Infectious and Communicable Diseases

1. Infectious and Communicable Diseases Ball & Bindler Donna Hills APN EdD

2. Clinical Considerations • Etiology: bacterial, fungal, viral, or protozoan • Cluster of symptoms are disease specific • fever secondary to the release of prostaglandins, triggered by the invading organism • may be a beneficial physiologic response. Fevers < 101-101.5 may not be treated right away.

3. Clinical Management • Fevers > 101.5 are only treated with Acetominophen or Ibuprophen;not Aspirin due to association with Reye’s syndrome • Symptomatic relief with viruses • Antibiotics with bacterial infection; (anti-fungal or protozoan as applicable) • Prevention of transmission/Isolation of infected child. • Good handwashing/ bacteriostatic hand gel

4. The Toxic Child • exhibits more severe symptomatology of illness • high fever, lethargy, poor ability to focus or give eye contact, decreased tone, poor perfusion (delayed cap refill), hypoventilation or hyperventilation, cyanosis, saturation less than 95% on room air, significantly low temperature in a premie or child with neurologic impairment.

5. Evaluating Child with Fever/illness • Body’s natural defense against infection Low grade fever may be beneficial to fight off organisms or enhance the effect of antibiotics. • Antipyretics are usually given for temps >100 or 101 Ax (per Dr.’s order). • Fevers >102 should be treated • Some children experience febrile seizures so may treat more rapidly in this case. • Acetominophen or Ibuprophen are preferred in children: no ASA d/t assoc with Reyes Syndr.

6. Case Study: 1 month old with a fever • Mrs. Carole calls the pediatric office to report that her 1 mo old has an axillary temp of 101. She is eating a little less than usual but otherwise seems fine. • What is your response to Mrs. Carole and what is your rationale?

7. Otitis Media • Used to be a common cause for fever • Incidence is now decreased with the use of the HIB and PCV vaccines. • Some children are still anatomically prone to OM due to poor eustachian tube dysfunction with or without a URI • Treatment with antibiotics: Amoxicillin, Azithromycin, Augmentin, Cefuroxime. • Persistent fluid (SOM) can lead to hearing loss over time.

8. Infectious Skin Infestations • Lice (Pediculosis Capitis) • Common among children of all socioeconomic levels; ages 3-10yr most common. • Nits found on hair shaft • Incub for eggs 8-10 days • Presents with itching and “flaking” • Rx with Permethrin (Nix) shampoo • Lindane is last resort: neurotoxic • No-nit policy can be diffic for parents; not recommended by AAP.

9. Scabies • Mite infestation: Sarcoptes scabei • Skin to skin contact; household transmission common • Most common in kids <2yrs • Presents with intense puritis and characteristic linear rash (on hands or fingers) or diffuse trunkal rash. • Rx with scabicide lotion (Permethrin 5%).

10. Impetigo • Bacterial infection caused by staph or streptococcus. • Common sites: face, around mouth, hands, neck, and extremities, intertriginous areas. • Irritation or break in the skin serves as an entry • Presentation as pustule surrounded by erythema/edema, erupts with honey colored crust. • Bullous impetigo: vesicles enlarge, stim by release of endotoxin: coalesce • Spread to face or extr: self innoculation.

11. Infectious and Communicable Diseases • Review and study table 12-5 pgs 620-635. • Complete the worksheet/handout for infectious diseases.