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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.

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pediatric infectious disease

Pediatric Infectious Disease

Brenda Beckett, PA-C

immunizations
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
Vaccine preventable diseases
  • Viral exanthems (covered in derm)
  • Hepatitis (covered in ID)
  • Polio
other dermatology
Other dermatology
  • Impetigo
  • Tinea
  • Molluscum
  • Cellulitis
fever
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
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
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
slide8
FUO
  • Fever of unknown origin
  • T >100.4 F lasting >14d with no obvious cause
  • List, p 463 Nelson
febrile seizure
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
Conjunctivitis
  • progressive redness of conjunctiva
  • discharge
    • bacterial = profuse,purulent
    • viral = minimal, mucoid
  • unilateral ---> bilateral
  • preauricular node enlargement – viral
  • Treat: bacterial – topical antibiotics
ophthalmia neonatorum
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
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
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
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
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
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 media1
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 media2
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
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
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
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
Lymphadenopathy
  • Most prominent in 4-8 yo
  • Cervical most common
  • Location can differentiate cause of infection
patient presentation
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
Pharyngitis/Tonsillitis
  • School-age 5-15 years
  • Symptoms :
    • sorethroat
    • fever/chills
    • general malaise
    • referred ear pain
    • headache
    • abdominal pain/vomiting
pharyngitis tonsillitis1
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 tonsillitis2
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
mononucleosis1
Mononucleosis
  • Lab: Positive monospot or EBV titer
  • Treat: usually supportive unless lymphadenopathy is severe, then oral steroids
patient presentation1
Patient Presentation
  • 18 month old with “wheezing”
  • URI sx for 2-3 days
  • No fever
  • Other history questions?
  • DD??
larnygotracheobronchitis croup
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
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
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
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
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
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
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
Pneumonia
  • S. pneumo and HiB – immunizations
  • Viral (RSV)
  • Sputum?
mycoplasma pneumonia
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 pneumonia1
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
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 pneumonia1
Chlamydial Pneumonia
  • Labs :
    • serum immunoglobins usually high
    • nasopharyngeal swab
    • peripheral eosinophilia > 400 cells/mm3
  • CXR :
    • diffuse infiltrates and hyperexpansion
  • Treatment :
    • Erythromycin, azythromycin
meningitis
Meningitis
  • Causative organisms change with age
  • Preceding URI sx
  • HA, irritability, nausea, nuchal rigidity, lethargy, photophobia, vomiting
  • Fever
  • Kernig and Brudzinski signs
  • LP
patient presentation2
Patient Presentation
  • 7 month old with 24 hrs of vomiting, diarrhea
  • No fever
  • Other history questions?
  • DD??
acute viral gastroenteritis
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
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
Signs of Dehydration
  • body weight
  • mucous membranes
  • skin turgor / color
  • fontanelles
  • pulse/BP/respirations/perfusion
  • tears
  • urinary output
treatment1
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
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
Urinary Tract Infection
  • Infants :
    • strong-smelling urine
    • Irritability
    • Or just fever
  • Preschooler :
    • abdominal pain
    • vomiting
    • strong-smelling urine
    • fever
slide60
UTI
  • School-age : ‘classic’
    • Dysuria, frequency, urgency, secondary enuresis, foul-smelling urine, fever, flank pain

Treat:

Neonates 10-14 days

Older children 7-14 days

recurrent uti s
Recurrent UTI’s
  • Renal ultrasound
  • VCUG
    • vesicoureteral reflux
  • Causes :
    • infrequent or incomplete voiding
    • poor perineal hygiene
    • pinworms
    • bubble baths
antibiotic dosing in children
Antibiotic Dosing in Children
  • Dose based on weight
  • Taste
  • Dosing schedule
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