pediatric infectious disease brenda beckett, pa-c

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Pediatric Infectious Disease Brenda Beckett, PA-C

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Page 1: Pediatric Infectious Disease Brenda Beckett, PA-C

Pediatric Infectious Disease

Brenda Beckett, PA-C

Page 2: 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

Page 3: Pediatric Infectious Disease Brenda Beckett, PA-C

Vaccine preventable diseases

Viral exanthems (covered in derm) Hepatitis (covered in ID) Polio

Page 4: Pediatric Infectious Disease Brenda Beckett, PA-C

Other dermatology

Impetigo Tinea Molluscum Cellulitis

Page 5: Pediatric Infectious Disease Brenda Beckett, PA-C

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

Page 6: Pediatric Infectious Disease Brenda Beckett, PA-C

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

Page 7: Pediatric Infectious Disease Brenda Beckett, PA-C

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

Page 8: Pediatric Infectious Disease Brenda Beckett, PA-C

FUO

Fever of unknown origin T >100.4 F lasting >14d with no obvious

cause List, p 463 Nelson

Page 9: Pediatric Infectious Disease Brenda Beckett, PA-C

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

Page 10: Pediatric Infectious Disease Brenda Beckett, PA-C

Conjunctivitis

progressive redness of conjunctiva discharge

– bacterial = profuse,purulent– viral = minimal, mucoid

unilateral ---> bilateral preauricular node enlargement – viral Treat: bacterial – topical antibiotics

Page 11: Pediatric Infectious Disease Brenda Beckett, PA-C
Page 12: Pediatric Infectious Disease Brenda Beckett, PA-C

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

Page 13: Pediatric Infectious Disease Brenda Beckett, PA-C

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

Page 14: Pediatric Infectious Disease Brenda Beckett, PA-C

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

Page 15: Pediatric Infectious Disease Brenda Beckett, PA-C
Page 16: Pediatric Infectious Disease Brenda Beckett, PA-C

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

Page 17: Pediatric Infectious Disease Brenda Beckett, PA-C
Page 18: Pediatric Infectious Disease Brenda Beckett, PA-C

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

Page 19: Pediatric Infectious Disease Brenda Beckett, PA-C

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

Page 20: Pediatric Infectious Disease Brenda Beckett, PA-C

Otitis Media

Recurrent: >6 episodes in 6 mo Treat: Typmanostomy tubes

Sx: Fever, irritability, poor feeding, otalgia. Otorrhea (rupture)

Exam: Effusion, erythema, decreased mobility

Page 21: Pediatric Infectious Disease Brenda Beckett, PA-C

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

Page 22: Pediatric Infectious Disease Brenda Beckett, PA-C
Page 23: Pediatric Infectious Disease Brenda Beckett, PA-C
Page 24: Pediatric Infectious Disease Brenda Beckett, PA-C

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

Page 25: Pediatric Infectious Disease Brenda Beckett, PA-C

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

Page 26: Pediatric Infectious Disease Brenda Beckett, PA-C

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

Page 27: Pediatric Infectious Disease Brenda Beckett, PA-C

Lymphadenopathy

Most prominent in 4-8 yo Cervical most common Location can differentiate cause of

infection

Page 28: Pediatric Infectious Disease Brenda Beckett, PA-C

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???

Page 29: Pediatric Infectious Disease Brenda Beckett, PA-C

Pharyngitis/Tonsillitis

School-age 5-15 years Symptoms :

– sorethroat– fever/chills– general malaise– referred ear pain– headache– abdominal pain/vomiting

Page 30: Pediatric Infectious Disease Brenda Beckett, PA-C

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

Page 31: Pediatric Infectious Disease Brenda Beckett, PA-C

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

Page 32: Pediatric Infectious Disease Brenda Beckett, PA-C
Page 33: Pediatric Infectious Disease Brenda Beckett, PA-C

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

Page 34: Pediatric Infectious Disease Brenda Beckett, PA-C

Mononucleosis

Lab: Positive monospot or EBV titer Treat: usually supportive unless

lymphadenopathy is severe, then oral steroids

Page 35: Pediatric Infectious Disease Brenda Beckett, PA-C
Page 36: Pediatric Infectious Disease Brenda Beckett, PA-C
Page 37: Pediatric Infectious Disease Brenda Beckett, PA-C

