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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.

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Pediatric Infectious Disease

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  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 >100.4F (38 C) is FEVER • Diurnal variation • Age variation

  6. 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

  7. 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

  8. FUO • Fever of unknown origin • T >100.4 F lasting >14d with no obvious cause • List, p 463 Nelson

  9. 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

  10. Conjunctivitis • progressive redness of conjunctiva • discharge • bacterial = profuse,purulent • viral = minimal, mucoid • unilateral ---> bilateral • preauricular node enlargement – viral • Treat: bacterial – topical antibiotics

  11. 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

  12. 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

  13. 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

  14. 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

  15. 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

  16. 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

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

  18. 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

  19. 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

  20. 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

  21. 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

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

  23. 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???

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

  25. 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

  26. 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

  27. 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

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

  29. Patient Presentation • 18 month old with “wheezing” • URI sx for 2-3 days • No fever • Other history questions? • DD??

  30. 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)

  31. 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

  32. 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

  33. 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

  34. 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)

  35. 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

  36. 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

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

  38. 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

  39. Mycoplasma Pneumonia • Signs : • widespread crackles • decreased breath sounds • CXR - patchy infiltrates • Labs : • WBC = normal • cold agglutinin titer = 1:32 or greater • Treatment – erythromycin, azythromycin

  40. 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

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