4th Pediatric Infectious Diseases Conference
 
 
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Specialist Answers
Question
Following cases need resolution could you please help.. 1.9 years old male child presented with steven johnson syndrome, he was on drug Carbazamapine(tegratol). Now,What are the drugs of choice for the child we can use? 2.10 years old boy presented with facial cellulytis without any infection or any trauma;we exclude supererior venacaval obstruction.Eye examination was normal,Clinical examination normal,MRI and other tests are normal.We are treating him with broad spectrum antibiotic Metronizone for ten days without any improvement,So please give some suggestion regarding the diagnosis and management? thanking you,Dr.tamanna
Answer
Various etiologic factors (e.g. infection, vaccination, drugs, systemic diseases, physical agents, food) have been implicated as causes of Steven Johnson syndrome. Drugs such as Antibiotics, analgesics, cough and cold medication, nonsteroidal anti-inflammatory drug (NSAID), psycho-epileptics are blamed. Pediatric cases are related more often to infections than to malignancy or a reaction to a drug. Viral diseases that have been reported include herpes simplex virus (HSV), AIDS, Coxsackie viral infections, influenza, hepatitis, mumps, lymphogranuloma venereum (LGV), rickettsial infections, and variola.
Bacterial etiologies include group A beta streptococci, diphtheria, Brucellosis, mycobacteria, Mycoplasma pneumoniae, tularemia, and typhoid. In children, Epstein-Barr virus and enteroviruses have been identified.
Hence one should rule out the above infections, do a mycoplasma antigen test and if all that is negative then assume the drug to have caused it. If the carbamezepine is the offending agent, one should avoid phenytoin and phenobaritone also.

2. For the facial cellulitis, one should be absolutely sure about the diagnosis. Cover with antistaphylocccal coverage and a blood culture would be advisable.
 
 
 
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Should teicoplannin, colistin be used in case of neonatal sepsis where culture does not reveal any organism_?
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