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Pediatric Infectious Diseases

Dr.abdulmahi .A.hasan

PhD, Pediatric & Mental health nursing

From Lice in the hair to blisters on their feet!

Ear, nose, throat

Respiratory infections

GI

Dermal Infections

Common Viral Infections

Their identification

Their Treatment

Lice

Parasites that infest the head, body and pubic area

A whole group of people now who are professional “ Nit pickers!” Not kidding

Lice: Pediculus Humanus

Spread by close person to person contact

Life cycle is Nit( Nymph ( Adult

Adult is the size of a pinhead, is rusty color and clings to hair

Lice

Treatment: Permethrin 1% cream rinse applied to clean dry hair and left on for 10 min. Repeat in 1 wk

OR Ovide applied to dry hair for 8-14 hours then rinse

OR a professional Nit picker in conjunction with the above. They use special fine tooth combs through every strand of hair. It’s costly though $330.00 for 3 sessions!!!!!

The Eyes Have It!

Conjunctivitis

Etiology

Acute conjunctivitis usually a bacterial or viral infection

Characterized by a rapid onset

Several days duration

Common bacterial causes

Nontypable H. influenza

S. pnuemoniae

M. catarrhalis

N. gonorrhoeae

P. aeruginosa

Incubation 24-72 hours

Conjunctivitis

Common viral causes:

Adenoviruses

Coxsackieviruses

Enteroviruses

Herpes simplex

Incubation 1-14 days

Epidemiology

Common in young children, especially if in contact with other children with conjunctivitis.

Predisposing factors for bacterial infection include

Nasolacrimal duct obstruction

Sinus disease

Ear infection

Allergic children who rub their eyes frequently

Allergic

Seasonal, itchy, bilateral chemosis

Conjunctivitis

Clinical Manifestations

Symptoms include

Redness

Discharge

Matted eyelids

Mild photophobia

Foreign body sensation

Physical examination findings include

Chemosis

Injection of the conjunctiva

Edema of the eyelids

Conjunctivitis

Diagnosis

Cultures are not routinely obtained because bacterial conjunctivitis is usually self-limited or responds quickly to antibiotic treatment.

Treatment for bacteria

Topical quinolone solution

Trimethoprim-polymyxin B solution

Sulfacetamide 10% solution

Erythromycin ointment

Conjunctivitis

Treatment for viral

Self limited

Treatment for allergic

Antihistamine, topical anti-inflammatory, cromalyn

The Ears Have It ?

Acute Otitis Media

Etiology

Arises as a complication preceding viral respiratory infection

Secretions and inflammation cause occlusion

Effusion fertile media for microbial growth

Rapid growth leads to infection

Acute Otitis Media

Etiology

Suppurative infection of the middle ear cavity

Common bacterial pathogens achieve access through blocked eustachian tube (infection, pharyngitis, or hypertrophied adenoids)

Air trapping → negative pressure → bacterial reflux

Bacterial reflux + obstructed flow → effusion

Acute Otitis Media

Common bacterial pathogens are

S. pnuemoniae

Nontypable H. influenza

M. catarrhalis

Group A streptococus

Sterile effusions occur in approximately 20% of cases

Acute Otitis Media

Epidemiology

One third of office visits to primary care.

The peak incidence - second 6 months of life.

By the first birthday, 62% of children experience at least one episode.

Few first episodes after 18 months

Acute Otitis Media

More common in boys

Lower socioeconomic status

Seasonal disease (distinct peak in January and February)

Corresponds to the rhinovirus, RSV, and influenza seasons

Is less common from July to September

Major risk factors for acute otitis media are

Young age

Bottle feeding

Drinking a bottle in bed

Parental history

Sibling history

Second hand smoke

Daycare

Acute Otitis Media

Clinical Manifestations

Symptoms often nonspecific, may include:

Fever

Irritability

Poor feeding

Otalgia

Otorrhea

Signs of a common cold

Acute Otitis Media

Diagnosis

Pneumatic otoscopy – standard for clinical diagnosis

tympanic membrane is characterized by hyperemia

Can be pink, white or yellow with bulging

Poor mobility with negative or positive pressure

Acute Otitis Media

The light reflex is lost - middle ear structures are obscured

A hole in the tympanic membrane or purulent drainage confirms perforation.

