Pediatric Infectious Disease
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Transcript Pediatric Infectious Disease
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
– 6mo-2yr
– >2yr
Antibiotics
ABX for certain, observation
or ABX for uncertain
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 days
Older 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