Pediatric Infectious Disease

1
Pediatric Infectious Disease

• Brenda Beckett, PA-C

2
Immunizations

• Reduced childhood infectious disease markedly
• US 14 diseases
• Diphtheria, tetanus, pertussis, measles, mumps,
  rubella, poliomyelitis, Hib, S. pneumoniae, HBV,
  HAV, influenza, varicella, rotavirus

3
Vaccine preventable diseases

• Viral exanthems (covered in derm)
• Hepatitis (covered in ID)
• Polio

4
Other dermatology

• Impetigo
• Tinea
• Molluscum
• Cellulitis

5
Fever

• Normal body temp 37 C, 98.6 F
• Range of 97-99.6
• Rectal temp gt100.4F (38 C) is FEVER
• Diurnal variation
• Age variation

6
Fever, Newborns

• Neonates do not have febrile response
• lt3 months old, any fever is risk of serious
  bacterial infection
• May not have localizing signs
• Warrants workup bacteremia, UTI, meningitis,
  pneumonia, etc

7
Fever, lt3 years

• Exaggerated febrile response up to 105
• No localizing sx risk of S. pneumo, N.
  meningititis, Hib, Salmonella
• Observe child for alertness, irritability,
  consolability

8
FUO

• Fever of unknown origin
• T gt100.4 F lasting gt14d with no obvious cause
• List, p 463 Nelson

9
Febrile Seizure

• Usually lt3 yo
• Seizure can be first sign of fever
• Rule out other causes
• Increased risk of repeat seizures with fever
• Treat with antipyretics

10
Conjunctivitis

• progressive redness of conjunctiva
• discharge
• bacterial profuse,purulent
• viral minimal, mucoid
• unilateral ---gt bilateral
• preauricular node enlargement viral
• Treat bacterial topical antibiotics

11
(No Transcript)
12
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

13
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

14
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

15
(No Transcript)
16
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

17
(No Transcript)
18
Otitis Externa

• Cause Pseudomonas or S. aureus
• minor itching ---gt intense pain
• tenderness tragus/auricle
• erythema/swelling of canal
• purulent discharge
• possible postauricular node involvement
• Treatment Otic antibiotics, drying

19
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

20
Otitis Media

• Recurrent gt6 episodes in 6 mo
• Treat Typmanostomy tubes
• Sx Fever, irritability, poor feeding, otalgia.
  Otorrhea (rupture)
• Exam Effusion, erythema, decreased mobility

21
Otitis Media

• Treat based on age and severity
• lt 6mo Antibiotics
• 6mo-2yr ABX for certain, observation or ABX
  for uncertain
• gt2yr Observation or ABX for severe

22
(No Transcript)
23
(No Transcript)
24
Acute Viral Rhinitis

• Under age 5 --gt 6-12 colds per year
• Symptoms
• clear to mucoid rhinorrhea/nasal congestion
• fever
• mild sore throat/cough
• Management
• saline drops/bulb suction

25
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

26
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

27
Lymphadenopathy

• Most prominent in 4-8 yo
• Cervical most common
• Location can differentiate cause of infection

28
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???

29
Pharyngitis/Tonsillitis

• School-age 5-15 years
• Symptoms
• sorethroat
• fever/chills
• general malaise
• referred ear pain
• headache
• abdominal pain/vomiting

30
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

31
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

32
(No Transcript)
33
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

34
Mononucleosis

• Lab Positive monospot or EBV titer
• Treat usually supportive unless lymphadenopathy
  is severe, then oral steroids

35
(No Transcript)
36
(No Transcript)
37
Patient Presentation

• 18 month old with wheezing
• URI sx for 2-3 days
• No fever
• Other history questions?
• DD??

38
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)

39
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

40
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

41
(No Transcript)
42
Bronchiolitis

• RSV respiratory syncytial virus
• winter and early spring
• peak age 2-10 months
• fever
• URI ---gt wheezing and tachypnea
• nasal flaring, retractions, crackles/wheezing
• labs CXR, nasal swab/washing

43
(No Transcript)
44
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)

45
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

46
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

47
Pneumonia

• S. pneumo and HiB immunizations
• Viral (RSV)
• Sputum?

48
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

49
Mycoplasma Pneumonia

• Signs
• widespread crackles
• decreased breath sounds
• CXR - patchy infiltrates
• Labs
• WBC normal
• cold agglutinin titer 132 or greater
• Treatment erythromycin, azythromycin

50
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

51
Chlamydial Pneumonia

• Labs
• serum immunoglobins usually high
• nasopharyngeal swab
• peripheral eosinophilia gt 400 cells/mm3
• CXR
• diffuse infiltrates and hyperexpansion
• Treatment
• Erythromycin, azythromycin

52
Meningitis

• Causative organisms change with age
• Preceding URI sx
• HA, irritability, nausea, nuchal rigidity,
  lethargy, photophobia, vomiting
• Fever
• Kernig and Brudzinski signs
• LP

53
Patient Presentation

• 7 month old with 24 hrs of vomiting, diarrhea
• No fever
• Other history questions?
• DD??

54
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

55
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

56
Signs of Dehydration

• body weight
• mucous membranes
• skin turgor / color
• fontanelles
• pulse/BP/respirations/perfusion
• tears
• urinary output

57
Treatment

• Infants
• continue breast feeding
• oral rehydration solution--gt1/2 strength
  formula--gtfull strength formula
• Older child
• sips of clear fluids
• ORT
• New vaccine

58
Pinworms

• Most common parasitic disease in children
• cause Enterobius vermicularis
• symptom perianal itching, esp. nocturnal
• labs adhesive tape test
• treatment mebendazole 100 mg CH

59
Urinary Tract Infection

• Infants
• strong-smelling urine
• Irritability
• Or just fever
• Preschooler
• abdominal pain
• vomiting
• strong-smelling urine
• fever

60
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

61
Recurrent UTIs

• Renal ultrasound
• VCUG
• vesicoureteral reflux
• Causes
• infrequent or incomplete voiding
• poor perineal hygiene
• pinworms
• bubble baths

62
Antibiotic Dosing in Children

• Dose based on weight
• Taste
• Dosing schedule