Pediatric respiratory infectionsDownloads

A 6-year-old boy and his parents present to the emergency department with high-grade fever, headache, and projectile vomiting. The boy was born at 39 weeks gestation via spontaneous vaginal delivery. He is up to date on all vaccines and is meeting all developmental milestones. Past medical history is noncontributory. He has had no sick contacts at school or at home. The family has not traveled out of the area recently. He likes school and playing videogames with his younger brother. Today, his blood pressure is 115/76 mm Hg, heart rate is 110/min, respiratory rate is 22/min, and temperature is 38.4°C (101.2°F). On physical exam, the child is disoriented. Kernig’s sign is positive. A head CT was performed followed by a lumbar puncture. Several aliquots of CSF were distributed throughout the lab. Cytology showed high counts of polymorphs, biochemistry showed low glucose and elevated protein levels, and a gram smear shows gram-positive lanceolate-shaped cocci alone and in pairs. A smear is prepared on blood agar in an aerobic environment and grows mucoid colonies with clearly defined edges and alpha hemolysis. On later evaluation they develop a ‘draughtsman’ appearance. Which one of the following is the most likely pathogen?

A 3-year-old girl is brought to the physician by her parents because of a barking cough, a raspy voice, and noisy breathing for the last 3 days. Five days ago, she had a low-grade fever and runny nose. She attends daycare. Her immunizations are up-to-date. Her temperature is 37.8°C (100°F) and respirations are 33/min. Physical examination shows supraclavicular retractions. There is a high-pitched sound present on inspiration. Examination of the throat shows erythema without exudates. Which of the following is the most likely location of the anatomic narrowing causing this patient's symptoms?