum burn. Dermatitis . 2010 Jun. 21(3):E11-5. . Cunningham MJ, Zone JJ, Petersen MJ, Green JA. Circulating activated (DR-positive) T lymphocytes in a patient with autoeczematization. J Am Acad Dermatol . 1986 Jun. 14(6):1039-41. . Kasteler

2014 eMedicine.com

123. Mold Allergy (Follow-up)

sinus infections, all of which can lead to poor quality of sleep. Some individuals may develop obstructive sleep apnea. Chronic sinus drainage can cause bronchitis, pneumonia, or bronchiectasis. For some children, sinusitis can lead to orbital or periorbital cellulitis. Allergic asthma Poorly treated mold allergy asthma can have the same clinical results as any other form of allergic asthma. This includes status asthmaticus, which can lead to acute death. Other acute complications include (...) . Frequency of familial occurrence in 164 patients with allergic bronchopulmonary aspergillosis. Ann Allergy Asthma Immunol . 2008 Oct. 101(4):363-9. . Matsuno O, Ueno T, Takenaka R, et al. Acute eosinophilic pneumonia caused by Candida albicans. Respir Med . 2007 Jul. 101(7):1609-12. . Kopp T, Mastan P, Mothes N, Tzaneva S, Stingl G, Tanew A. Systemic allergic contact dermatitis due to consumption of raw shiitake mushroom. Clin Exp Dermatol . 2009 Dec. 34(8):e910-3. . Ampere A, Delhaes L, Soots J, Bart F

2014 eMedicine Pediatrics

124. White Blood Cell Function (Follow-up)

of virally infected cells. Immunodeficiency diseases The table below provides a brief overview of several immunodeficiency diseases. The normal functions of the immune system and the disorders that affect it are considered in detail below. Next: Innate Immune System Key components Granulocytes are a key component of the innate immune system (ie, nonspecific immune defense system). The granulocyte network includes 3 main components: neutrophils, eosinophils, and basophils. This network makes up 50 (...) of invasion by means of chemotaxis, which occurs in response to microbial products, activated complement proteins, and cytokines. Chemotaxis of neutrophils involves movement of pseudopodia and polymerization of cytoskeletal proteins or actin. The cell may then ingest the foreign invader. PMNs, monocytes, and eosinophils can participate in phagocytosis. Opsonins are often antibodies or components of the complement pathway that bind to the surface of target organisms to facilitate this phagocytosis

2014 eMedicine Pediatrics

125. White Blood Cell Function (Treatment)

of virally infected cells. Immunodeficiency diseases The table below provides a brief overview of several immunodeficiency diseases. The normal functions of the immune system and the disorders that affect it are considered in detail below. Next: Innate Immune System Key components Granulocytes are a key component of the innate immune system (ie, nonspecific immune defense system). The granulocyte network includes 3 main components: neutrophils, eosinophils, and basophils. This network makes up 50 (...) of invasion by means of chemotaxis, which occurs in response to microbial products, activated complement proteins, and cytokines. Chemotaxis of neutrophils involves movement of pseudopodia and polymerization of cytoskeletal proteins or actin. The cell may then ingest the foreign invader. PMNs, monocytes, and eosinophils can participate in phagocytosis. Opsonins are often antibodies or components of the complement pathway that bind to the surface of target organisms to facilitate this phagocytosis

2014 eMedicine Pediatrics

126. Leukocyte Adhesion Deficiency (Overview)

of infection. Thus the infections in patients with leukocyte adhesion deficiency act similarly as those observed in patients with neutropenia. See the images below. Labial ulceration from which Escherichia coli was cultured in an 8-month-old girl with leukocyte adhesion deficiency type 1 (LAD I). Note the thin bluish scar at the superior aspect of the labia from an earlier cellulitis. This 3-year-old girl had leukocyte adhesion deficiency type I (LAD I) with complete absence of CD18 expression. Note (...) are expressed on lymphocytes, eosinophils, and natural killer cells. Irish setter dogs and Holstein cattle have a disorder similar to human leukocyte adhesion deficiency I with leukocytosis and increased infections. This is secondary to a mutation in the gene homologous to human CD18 . Both strains serve as promising large-animal models for leukocyte adhesion deficiency. Knockout mice have been developed with the genes deleted for many of the adhesion-related molecules, (eg, CD18, CD11a, CD11b, ICAM1, ICAM2