Bullae maybe present on the lateral aspect

Acute Otitis Media

Acute

Definition

Recent

Usually abrupt

Signs of acute illness

Fever

Pain

URI

Middle ear inflammation

Middle ear effusion

Chronic

Definition

Presence of effusion without any other signs and symptoms of acute illness

Acute Otitis Media

Treatment Recommendations

Infants younger than 6 months should receive antibiotics

Children 6 months to 2 years should receive antibiotics if the diagnosis is certain

Diagnosis uncertain observation period 48 to 72 hours with analgesics and follow up

Children 2 years and older should receive antibiotics if diagnosis is certain or illness severe

Observation period an option

Acute Otitis Media

Treatment

Amoxicillin – First line therapy

Second line therapy

Amoxicillin-clavulanate

Cefuroxime axetil

Cefdinir

ceftriaxone

Say Aah!

Pharyngitis

Etiology

Caused by many infectious agents

Most common bacterial

Group A streptococci (Strep pyogenes)

Group C beta hemolytic streptococcus

Group G streptococci

Neisseria gonorrhoeae

Most common viral

Rhinovirus

Adenovirus

Influenza A and B

Parainfluenza

Coxsackievirus

Coronavirus

Echovirus

Herpes simplex virus

EBV

CMV

Pharyngitis

Diagnosis

The challenge is to distinguish pharyngitis caused by group A streptococci from pharyngitis caused by nonstreptococcal organisms

Throat culture is the diagnostic “gold standard”

Rapid streptococcal antigen tests

Pharyngitis

Epidemiology

Relatively uncommon before 2 to 3 years of age

Increased incidence school-age children

Decreased incidence in late adolescence and adulthood

Occurs throughout the year in temperate climates

Peaks during the winter and spring

Easily spreads to siblings and classmates

Pharyngitis

Clinical Manifestations

Inflammation of pharyngitis causes

Cough

Sore throat

Dysphagia

Onset often rapid and associated with

Prominent sore throat

Moderate to high fever

Headache

Nausea

Vomiting

Abdominal pain

Pharyngitis

Typical, florid case

Pharynx is distinctly red

Tonsils are enlarged, with a yellow, blood-tinged exudate

Petechiae or doughnut-shaped lesions on the soft palate and posterior pharynx may be present

Uvula may be red, stippled, and swollen

Anterior cervical lymph nodes are tender and enlarged

Pharyngitis

Treatment

Untreated most episodes of streptococcal pharyngitis resolve

Antimicrobial therapy accelerates clinical recovery by 12-24 hours

Major benefit of antimicrobial therapy is the prevention of acute rheumatic fever

Penicillin given orally three or four times daily for a full 10 days

MRSA

Keep this in mind with any dermal infection!

Cutaneous abscesses that are stubborn, and require special treatment

MRSA

Should culture every abscess to R/O MRSA

Important to differentiate due to different treatment protocol, and need for nasal and body eradication

MRSA

Must I & D if needed,

Iodoform packing and dressing’s with bactroban topically

Treatment is bactrim or clindamycin PO in children. Can use Doxy in children over 8 y/o

Bad infections can require IV medication and hospitalization

Contagious to others in household

MRSA Eradication

Culture Nares

Consider culturing groin area in adolescents and adults

Bactroban intranasal with q tip BID for 7 days for everyone in house hold to eradicate colonization

“ Hibiclens” in shower BID for a period of 2-3 weeks to eradicate colonized areas on body

Rotavirus

Electron micrograph of rotavirus.

I’m Thirsty!

Baby being feed oral rehydration.

Rotavirus

Etiology

Invades the epithelium and damages villi of the upper small intestine

In severe cases involves the entire small bowel and colon

Vomiting may last 3 to 4 days, and diarrhea may last 7 to 10 days

Dehydration is common in younger children

Primary infection with rotavirus in infancy may cause moderate to severe disease but is less severe later in life

Rotavirus

Epidemiology

Occurs in both developed and developing countries

Peaks in the winter each year

Highest rate of illness occurs in children 3-24 months of age

Fecal oral route is the major mechanism of transmission

Rotavirus

Clinical Manifestation

Fever (low grade)

Lethargy

Abdominal pain

Dehydration

Diarrhea is characterized by watery stools, with no blood or mucus

Stools may be odorless or foul-smelling

Vomiting may be present

Dehydration may be prominent

Rotavirus

Diagnosis

CBC

BMP

UA for specific gravity as an indicator of hydration status

Stool specimens

Stool cultures

Rotavirus

Treatment

Most infectious causes of diarrhea in children are self-limited

Correcting dehydration and electrolyte deficits

Rotavirus

Prevention

Hand washing

Diaper changing

Water purification

Vaccines

RotaTeq – pentavalent RV5 (ages 2, 4, 6 mths)

Rotarix – RV1 (2 mths and 4 mths)

QUICK QUIZ?

