pediatric infectious disease
DESCRIPTION
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. - PowerPoint PPT PresentationTRANSCRIPT
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Pediatric Infectious Disease
Brenda Beckett, PA-C
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Immunizations
Reduced childhood infectious disease markedly
US: 14 diseases– Diphtheria, tetanus, pertussis, measles,
mumps, rubella, poliomyelitis, Hib, S. pneumoniae, HBV, HAV, influenza, varicella, rotavirus
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Vaccine preventable diseases
Viral exanthems (covered in derm) Hepatitis (covered in ID) Polio
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Other dermatology
Impetigo Tinea Molluscum Cellulitis
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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
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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
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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
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FUO
Fever of unknown origin T >100.4 F lasting >14d with no obvious
cause List, p 463 Nelson
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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
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Conjunctivitis
progressive redness of conjunctiva discharge
– bacterial = profuse,purulent– viral = minimal, mucoid
unilateral ---> bilateral preauricular node enlargement – viral Treat: bacterial – topical antibiotics
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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
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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
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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
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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
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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
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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
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Otitis Media
Recurrent: >6 episodes in 6 mo Treat: Typmanostomy tubes
Sx: Fever, irritability, poor feeding, otalgia. Otorrhea (rupture)
Exam: Effusion, erythema, decreased mobility
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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
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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
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Sinusitis
Symptoms :– URI lasting longer than 10-12 days– low-grade fever, cough, HA in older child– malodorous breath– intermittent AM periorbital swelling/rednessTrt: amox, augmentin, azythromycin
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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
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Lymphadenopathy
Most prominent in 4-8 yo Cervical most common Location can differentiate cause of
infection
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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 nodesDD???
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Pharyngitis/Tonsillitis
School-age 5-15 years Symptoms :
– sorethroat– fever/chills– general malaise– referred ear pain– headache– abdominal pain/vomiting
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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
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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
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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
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Mononucleosis
Lab: Positive monospot or EBV titer Treat: usually supportive unless
lymphadenopathy is severe, then oral steroids
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Patient Presentation
18 month old with “wheezing” URI sx for 2-3 days No fever Other history questions? DD??
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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)
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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
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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
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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
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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)
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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
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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
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Pneumonia
S. pneumo and HiB – immunizations Viral (RSV) Sputum?
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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
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Mycoplasma Pneumonia
Signs :– widespread crackles– decreased breath sounds
CXR - patchy infiltrates Labs :
– WBC = normal– cold agglutinin titer = 1:32 or greater
Treatment – erythromycin, azythromycin
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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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Chlamydial Pneumonia
Labs : – serum immunoglobins usually high– nasopharyngeal swab– peripheral eosinophilia > 400 cells/mm3
CXR :– diffuse infiltrates and hyperexpansion
Treatment :– Erythromycin, azythromycin
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Meningitis
Causative organisms change with age Preceding URI sx HA, irritability, nausea, nuchal rigidity,
lethargy, photophobia, vomiting Fever Kernig and Brudzinski signs LP
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Patient Presentation
7 month old with 24 hrs of vomiting, diarrhea
No fever Other history questions? DD??
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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
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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
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Signs of Dehydration
body weight mucous membranes skin turgor / color fontanelles pulse/BP/respirations/perfusion tears urinary output
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Treatment
Infants : – continue breast feeding– oral rehydration solution-->1/2 strength
formula-->full strength formula Older child :
– sips of clear fluids– ORT**New vaccine
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Pinworms
Most common parasitic disease in children
cause : Enterobius vermicularis symptom : perianal itching, esp.
nocturnal labs : adhesive tape test treatment : mebendazole 100 mg CH
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Urinary Tract Infection
Infants :– strong-smelling urine– Irritability– Or just fever
Preschooler :– abdominal pain– vomiting– strong-smelling urine– fever
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UTI
School-age : ‘classic’– Dysuria, frequency, urgency, secondary
enuresis, foul-smelling urine, fever, flank pain
Treat: Neonates 10-14 daysOlder children 7-14 days
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Recurrent UTI’s
Renal ultrasound VCUG
– vesicoureteral reflux Causes :
– infrequent or incomplete voiding– poor perineal hygiene– pinworms– bubble baths
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Antibiotic Dosing in Children
Dose based on weight Taste Dosing schedule