2014 eMedicine Pediatrics

127. Agranulocytosis (Diagnosis)

, namely neutrophils, eosinophils, and basophils. However, the term granulocytopenia is often used synonymously with neutropenia and, in that sense, is again confined to the neutrophil lineage alone. The risk of serious infection increases as the absolute neutrophil count (ANC) falls to the severely neutropenic range (< 500/µL). The duration and severity of neutropenia directly correlate with the total incidence of all infections and of those infections that are life threatening. Tuberculosis (see (...) ). [ , ] Granulocytopenia is defined as a reduced number of blood granulocytes, namely neutrophils, eosinophils, and basophils. However, the term granulocytopenia is often used synonymously with neutropenia and, in that sense, is again confined to the neutrophil lineage alone. Neutropenia is defined in terms of the absolute neutrophil count (ANC). The ANC is calculated by multiplying the total white blood cell (WBC) count by the percentage of neutrophils (segmented neutrophils or granulocytes) plus the band forms

2014 eMedicine.com

128. Nephrotic Syndrome (Diagnosis)

to a hypercoagulable state in INS. [ , ] Infection Patients with INS are at increased risk of infection. Peritonitis and sepsis are the most common and serious infections. Peritonitis occurs at a rate of approximately 2-6% and may be accompanied by sepsis or bacteremia. The predominant bacterial causes are Streptococcus pneumoniae and Gram-negative enteric organisms such as Escherichia coli. [ ] Various infections can also occur, including meningitis, cellulitis, viral infections, and others. Varicella (...) with polyangiitis), Churg-Strauss syndrome (eosinophilic granulomatosis with polyangiitis), , microscopic polyangiitis, Henoch-Schönlein purpura (HSP) Immune-complex–mediated - Poststreptococcal (postinfectious) glomerulonephritis Previous Next: Epidemiology In the United States, the reported annual incidence rate of nephrotic syndrome is 2-7 cases per 100,000 children younger than 16 years. The cumulative prevalence rate is approximately 16 cases per 100,000 individuals. [ ] The ISKDC found that 76.6

2014 eMedicine Pediatrics

129. Leukocyte Adhesion Deficiency (Diagnosis)

at the site of infection. Thus the infections in patients with leukocyte adhesion deficiency act similarly as those observed in patients with neutropenia. See the images below. Labial ulceration from which Escherichia coli was cultured in an 8-month-old girl with leukocyte adhesion deficiency type 1 (LAD I). Note the thin bluish scar at the superior aspect of the labia from an earlier cellulitis. This 3-year-old girl had leukocyte adhesion deficiency type I (LAD I) with complete absence of CD18 expression (...) are expressed on lymphocytes, eosinophils, and natural killer cells. Irish setter dogs and Holstein cattle have a disorder similar to human leukocyte adhesion deficiency I with leukocytosis and increased infections. This is secondary to a mutation in the gene homologous to human CD18 . Both strains serve as promising large-animal models for leukocyte adhesion deficiency. Knockout mice have been developed with the genes deleted for many of the adhesion-related molecules, (eg, CD18, CD11a, CD11b, ICAM1, ICAM2

2014 eMedicine Pediatrics

130. Dirofilariasis (Treatment)

Thighs Abdominal wall Male genitalia Ophthalmic involvement may be periorbital, [ , ] subconjunctival, [ ] subtenon, [ ] or intraocular. [ ] See for more detail. Diagnosis Studies used in the diagnosis and evaluation of dirofilariasis include the following: Complete blood count (CBC) - Using a CBC, eosinophilia may be detected in up to 20% of cases of HPD Sputum cytology - The presence of eosinophils may support a diagnosis of HPD in patients with a coin lesion observed on radiography, although (...) in endemic areas of northeastern Italy indicated that the mosquito host Culex pipiens fed on dogs 70% of the time and on humans 26% of the time. [ ] D immitis is most often associated with coin lesions of the lung (human pulmonary dirofilariasis, or HPD), but isolated reports exist of D immitis or D immitis –like worms causing cutaneous or conjunctival disease. Extrapulmonary D immitis infections described in the literature include a hepatic nodule, [ ] eosinophilic meningitis, [ ] intraocular infection