Patient Presentation

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

Page 38: Pediatric Infectious Disease Brenda Beckett, PA-C

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)

Page 39: Pediatric Infectious Disease Brenda Beckett, PA-C

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

Page 40: Pediatric Infectious Disease Brenda Beckett, PA-C

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

Page 41: Pediatric Infectious Disease Brenda Beckett, PA-C
Page 42: Pediatric Infectious Disease Brenda Beckett, PA-C

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

Page 43: Pediatric Infectious Disease Brenda Beckett, PA-C
Page 44: Pediatric Infectious Disease Brenda Beckett, PA-C

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)

Page 45: Pediatric Infectious Disease Brenda Beckett, PA-C

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

Page 46: Pediatric Infectious Disease Brenda Beckett, PA-C

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

Page 47: Pediatric Infectious Disease Brenda Beckett, PA-C

Pneumonia

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

Page 48: Pediatric Infectious Disease Brenda Beckett, PA-C

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

Page 49: Pediatric Infectious Disease Brenda Beckett, PA-C

Mycoplasma Pneumonia

Signs :– widespread crackles– decreased breath sounds

CXR - patchy infiltrates Labs :

– WBC = normal– cold agglutinin titer = 1:32 or greater

Treatment – erythromycin, azythromycin

Page 50: Pediatric Infectious Disease Brenda Beckett, PA-C

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

Page 51: Pediatric Infectious Disease Brenda Beckett, PA-C

Chlamydial Pneumonia

Labs : – serum immunoglobins usually high– nasopharyngeal swab– peripheral eosinophilia > 400 cells/mm3

CXR :– diffuse infiltrates and hyperexpansion

Treatment :– Erythromycin, azythromycin

Page 52: Pediatric Infectious Disease Brenda Beckett, PA-C

Meningitis

Causative organisms change with age Preceding URI sx HA, irritability, nausea, nuchal rigidity,

lethargy, photophobia, vomiting Fever Kernig and Brudzinski signs LP

Page 53: Pediatric Infectious Disease Brenda Beckett, PA-C

Patient Presentation

7 month old with 24 hrs of vomiting, diarrhea

No fever Other history questions? DD??

Page 54: Pediatric Infectious Disease Brenda Beckett, PA-C

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

Page 55: Pediatric Infectious Disease Brenda Beckett, PA-C

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

Page 56: Pediatric Infectious Disease Brenda Beckett, PA-C

Signs of Dehydration

body weight mucous membranes skin turgor / color fontanelles pulse/BP/respirations/perfusion tears urinary output

Page 57: Pediatric Infectious Disease Brenda Beckett, PA-C

Treatment

Infants : – continue breast feeding– oral rehydration solution-->1/2 strength

formula-->full strength formula Older child :

– sips of clear fluids– ORT**New vaccine

Page 58: Pediatric Infectious Disease Brenda Beckett, PA-C

Pinworms

Most common parasitic disease in children

cause : Enterobius vermicularis symptom : perianal itching, esp.

nocturnal labs : adhesive tape test treatment : mebendazole 100 mg CH

Page 59: Pediatric Infectious Disease Brenda Beckett, PA-C

Urinary Tract Infection

Infants :– strong-smelling urine– Irritability– Or just fever

Preschooler :– abdominal pain– vomiting– strong-smelling urine– fever

Page 60: Pediatric Infectious Disease Brenda Beckett, PA-C

UTI

School-age : ‘classic’– Dysuria, frequency, urgency, secondary

enuresis, foul-smelling urine, fever, flank pain

Treat: Neonates 10-14 daysOlder children 7-14 days

Page 61: Pediatric Infectious Disease Brenda Beckett, PA-C

Recurrent UTI’s

Renal ultrasound VCUG

– vesicoureteral reflux Causes :

– infrequent or incomplete voiding– poor perineal hygiene– pinworms– bubble baths

Page 62: Pediatric Infectious Disease Brenda Beckett, PA-C

Antibiotic Dosing in Children

Dose based on weight Taste Dosing schedule