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Instructions for Authors - Diagnosis Detective

March 8, 2024


Instructions for Authors

Please review the instructions below prior to submission.

Submission Form


Launched in October 2023, Diagnosis Detective on Red Book Online challenges users to solve a new infectious disease case every month. The goal of Diagnosis Detective is to provide a quick, case-based review of an infectious disease and highlight specific Red Book resources.  Authors will be credited if their case is published.

00:00: Are you a Diagnosis Detective? Help others to enhance their diagnostic skills by submitting a case to Red Book Online. Just follow these straightforward instructions to submit your case effectively. 00:13: From the Red Book Online home page, access the author instructions. 00:18: Navigate to the submission form. 00:21: Fill in the submission form, attach your case, and click submit 00:26: Submit your case and we will contact you with questions! 00:30: This guide covered the process of accessing author instructions, navigating to the submission form, and submitting a case to Red Book Online's Diagnosis Detective. Visit us at publications dot A A P dot org slash redbook

How to Create a Case

  1. Select an infectious disease/chapter from Section 3 of the Red Book to spotlight in the case.
  2. Write a brief description of the patient’s presenting symptoms, anything observed by the parent/caregiver, and the physician’s observations. A word count of about 120-150 is ideal, not to exceed 200 words.


Example Case:

  • An 8-year-old presents with acute onset of fever to 102°F, sore throat, and headache. The child has a slight runny nose but their mother reports the child “always has a runny nose”. There is no cough or diarrhea but the child did throw up on the way to your office. The child’s mother also mentions that the school nurse said there have been cases of flu, RSV, and strep throat in the child’s classroom. During your exam, the child says they do not feel well. During the exam, which is otherwise completely normal, you note that the child’s throat shows inflammation of the oropharynx with petechiae on the soft palate.

  1. If appropriate, include images that show symptoms. Images should be sourced from the Red Book Online chapter. (Note: Use images that are from CDC or other public domain as much as possible. Do not use images that are copyright by individuals even though they are featured in Red Book Online. Do not submit  images that you have taken of a patient.)
  2. A quiz must be created for each case. Include a minimum of 3 questions.
    • First question will always be: Which pathogen is most likely?
    • Provide the correct answer, as well as several other choices.
    • For each answer, indicate if it is correct or incorrect and provide a description of why each answer is correct or incorrect.
    • Subsequent questions can focus on next steps or other relevant information the reader should learn about the infectious disease, such as:
      • What treatment is recommended for this patient?
      • Which of the following additional tests should be performed?
      • What prophylaxis is needed for exposed persons? (this will not be relevant for all cases).
      • For each answer, indicate if it is correct or incorrect and provide a description of why each answer is correct or incorrect.
  1. Include references when appropriate.
  2. Refer to past cases in the Red Book Online Diagnosis Detective Archive.  

Submit your completed case using the submission form at https://www.aap.org/en/forms/rbo-submission-form. You will be contacted with any questions and notified of the publication date.

See below for a sample case submission template:

Month 2024

William Martin, MD, FAAP, Cedars-Sinai Medical Center

A 15-year-old previously healthy male presents with 10 days of right (R) inguinal lymphadenopathy. He also endorses dysuria, but denied fever, rash, URI symptoms or change in mental status. The physical exam is notable for a palpable 3 cm right inguinal lymph node and an ulcerated skin lesion on the distal right anterior thigh. Ultrasound of the R groin demonstrates enlarged R external iliac and inguinal lymph nodes with surrounding inflammatory changes. Urine Neisseria gonorrhea/Chlamydia trichomatis nucleic acid amplification test (NAAT) is negative. The patient lives in a suburban setting in Missouri, USA and engages in outdoor sports. He reports recent tick exposure during sporting events but denies animal exposure or recent travel. The patient denies any sexual activity.