2014 eMedicine Pediatrics

131. Dirofilariasis (Overview)

Thighs Abdominal wall Male genitalia Ophthalmic involvement may be periorbital, [ , ] subconjunctival, [ ] subtenon, [ ] or intraocular. [ ] See for more detail. Diagnosis Studies used in the diagnosis and evaluation of dirofilariasis include the following: Complete blood count (CBC) - Using a CBC, eosinophilia may be detected in up to 20% of cases of HPD Sputum cytology - The presence of eosinophils may support a diagnosis of HPD in patients with a coin lesion observed on radiography, although (...) in endemic areas of northeastern Italy indicated that the mosquito host Culex pipiens fed on dogs 70% of the time and on humans 26% of the time. [ ] D immitis is most often associated with coin lesions of the lung (human pulmonary dirofilariasis, or HPD), but isolated reports exist of D immitis or D immitis –like worms causing cutaneous or conjunctival disease. Extrapulmonary D immitis infections described in the literature include a hepatic nodule, [ ] eosinophilic meningitis, [ ] intraocular infection

2014 eMedicine Pediatrics

132. Nephrotic Syndrome (Overview)

to a hypercoagulable state in INS. [ , ] Infection Patients with INS are at increased risk of infection. Peritonitis and sepsis are the most common and serious infections. Peritonitis occurs at a rate of approximately 2-6% and may be accompanied by sepsis or bacteremia. The predominant bacterial causes are Streptococcus pneumoniae and Gram-negative enteric organisms such as Escherichia coli. [ ] Various infections can also occur, including meningitis, cellulitis, viral infections, and others. Varicella (...) with polyangiitis), Churg-Strauss syndrome (eosinophilic granulomatosis with polyangiitis), , microscopic polyangiitis, Henoch-Schönlein purpura (HSP) Immune-complex–mediated - Poststreptococcal (postinfectious) glomerulonephritis Previous Next: Epidemiology In the United States, the reported annual incidence rate of nephrotic syndrome is 2-7 cases per 100,000 children younger than 16 years. The cumulative prevalence rate is approximately 16 cases per 100,000 individuals. [ ] The ISKDC found that 76.6

2014 eMedicine Pediatrics

133. Conjunctivitis (Follow-up)

. Vernal disease is often associated with shield corneal ulcers. Perilimbal accumulation of eosinophils (Horner-Trantas dots) typifies vernal disease. Vernal keratoconjunctivitis (VKC), usually affects young boys, tends to be bilateral, and occurs in warm weather. VKC is presumed to be a hypersensitivity to exogenous antigens and may be associated with or accompanied by keratoconus. Preauricular adenopathy is absent; chemosis is common. The conjunctival discharge amount is moderate, stringy, or sparse (...) and/or available. Risk of chlamydial pneumonia exists. Pneumonia can occur in 10-20% of infants with chlamydial conjunctivitis as many as 6 months later. Untreated chlamydial conjunctivitis in adults can lead to conjunctival scarring. Any of the bacterial organisms that cause conjunctivitis, particularly in a premature infant, can lead to sepsis and death. Neonates are at risk for secondary meningitis, cellulitis, and septicemia, particularly if the conjunctivitis is caused by Escherichia coli, Staphylococcus

2014 eMedicine Emergency Medicine

134. Toxicity, Cocaine (Diagnosis)

aspiration pneumonitis or after an intravenous injection of bacteria or toxic organic or inorganic materials Aneurysm or pseudoaneurysm: May be noted with mainlining (ie, directly injecting into a central artery or vein); this finding is an indication for further imaging studies In addition, radiography may be useful for evaluating cellulitis, an abscess, or a nonhealing wound in an intravenous drug user; it may reveal a foreign body or subcutaneous emphysema produced by gas-forming organisms (...) producing these effects are unknown, but hypotheses include a direct effect on lymphocyte activity, myocardial cell cytotoxicity secondary to an increase in the activity of natural killer cells, hypersensitivity reactions (suggested by eosinophilic infiltrate), and induction of focal myocarditis from catecholamine administration. Cocaine causes a direct negative inotropic effect on cardiac muscle, resulting in transient toxic cardiomyopathy. In one small series, 8 of 10 subjects who used cocaine long

