MMWR Clinical Pearls

April 2024

Think Horses First

Unsupervised Melatonin Ingestion

During 2019–2022, there were approximately 11,000 emergency department visits among young children for unsupervised melatonin ingestions. Approximately 6% resulted in hospitalization. Many incidents involved ingestion of flavored products (e.g., gummy formulations). Clinicians can educate parents and other caregivers about keeping all medications and supplements (including gummies) out of children’s reach and sight.

Hypertension

Hypertension is a major risk factor for heart disease and stroke. During 2017–2021, approximately one third of U.S. adults reported diagnosed hypertension. Prevalence varied by sociodemographic characteristics and state of residence. Among those who had hypertension diagnosed, 63% used antihypertensive medications. Clinicians can promote lifestyle modifications and antihypertensive medication use when indicated to optimize blood pressure control and reduce disparities.

Don’t Forget Zebras

Measles

Syndromic polymerase chain reaction panels test for pathogens that cause rash illnesses, including measles. Positive tests were reported in recently vaccinated children without known measles risk factors. Their results were attributed to detection of measles vaccine virus, which is not transmitted to others and does not cause disease in immunocompetent persons. Approximately 5% of patients experience a rash after measles vaccination. Although not unexpected after vaccination, any detection of measles virus should immediately be reported to public health agencies to determine the appropriate public health response.

Opportunities to Improve Clinical Outcomes

Fungal diseases

Coccidioidomycosis, histoplasmosis, and blastomycosis, fungal diseases that can cause severe respiratory illness or disseminated disease and death, are underdiagnosed and underreported. Fluctuating case counts and atypical seasonality suggest these infections might have been affected by changes in health care-seeking behavior, diagnostic testing, or underreporting during the COVID-19 pandemic. Clinicians might want to consider testing for fungal infections in patients with pneumonia whose symptoms do not improve with antibiotics or who have geographic or other risk factors.

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