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Pediatric Infectious Disease
Brenda Beckett, PA-C
Immunizations
Reduced childhood infectious disease markedly
US: 14 diseases– Diphtheria, tetanus, pertussis, measles,
mumps, rubella, poliomyelitis, Hib, S. pneumoniae, HBV, HAV, influenza, varicella, rotavirus
Vaccine preventable diseases
Viral exanthems (covered in derm) Hepatitis (covered in ID) Polio
Other dermatology
Impetigo Tinea Molluscum Cellulitis
Fever
Normal body temp: 37 C, 98.6 F Range of 97-99.6 Rectal temp >100.4F (38 C) is FEVER Diurnal variation Age variation
Fever, Newborns
Neonates do not have febrile response <3 months old, any fever is risk of
serious bacterial infection May not have localizing signs Warrants workup: bacteremia, UTI,
meningitis, pneumonia, etc
Fever, <3 years
Exaggerated febrile response: up to 105 No localizing sx: risk of S. pneumo, N.
meningititis, Hib, Salmonella Observe child for alertness, irritability,
consolability
FUO
Fever of unknown origin T >100.4 F lasting >14d with no obvious
cause List, p 463 Nelson
Febrile Seizure
Usually <3 yo Seizure can be first sign of fever Rule out other causes Increased risk of repeat seizures with
fever Treat with antipyretics
Conjunctivitis
progressive redness of conjunctiva discharge
– bacterial = profuse,purulent– viral = minimal, mucoid
unilateral ---> bilateral preauricular node enlargement – viral Treat: bacterial – topical antibiotics
Ophthalmia Neonatorum
Conjunctivitis in the newborn– occurs during first 10 days of life– Acquired at brith
red, swollen lids & conjunctiva, discharge.– Can lead to blindness
Erythromycin at birth Cause : includes
– Chlamydia trachomatis– N. gonorrhoeae
Nasolacrimal Duct Obstruction
Cause - obstruction in any part of drainage system
wet eye with mucoid discharge– skin irritation– Increased risk of bacterial conjunctivitis
most clear spontaneously– massage– Antibiotics for bacterial
surgical treatment - probing
Periorbital Cellulitis
Infection of the structures around the eye
Cause :– S. aureus or S. pyogenes
Lid edema, pain, mild fever Arises from local, exogenous source Treatment
– systemic antibiotics
Orbital Cellulitis
Usually from bacterial sinus infection Signs of periorbital cellulitis, plus:
– proptosis– restricted and painful eye movement– high fever
CT or MRI Treatment – drainage, systemic
antibiotics
Otitis Externa
Cause : Pseudomonas or S. aureus minor itching ---> intense pain tenderness tragus/auricle erythema/swelling of canal purulent discharge possible postauricular node involvement Treatment: Otic antibiotics, drying
Otitis Media
S. pneumo, H. influenza, M. catarrhalis Many resistant to penicillin Major reason for pediatrics visit Risks: young age, bottle feeding, fam
hx, smoke exposure, viral URI
Otitis Media
Recurrent: >6 episodes in 6 mo Treat: Typmanostomy tubes
Sx: Fever, irritability, poor feeding, otalgia. Otorrhea (rupture)
Exam: Effusion, erythema, decreased mobility
Otitis Media
Treat: based on age and severity– < 6mo Antibiotics– 6mo-2yr ABX for certain, observation
or ABX for uncertain– >2yr Observation or ABX for severe
Acute Viral Rhinitis
Under age 5 --> 6-12 colds per year Symptoms :
– clear to mucoid rhinorrhea/nasal congestion
– *fever– mild sore throat/cough
Management :– saline drops/bulb suction
Sinusitis
Symptoms :– URI lasting longer than 10-12 days– low-grade fever, cough, HA in older child– malodorous breath– intermittent AM periorbital swelling/redness
Trt: amox, augmentin, azythromycin
Thrush
Cause : Candida albicans mainly affects infants
– refusal of feedings (?soreness of mouth) lesions are white plaques on buccal
mucosa– cannot be washed away– bleed if scraped
treatment - nystatin oral suspension
Lymphadenopathy
Most prominent in 4-8 yo Cervical most common Location can differentiate cause of
infection
Patient Presentation
5 year old with sore throat x48 hrs Temp 101 at home last night Other history questions? PE: erythematous pharynx, white
exudate. Enlarged ant. Cervical nodes
DD???
Pharyngitis/Tonsillitis
School-age 5-15 years Symptoms :
– sorethroat– fever/chills– general malaise– referred ear pain– headache– abdominal pain/vomiting
Pharyngitis/Tonsillitis
Signs :– red, inflamed posterior pharyngeal wall– swollen, erythematous tonsils– petechiae and beefy red uvula– tender cervical adenopathy
Causes: Group A strep, rhinovirus, EBV, etc
Pharyngitis/Tonsillitis
Scarlet fever: strawberry tongue Peritonsillar abscess: “hot potato voice” Strep pharyngitis: Always treat with abx,
definitively diagnose strep EBV: blood test - “monospot”, EBV
titers Viral pharyngitis: URI sx
Mononucleosis
Symptoms :– prodromal phase– fever– sorethroat– *tender lymph nodes– abdominal pain
Signs :– exudative
pharyngitis/tonsillitis– **lymphatic
enlargement - posterior cervical, axillary, inguinal
– splenomegaly, less often hepatomegaly
Mononucleosis
Lab: Positive monospot or EBV titer Treat: usually supportive unless
lymphadenopathy is severe, then oral steroids
Patient Presentation
18 month old with “wheezing” URI sx for 2-3 days No fever Other history questions? DD??