2014 eMedicine Emergency Medicine

135. Conjunctivitis (Overview)

. Vernal disease is often associated with shield corneal ulcers. Perilimbal accumulation of eosinophils (Horner-Trantas dots) typifies vernal disease. Vernal keratoconjunctivitis (VKC), usually affects young boys, tends to be bilateral, and occurs in warm weather. VKC is presumed to be a hypersensitivity to exogenous antigens and may be associated with or accompanied by keratoconus. Preauricular adenopathy is absent; chemosis is common. The conjunctival discharge amount is moderate, stringy, or sparse (...) and/or available. Risk of chlamydial pneumonia exists. Pneumonia can occur in 10-20% of infants with chlamydial conjunctivitis as many as 6 months later. Untreated chlamydial conjunctivitis in adults can lead to conjunctival scarring. Any of the bacterial organisms that cause conjunctivitis, particularly in a premature infant, can lead to sepsis and death. Neonates are at risk for secondary meningitis, cellulitis, and septicemia, particularly if the conjunctivitis is caused by Escherichia coli, Staphylococcus

2014 eMedicine Emergency Medicine

136. Shock, Septic (Diagnosis)

into a morphologic picture termed diffuse alveolar damage (DAD). The clinical and pathologic evolution can be categorized into the following 3 overlapping phases [ ] : Exudative phase (edema and hemorrhage) Proliferative phase (organization and repair) Fibrotic phase (end-stage fibrosis) The exudative phase of DAD occurs in the first week and is dominated by alveolar edema and hemorrhage (see the images below). Other histologic features include dense eosinophilic hyaline membranes and disruption of the capillary

2014 eMedicine Emergency Medicine

137. Neutropenia (Diagnosis)

, namely neutrophils, eosinophils, and basophils. However, the term granulocytopenia is often used synonymously with neutropenia and, in that sense, is again confined to the neutrophil lineage alone. The risk of serious infection increases as the absolute neutrophil count (ANC) falls to the severely neutropenic range (< 500/µL). The duration and severity of neutropenia directly correlate with the total incidence of all infections and of those infections that are life threatening. Tuberculosis (see (...) ). [ , ] Granulocytopenia is defined as a reduced number of blood granulocytes, namely neutrophils, eosinophils, and basophils. However, the term granulocytopenia is often used synonymously with neutropenia and, in that sense, is again confined to the neutrophil lineage alone. Neutropenia is defined in terms of the absolute neutrophil count (ANC). The ANC is calculated by multiplying the total white blood cell (WBC) count by the percentage of neutrophils (segmented neutrophils or granulocytes) plus the band forms

2014 eMedicine.com

138. Septic Shock (Diagnosis)

into a morphologic picture termed diffuse alveolar damage (DAD). The clinical and pathologic evolution can be categorized into the following 3 overlapping phases [ ] : Exudative phase (edema and hemorrhage) Proliferative phase (organization and repair) Fibrotic phase (end-stage fibrosis) The exudative phase of DAD occurs in the first week and is dominated by alveolar edema and hemorrhage (see the images below). Other histologic features include dense eosinophilic hyaline membranes and disruption of the capillary

2014 eMedicine.com

139. Sinusitis, Chronic (Diagnosis)

. Confounding factors that may contribute to inflammation include the following: Persistent infection (including biofilms and osteitis) [ , ] Allergy and other immunologic disorders Intrinsic factors of the upper airway Superantigens Colonizing fungi that induce and sustain eosinophilic inflammation Metabolic abnormalities such as aspirin sensitivity All of these factors can play a role in disruption of the intrinsic mucociliary transport system. This is because an alteration in sinus ostia patency, ciliary (...) A, Chandra M, Nag TC. Clinical implications of microbial biofilms in chronic rhinosinusitis and orbital cellulitis. BMC Ophthalmol . 2016 Sep 21. 16 (1):165. . Brook I, Foote PA, Hausfeld JN. Increase in the frequency of recovery of meticillin-resistant Staphylococcus aureus in acute and chronic maxillary sinusitis. J Med Microbiol . 2008 Aug. 57:1015-7. . Brook I. Acute and chronic bacterial sinusitis. Infect Dis Clin North Am . 2007 Jun. 21(2):427-48, vii. . Brook I. Bacteriology of chronic maxillary

2014 eMedicine.com

140. Paraneoplastic Diseases (Diagnosis)

are the usual manifestations. These changes may progress to the point that the nail sheds. Diagnosis Histopathologic analysis of samples from the affected sites reveals nonspecific changes, including hyperkeratosis, acanthosis, parakeratosis, and dyskeratotic keratinocytes. Perivascular lymphocytic infiltrates are variably present with eosinophils and neutrophils. Direct immunofluorescence is also nonspecific. The diagnosis is based on the characteristic distribution of skin changes. The main entity

2014 eMedicine.com

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