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Pediatric Infectious Diseases

الكلية كلية التمريض     القسم قسم التخصصات التمريضية     المرحلة 3
أستاذ المادة عبد المهدي عبد الرضا حسن الشحماني       25/10/2012 20:05:47
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 Nità Nymph à 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


المادة المعروضة اعلاه هي مدخل الى المحاضرة المرفوعة بواسطة استاذ(ة) المادة . وقد تبدو لك غير متكاملة . حيث يضع استاذ المادة في بعض الاحيان فقط الجزء الاول من المحاضرة من اجل الاطلاع على ما ستقوم بتحميله لاحقا . في نظام التعليم الالكتروني نوفر هذه الخدمة لكي نبقيك على اطلاع حول محتوى الملف الذي ستقوم بتحميله .