21 - Childhood Illnesses

Question 1

What causes whooping cough?

Answer 1

Bordatella pertussis bacterium

Question 2

Important notes about whooping cough

Answer 2

• 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)

Question 3

What is the clinical presentation of whooping cough?

Answer 3

• 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

Question 4

How is whooping cough diagnosed?

Answer 4

• 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)

Question 5

What are some non-pharms for whooping cough?

Answer 5

• 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

Question 6

What are the pharm options for whooping cough?

Answer 6

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

Question 7

What usually causes croup? What is another name for croup?

Answer 7

• Aka laryngotracheitis
• Virus
• Parainfluenza virus type 1 is most common cause

Question 8

What are the signs and sx of croup?

Answer 8

• Inflammation of larynx and subglottic airway (lower airway sx generally absent)
• Anatomic hallmark = narrowing of subglottic airway (restricting airflow)

Question 9

What ages does croup occur in?

Answer 9

• Children aged 6 months - 3 y/o most frequently
• Rarely over 6 y/o
• Can be recurrent

Question 10

What is the clinical presentation of croup?

Answer 10

• 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

Question 11

When should a parent seek medical attention for suspected croup?

Answer 11

• 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

Question 12

What are non-pharms for croup?

Answer 12

• 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

Question 13

What is the pharm tx for croup?

Answer 13

• Corticosteroids (dexamethasone 0.6 mg/kg given once po/IV/IM)
• Nebulized epinephrine (severe cases in hospital)
• Antipyretics for fever

Question 14

Is there a vaccine for croup?

Answer 14

No

Question 15

What are 2 other names for erythema infectiosum?

Answer 15

• Fifth disease

- Slapped cheek

Question 16

What causes erythema infectiosum?

Answer 16

Parvovirus B19

Question 17

What is the incubation period for parvovirus B19? How long is a person contagious? How is it spread?

Answer 17

• 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

Question 18

Can pregnant women infected w/ parvovirus B19 pass it on the their fetus?

Answer 18

Yes, which can cause miscarriage or intrauterine fetal death

Question 19

What is the clinical presentation of erythema infectiosum?

Answer 19

• 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)

Question 20

What are some non-pharms for erythema infectiosum?

Answer 20

• Hand hygiene

- Pregnant women should have serology testing if known/suspected exposure

Question 21

What is the pharm tx for erythema infectiosum?

Answer 21

• None if rash isn’t itchy

- Supportive care for prodrome (antipyretics, analgesics)

Question 22

Is there a vaccine for erythema infectiosum?

Answer 22

No

Question 23

What is hand, foot and mouth disease? What causes it?

Answer 23

Relatively benign syndrome caused by a virus

Question 24

When and in whom do the majority of hand, foot and mouth disease outbreaks occur?

Answer 24

• Infants and children

- Late summer/early fall

Question 25

What are sx of hand, foot and mouth disease?

Answer 25

• Flu-like sx
• Painful blisters on oral mucosa
• Non-painful blisters on hands and feet

Question 26

How is hand, foot and mouth disease transmitted?

Answer 26

• Fecal-to-oral route

- Oral/respiratory secretions and contact w/ fluid in rash vesicle

Question 27

Is hand, foot and mouth disease contagious?

Answer 27

• Very!

- Virus is shed in feces up to 4 weeks after contracting

Question 28

How long does it normally take for hand, foot and mouth disease to resolve?

Answer 28

7 days

Question 29

What are some non-pharms for hand, foot and mouth disease?

Answer 29

• Cold, easy-to-eat foods
• Clean diaper change areas well
• Handwashing

Question 30

What is the pharm tx for hand, foot and mouth disease?

Answer 30

• None (virus will run its course)

- Sx management (acetaminophen, ibuprofen)

Question 31

Is there a vaccine for hand, foot and mouth disease?

Answer 31

No

Question 32

What causes chicken pox?

Answer 32

Varicella-zoster virus

Question 33

Is chicken pox serious in children? Is it contagious? What is the incubation period?

Answer 33

• Normally mild in children, but more significant in adults
• Highly contagious (aerosolized or contact w/ vesicle fluid)
• Incubation = 7-21 days

Question 34

When should a suspected case of chicken pox be referred?

Answer 34

Immunocompromised (AIDS, cancer, chemotherapy)

Question 35

What is the primary and secondary infection of varicella?

Answer 35

• Primary = chicken pox (varicella rash)

- Secondary = shingles (herpes zoster)

Question 36

Does vaccination against varicella-zoster virus guarantee immunity?

Answer 36

No, about 10% of children vaccinated may experience chicken pox if exposed to the disease
- Especially if they’ve only received one dose

Question 37

What is the clinical presentation of chicken pox?

Answer 37

• 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)

Question 38

What is the clinical presentation of shingles?

Answer 38

Very painful rash located along dermatomes

Question 39

What are some non pharms for chicken pox?

Answer 39

• Keep children home until lesions crust (about 5 days after 1st spots appear)
• Discourage scratching
• Cut nails short to prevent infection
• Wash hands frequently

Question 40

What is the pharm tx for chicken pox?

Answer 40

• Nothing for most children
• At-risk children (immunocompromised) may need antiviral tx
• Can use tylenol for fever
• Can use benadryl for itching
• Vaccination