Larnygotracheobronchitis(Croup)
Cause : parainfluenza virus type 1 peak age 6 months to 2 years Symptoms :
– URI (prodrome)– harsh, barking (seal-like) cough– hoarseness– inspiratory stridor– fever (absent or low-grade)
Treatment for Croup
Self-limiting– mist– hydration
Dexamethasone Injection– 0.3-0.6mg/kg, repeated in 12 hours
Racemic epinephrine– via nebulizer– rebound effect in 2 hours
Epiglottitis
*true medical emergency cause : Haemophilus influenza type B sudden onset of fever dysphagia / drooling / muffled voice inspiratory retractions / soft stridor **sitting position *cherry-red, swollen epiglotittis **Endotracheal intubation
Bronchiolitis
RSV = respiratory syncytial virus winter and early spring peak age 2-10 months fever URI ---> wheezing and tachypnea
– nasal flaring, retractions, crackles/wheezing
labs : CXR, nasal swab/washing
Treatment Usually self-limiting, supportive
– 3-7 days Hospitalization, O2
– younger than 6 months of age– respiratory distress, hypoxemia– underlying disease
Ribavirin (antiviral therapy) Immunoglobulin anti RSV (Synagis)
Pertussis(Whooping cough)
Cause : Bordetella pertussis most common and most severe under 1
year adults frequently source of infection Three stages of disease
– catarrhal stage– paroxysmal stage– convalescent stage
Pertussis
Labs : – WBC = 20-30K, 70-80% lymphs– nasopharyngeal swab for PCR, culture
Treatment :– erythromycin 40-50mg/kg/24hours x 14 d– nutritional support– steroids/albuterol
Pneumonia
S. pneumo and HiB – immunizations Viral (RSV) Sputum?
Mycoplasma Pneumonia
Most common cause of pneumonia in school-age children
peaks in fall slow onset of symptoms
– scratchy throat– low-grade fever– headache– dry, non-productive cough
Mycoplasma Pneumonia
Signs :– widespread crackles– decreased breath sounds
CXR - patchy infiltrates Labs :
– WBC = normal– cold agglutinin titer = 1:32 or greater
Treatment – erythromycin, azythromycin
Chlamydial Pneumonia
Acquired from infected mother at delivery Age : 2-12 weeks Symptoms/Signs :
– *conjunctivitis– rhinitis and cough (resembles pertussis) / OM– scattered inspiratory crackles / tachypnea– **wheezes rarely present– no fever
Chlamydial Pneumonia
Labs : – serum immunoglobins usually high– nasopharyngeal swab– peripheral eosinophilia > 400 cells/mm3
CXR :– diffuse infiltrates and hyperexpansion
Treatment :– Erythromycin, azythromycin
Meningitis
Causative organisms change with age Preceding URI sx HA, irritability, nausea, nuchal rigidity,
lethargy, photophobia, vomiting Fever Kernig and Brudzinski signs LP
Patient Presentation
7 month old with 24 hrs of vomiting, diarrhea
No fever Other history questions? DD??
Acute Viral Gastroenteritis
Rotavirus - cause of 80% of infections in infants and young children (4-24 months)
winter months vomiting, followed by profuse, watery
diarrhea and low-grade fever abdominal pain, nausea, cramping
History
duration, frequency, description of stool duration, frequency of vomiting amount and type of fluids and solids
ingested frequency of urination exposure to others with V/D
Signs of Dehydration
body weight mucous membranes skin turgor / color fontanelles pulse/BP/respirations/perfusion tears urinary output
Treatment
Infants : – continue breast feeding– oral rehydration solution-->1/2 strength
formula-->full strength formula Older child :
– sips of clear fluids– ORT**New vaccine
Pinworms
Most common parasitic disease in children
cause : Enterobius vermicularis symptom : perianal itching, esp.
nocturnal labs : adhesive tape test treatment : mebendazole 100 mg CH
Urinary Tract Infection
Infants :– strong-smelling urine– Irritability– Or just fever
Preschooler :– abdominal pain– vomiting– strong-smelling urine– fever
UTI
School-age : ‘classic’– Dysuria, frequency, urgency, secondary
enuresis, foul-smelling urine, fever, flank pain
Treat: Neonates 10-14 daysOlder children 7-14 days
Recurrent UTI’s
Renal ultrasound VCUG
– vesicoureteral reflux Causes :
– infrequent or incomplete voiding– poor perineal hygiene– pinworms– bubble baths
Antibiotic Dosing in Children
Dose based on weight Taste Dosing schedule