Rotavirus invades which portion of our intestinal tract?

Large intestine

Colon

Upper small intestine

Lower small intestine

All of the above

KFC

Chickenpox (Varicella)

Etiology

Varicella-zoster (VZV) is a herpesvirus

Humans are the only source of infection

Chickenpox

Epidemiology

Person to person

Occurs by direct contact with varicella or zoster and respiratory secretions

Most common during late winter and early spring

Most reported cases occur between the ages of 5 and 9 years

Congenital varicella syndrome risk is about 2%, and is greatest in the first trimester

Incubation 10 to 21 days after contact

Cases most contagious 2 days before the rash appears, until 5 days after new lesions stop erupting

Chickenpox

Clinical Manifestation

Rash has multiple stages

Starts on the trunk, followed by head, face, then extremities

The appearance of a typical rash that occurs in successive crops of macules, papules, and vesicles is distinctive

Diagnosis

Immunofluorescence of the vesicular fluid

Culture of the vesicular fluid

PCR of any tissue of vesicular fluid

Chickenpox

Treatment

Acyclovir, vidarabine, famvir, foscarnet

Acyclovir is the drug of choice for children

Acetominophen may be used to control fever

NO ASPIRIN

Immunization

Varicella

MMRV

????

Impetigo

Etiology

Superficial skin infection involving almost any part of the body

Two forms: bullous and nonbullous

Bullous always S. aureus

Nonbullous predominantly S. aureus but may also be A B-hemolytic streptococcus

Impetigo

Epidemiology

Warm temperature

High humidity

Associated with socioeconomic disadvantage, especially crowding

Most common bacterial skin infection in children

Rare under 2 years of age; most common between 2 and 7 years of age

Impetigo

Clinical Manifestation

Bullous: transparent bullae that rupture easily, leaving a rim surrounding a shallow ulcer; normal surrounding skin; regional adenopathy rare

Nonbullous: papule or vesicle progression to a honey-crusted plaque; erythema of surrounding skin; regional adenopathy common

Impetigo

Diagnosis

Clinical diagnosis

Treatment

First line: cephalexin 50 mg/kg/d in two divided doses

Topical

Bactraban

Altabax

QUICK QUIZ?

What age group is most susceptible to impetigo?

1 – 2 years

2- 7 years

6- 10 years

7-11 years

Forgot the Sunscreen?

Roseola

Etiology

A common illness in preschool aged children characterized by fever lasting 3 to 7 days followed by rapid defervescence and the appearance of a blanching maculopapular rash lasting only 1 to 2 days

Major cause appears to be human herpesvirus 6 (HHV6)

Human herpesvirus 7 (HHV7) may also play a role

Roseola

Epidemiology

Occurs throughout the year

Commonly affects children 3 months to 4 years

The peak age 7 to 13 months

90% of cases occur in the first 2 years of life

Affects males and females equally

Incubation period is 5 to 15 days

Roseola

Clinical Manifestation

Rash appears as fever disappears and last 1 to 2 days

Cough

Coryza

Children remain alert and are not ill appearing

Eyelid edema has been noted

Lymphadenopathy

Roseola

Diagnosis

Clinical

History very important (telltale rash)

Can check blood test

Treatment

Supportive care

Hand Foot Mouth Disease

Enterovirus family

Coxsackie virus A16 infection MCC

Sores in mouth with associated blisters on hands and feet classically

May only have sores in mouth on exam in a lot of cases

Hand Foot Mouth

Can’t catch it from animals!

Mostly in children under 10 yo

Spread to other children through hand contamination

3-7 day incubation period

Hand Foot Mouth

Exam shows ulcers or blisters in the pharynx, lips and or tongue

Fevers, loss of appetite, headache

Supportive treatment. Control fever, good hydration

Has a benign course

QUESTION?

Predisposing factors for bacterial conjunctivitis include all except?

Nasolacromal duct obstruction

Sinusitis

Asthmatic bronchitis

Otitis media

Allergic conjunctivitis

QUESTION?

A diagnosis of acute otitis media includes all of the following except?

Fever

Middle ear effusion without pain

Middle ear inflammation

Recent onset

Otalgia

QUESTION?

Below what age is streptococcus pharyngitis rarely seen?

2-3 years

4-5 years

5-6 years

6-7 years

7-8 years

QUESTION?

Which virus appears to be the major cause of Roseola?

Enterovirus

Parainfluenza virus

Human herpes virus

Adenovirus

Eptein barr virus

QUESTION?

During which trimester of pregnancy is varicella of primary concern?

Second

First

Third

All the above

Not a concern for pregnant women

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