Download 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
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*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
