21 - Childhood Illnesses Flashcards
What causes whooping cough?
Bordatella pertussis bacterium
Important notes about whooping cough
- Respiratory disease
- Co-infection w/ other respiratory pathogens can occur
- Can be fatal to infants under 1 y/o
- Aerosolized transmission
- Incubation period about 7-10 days (up to 20 days)
What is the clinical presentation of whooping cough?
- Stage 1 (catarrhal) - mild cold sx (sneezing, runny nose); fever uncommon
- Stage 2 (paroxysmal) - 1-2 weeks after, nasal sx improve but cough worsens; hallmark sx is persistent, violent cough to the point of breathlessness/vomiting w/ a “whoop” sound on inspiration
- Stage 3 (convalescent) - cough improves slowly over 2-6 weeks; may take months to completely resolve
How is whooping cough diagnosed?
- Clinical presentation - persistent cough illness (non-productive, paroxysms of coughing, whoop) usually w/o fever
- Lab findings - leukocytosis (usually due to elevated lymphocytes)
- General diagnosis = 2 or more weeks of cough illness w/ at least 1 characteristic feature (cough paroxysms, “whoop” on inspiration, post-tussive vomiting)
What are some non-pharms for whooping cough?
- Handwashing for prevention
- Humidifier
- Keep children home from school/daycare until antibiotic tx complete
- Avoid paroxysm triggers (exercise, cold temps)
- Ensure adequate fluid and nutrition
What are the pharm options for whooping cough?
Azithromycin
- Infants 1-5 months = 10 mg/kg/dose for 5 days
- Anyone 6 months or older = 10 mg/kg on day 1 (max 500 mg/dose) then 5 mg/kg on days 2-5 (max 250 mg/dose)
- Treat all household contacts prophylactically
- *Vaccination for prevention
What usually causes croup? What is another name for croup?
- Aka laryngotracheitis
- Virus
- Parainfluenza virus type 1 is most common cause
What are the signs and sx of croup?
- Inflammation of larynx and subglottic airway (lower airway sx generally absent)
- Anatomic hallmark = narrowing of subglottic airway (restricting airflow)
What ages does croup occur in?
- Children aged 6 months - 3 y/o most frequently
- Rarely over 6 y/o
- Can be recurrent
What is the clinical presentation of croup?
- Starts w/ general cold sx (rhinorrhea, congestion, coryza)
- 24-48 h develops into fever and cough
- Hallmark sx = “barking cough” distressed breathing and stridor (high pitched wheezing sound)
- Sx worse at night
When should a parent seek medical attention for suspected croup?
- Stridor at rest
- Drooling/inability to swallow
- Retractions around sternum and rib cage
- Pallor and/or cyanosis
- High fever
- Worsening course and/or prolonged illness (greater than 7 days)
- Difficulty breathing
What are non-pharms for croup?
- Keep child calm (very important)
- Position child however they are most comfortable
- Sleep in same room w/ child in event of breathing distress
- Oxygen therapy (in hospital)
- Encourage fluid intake
What is the pharm tx for croup?
- Corticosteroids (dexamethasone 0.6 mg/kg given once po/IV/IM)
- Nebulized epinephrine (severe cases in hospital)
- Antipyretics for fever
Is there a vaccine for croup?
No
What are 2 other names for erythema infectiosum?
- Fifth disease
- Slapped cheek
What causes erythema infectiosum?
Parvovirus B19
What is the incubation period for parvovirus B19? How long is a person contagious? How is it spread?
- Incubation = 4-20 days from contact w/ infected person
- Contagious for 7-10 days prior to onset of rash sx; no longer contagious once rash has started
- Spread via respiratory and salivary secretions
Can pregnant women infected w/ parvovirus B19 pass it on the their fetus?
Yes, which can cause miscarriage or intrauterine fetal death
What is the clinical presentation of erythema infectiosum?
- Prodrome = non-specific (fever, rhinorrhea, headache, N/V, diarrhea)
- Rash on cheek appears that looks bright red, like “slapped cheeks” 2-5 days after prodrome
- Rash is symmetric, macular (flat), and “lace-like” in appearance; not itchy or painful
- Rash may spread to trunk, arms, buttocks, and thighs (usually 1-4 days after rash appears on face)
- Rash usually resolves over 7-10 days
- Rash may reappear over subsequent weeks in response to various stimuli (sun/heat, hot baths, exercise, emotional stress)
What are some non-pharms for erythema infectiosum?
- Hand hygiene
- Pregnant women should have serology testing if known/suspected exposure
What is the pharm tx for erythema infectiosum?
- None if rash isn’t itchy
- Supportive care for prodrome (antipyretics, analgesics)
Is there a vaccine for erythema infectiosum?
No
What is hand, foot and mouth disease? What causes it?
Relatively benign syndrome caused by a virus
When and in whom do the majority of hand, foot and mouth disease outbreaks occur?
- Infants and children
- Late summer/early fall
What are sx of hand, foot and mouth disease?
- Flu-like sx
- Painful blisters on oral mucosa
- Non-painful blisters on hands and feet
How is hand, foot and mouth disease transmitted?
- Fecal-to-oral route
- Oral/respiratory secretions and contact w/ fluid in rash vesicle
Is hand, foot and mouth disease contagious?
- Very!
- Virus is shed in feces up to 4 weeks after contracting
How long does it normally take for hand, foot and mouth disease to resolve?
7 days
What are some non-pharms for hand, foot and mouth disease?
- Cold, easy-to-eat foods
- Clean diaper change areas well
- Handwashing
What is the pharm tx for hand, foot and mouth disease?
- None (virus will run its course)
- Sx management (acetaminophen, ibuprofen)
Is there a vaccine for hand, foot and mouth disease?
No
What causes chicken pox?
Varicella-zoster virus
Is chicken pox serious in children? Is it contagious? What is the incubation period?
- Normally mild in children, but more significant in adults
- Highly contagious (aerosolized or contact w/ vesicle fluid)
- Incubation = 7-21 days
When should a suspected case of chicken pox be referred?
Immunocompromised (AIDS, cancer, chemotherapy)
What is the primary and secondary infection of varicella?
- Primary = chicken pox (varicella rash)
- Secondary = shingles (herpes zoster)
Does vaccination against varicella-zoster virus guarantee immunity?
No, about 10% of children vaccinated may experience chicken pox if exposed to the disease
- Especially if they’ve only received one dose
What is the clinical presentation of chicken pox?
- Prodrome = fever, malaise, sore throat
- About 24 h later - very itchy rash, red spots -> blisters -> crusty (crusts fall off in 1-2 weeks)
- Complications = skin infections (group A strep) or Reye’s syndrome (ASA)
What is the clinical presentation of shingles?
Very painful rash located along dermatomes
What are some non pharms for chicken pox?
- Keep children home until lesions crust (about 5 days after 1st spots appear)
- Discourage scratching
- Cut nails short to prevent infection
- Wash hands frequently
What is the pharm tx for chicken pox?
- Nothing for most children
- At-risk children (immunocompromised) may need antiviral tx
- Can use tylenol for fever
- Can use benadryl for itching
- Vaccination
