Management of Pustules and Vesicles in Afebrile Infants ≤60 Days Evaluated by Dermatology.

Autor:	Yun S; Columbia University Vagelos College of Physicians and Surgeons, New York, New York., Cotton C; Department of Dermatology, George Washington School of Medicine and Health Sciences, Washington, District of Columbia.; Division of Dermatology, Children's National Hospital, Washington, District of Columbia., Faith EF; Departments of Pediatrics.; Dermatology.; Nationwide Children's Hospital, Columbus, Ohio., Jacobs L; Departments of Pediatrics.; Dermatology.; Palo Alto Foundation Medical Group, Palo Alto, California., Kittler N; Dermatology.; University of California San Franscico, San Franscico, California., Monir RL; Dermatology.; University of Florida, Gainesville, Florida., Ravi M; Dermatology.; Ohio State University, Columbus, Ohio., Richmond A; Dermatology.; Medical University of South Carolina, Charleston, South Carolina., Schoch J; Departments of Pediatrics.; Dermatology.; University of Florida, Gainesville, Florida., Workman E; Dermatology.; Texas Children's Hospital, Baylor College of Medicine, Houston, Texas., Zucker J; Departments of Pediatrics.; Division of Pediatric Infectious Diseases.; Columbia University Vagelos College of Physicians and Surgeons, New York, New York.; NewYork-Presbyterian Hospital, New York, New York., Hunt R; Departments of Pediatrics.; Dermatology.; Texas Children's Hospital, Baylor College of Medicine, Houston, Texas., Lauren CT; Departments of Pediatrics.; Dermatology.; Columbia University Vagelos College of Physicians and Surgeons, New York, New York.; NewYork-Presbyterian Hospital, New York, New York.
Jazyk:	angličtina
Zdroj:	Pediatrics [Pediatrics] 2024 Jul 01; Vol. 154 (1).
DOI:	10.1542/peds.2023-064364
Abstrakt:	Objectives: To assess the management and outcomes of afebrile infants who received a pediatric dermatology consultation for pustules and/or vesicles. Methods: Medical records were reviewed for all infants 60 days of age or younger who received a pediatric dermatology consult across 6 academic institutions between September 1, 2013 and August 31, 2019 to identify those infants with pustules and/or vesicles. Results: Of the 879 consults, 183 afebrile infants presented with pustules and/or vesicles. No cerebrospinal fluid cultures or blood cultures were positive for bacteria. No concordant positive urine cultures were identified in infants with cutaneous infection. Nine infants were diagnosed with herpes simplex virus (HSV). Five preterm infants were diagnosed with angioinvasive fungal infections. Conclusions: No serious bacterial infections attributable to a skin source were identified, yet 53% of these infants received parenteral antibiotics. HSV was diagnosed in 7% of this cohort, 77.8% (7/9) of whom were term infants and 22.2% (2 of 9) of whom were preterm. Angioinvasive fungal infection was diagnosed in 3%, all of whom (100%, 5 of 5) were extremely preterm at <28 weeks gestational age. These findings suggest that in full-term afebrile infants ≤60 days, the likelihood of a life-threatening etiology of isolated pustules or vesicles is low once HSV infection is excluded. In preterm infants with pustules and/or vesicles, a high index of suspicion must be maintained, and broad infectious evaluation is recommended. HSV testing is recommended for all infants with vesicles, grouped pustules and/or punched-out erosions. (Copyright © 2024 by the American Academy of Pediatrics.)
Databáze:	MEDLINE
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