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Pediatric Infectious Disease

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Pediatric Infectious Disease Brenda Beckett, PA-C 4. Lower in morning higher in afternoon 5. Infants don t mount much of a fever response, older kids mount a large ... – PowerPoint PPT presentation

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Title: 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
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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
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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
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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

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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
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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
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36
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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
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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
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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
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