[LIST RELEVANT PHOTO(S) HERE]

QUIZ

  1. What is the most likely causal organism?
    1. Herpes Simplex Virus (HSV)
    2. Treponema pallidum
    3. Francisella tularensis
    4. Bartonella henselae
    5. Neisseria gonorrhea

CORRECT ANSWER: c. Francisella tularensis: Painful inguinal lymphadenopathy with an adjacent ulcerated skin lesion and recent tick exposure in the south-central United States, should raise concern for infection secondary to Francisella tularensis, known as tularemia. In the United States, tick bites account for most human cases but others result from arthropods such as deer flies or direct contact with infected (vertebrate) species such as rabbits, rodents, beavers, and prairie dogs. Tularemia is a nationally notifiable disease and has been reported in all US states except Hawaii, with higher rates in central and western states. Tularemia | CDC

Incorrect answers:

a. HSV: HSV infection is less likely given adjacent ulceration. Gram-negative (GN) coccobacilli would not be seen on Gram stain in HSV.

b. Treponema pallidum: The localized distribution of lymphadenopathy is not classic for syphilis. Additionally, the rash seen in secondary syphilis in also not localized and often involves the palms and soles. Spirochetes would be seen on Gram stain rather than GN coccobacilli.

c. Bartonella henselae: The constellation of tender lymphadenopathy is consistent with Bartonella infection, but the inguinal distribution and lack of cat exposure are not typical.

d. Neisseria gonorrhea: While inguinal lymphadenopathy can be seen with infection secondary to gonorrhea, the urine NAAT does not detect Neisseria gonorrhea and the patient reports he is not sexually active.

 

  1. What treatment is recommended for this patient?
    1. Ampicillin
    2. Ceftriaxone
    3. Gentamicin
    4. Azithromycin

CORRECT ANSWER: c. Gentamicin: Gentamicin (5 mg/kg/day) divided twice or 3 times/day, intravenously or intramuscularly is the drug of choice for the treatment of tularemia in children. Duration of therapy is usually 10 days but 5 to 7 days may be sufficient in mild disease. Ciprofloxacin is an alternative for mild disease (10-14 day course of oral ciprofloxacin; 20-40 mg/kg daily, twice daily, maximum of 500 mg/dose) but is not approved by the US Food and Drug Administration (FDA) for the treatment of tularemia.

Incorrect answers:

a and b: Ampicillin and ceftriaxone: Tularemia is not susceptible to beta-lactam drugs, including carbapenems.

d. Azithromycin: While azithromycin can be used in the treatment of Bartonella, there is no role for azithromycin in the treatment of tularemia.

 

  1. Which clinical manifestation is the most common in tularemia?
    1. Oropharyngeal
    2. Oculoglandular
    3. Glandular
    4. Pneumonic
    5. Ulceroglandular
    6. Typhoidal

 CORRECT ANSWER: e. Ulceroglandular: Although there are several common presentations of tularemia in children, ulceroglandular (UG) disease is the most frequently identified. UG disease presents with a maculopapular lesion at the entry site with subsequent ulceration and slow healing. UG presentation is associated with tender regional lymphadenopathy that can drain spontaneously.

Incorrect answers:

  • Oropharyngeal tularemia presents with severe exudative stomatitis, pharyngitis, or tonsillitis with cervical lymphadenopathy.
  • Oculoglandular tularemia presents with severe conjunctivitis with preauricular lymphadenopathy.
  • The glandular presentation presents with regional lymphadenopathy with no ulcer. Glandular tularemia is also common but not as frequently seen as UG.
  • Pneumonic tularemia is characterized by influenza-like symptoms often with normal chest imaging chest radiograph abnormalities. Symptoms can include fever, dry cough, chest pain, and hilar adenopathy. Pneumonic tularemia is normally associated with farming or lawn maintenance that create aerosol or dust exposure.
  • Typhoidal tularemia presents with high fever, hepatomegaly, splenomegaly and systemic infection including septicemia; pneumonia and or meningitis can be seen as complications.

 End of quiz link: Tularemia | Red Book Online


Launched in October 2023, Diagnosis Detective on Red Book Online challenges you to solve a new infectious disease case every month. Developed by a dedicated subteam of the American Academy of Pediatrics Committee on Infectious Diseases, this feature offers:

Monthly Diagnostic Challenge: Return monthly to test your diagnostic skills with new infectious disease content.

Interactive Quiz: Actively participate and learn by solving real-world infectious disease cases.

Teaching/Learning: Use the valuable infectious disease educational content to learn, as well as reference as needed.

Social Sharing: Share your success on social media platforms—Facebook, LinkedIn, and Twitter/X.

Archived Cases: Challenge yourself with previous cases, which will be archived, for continued learning, or if you missed a previous month’s case.

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