Ch 40 PEDS infections: Viral, rickets, enteroviruses/parecho, Rashes (hand,foot,mouth) Flashcards
What are common predisposing illnesses that can lead to bacterial respiratory infections?
(SOAP)
Otitis media
Sinusitis
Pneumonia
Acute otitis media/menigitis (bacterial CAP)
Symptoms often found in a common cold include:
runny nose (rhinorrhea) nasal congestion sore throat tearing cough sneezing low-grade fever
What pathogens frequently cause common cold symptoms?
Rhinoviruses Adenoviruses RSV Parainfluenza Human metapneumovirus Influenza Enteroviruses
What are some expected outcomes of the common cold?
MAL
morbidity for 5 - 7 days
local mucosal swelling
altered local immunity (precursors for more severe illness, OM, pneumonia, sinusitis)
T/F Prescribing antibiotics for the common cold may prevent complications and limit duration of purulent rhinitis
FALSE - antibiotics cannot PREVENT complications and will not LIMIT duration of purulent rhinitis
How should the NP treat a child that is < 2 years old for the common cold?
Supportive measures such as:
hydration
humidified air
suctioning
How should the NP treat a child that is over the age of 2 for the common cold?
PO antihistamines
PO decongestants
PO cough suppressants
What treatments have no/limited effective reliability to improve symptoms for the common cold?
topical decongestants
Vitamin C
Zinc
Childhood ______ is caused mostly from enteric adnoviruses in children less than 4 years old
diarrhea
Adenovirus
What is the incubation period?
Early s/s?
Associated rash?
Lab test findings?
incubation: 4 - 5 days
early s/s: URI, cough, fever
rash: Morbilliform (petechial) resembles MMR
lab: leukopenia sometimes
What viruses have an incubation period greater than 2 weeks (14 days)?
Mononucleosis
Rubella
What specific adenovirus presents with fever, adenopahty, exudative tonsillitis, rhinitis, and influenza-like systemic illness findings? This is also the most common adenovirus disease.
Pharyngitis
What specific adenovirus will have no lower respiratory symptoms, conjunctivitis associated with preauricular adenopathy, fever, pharyngitis, and cervical adenopahty?
Pharyngoconjunctival fever (viral pharynigitis)
What two specific adenoviruses may present with a foreign-body sensation in the eye?
Pharyngoconjunctival fever
Epidemic keratoconjunctivitis
What specific adenovirus presents with severe conjunctivitis, photophobia, swelling of the eyelids, and subconjunctival hemorrhage?
Epidemic keratoconjunctivitis
On chest XRAY, bilateral peribronchial and patchy ground-glass interstitial infiltrates are present in the lower lobes. What should the NP suspect? What kind of virus may have caused this?
Pneumonia
adenovirus
What are complications of adenovirus pneumonia? What serotype is unusually severe and fatal in children and adults?
Bronchiectasis (hard to clear mucus)
Bronchiolitis (inflammation)
Bronchiolitis Obliterans (inflammatory obstruction of the lung’s)
serotype 14
What rash is absent in adenovirus?
kolpik spots
What adenovirus serotypes are causes of short-lived diarrhea in afebrile children? What age range is this finding common in?
serotype 40 and 41
< 4 years old
Any treatment specific for adenovirus illness?
What would you consider for the immunocompromised patient with severe pneumonia?
none!
IV IG for immunnocompromised patients
What types of diagnostic tests can identify adenoviruses?
Viral culture - 48 hours
PCR - rapid
ELISA - diarrheal
What viral infection presents as fever, cough, pharyngitis, malaise, congestion, pneumonia, and encephalitis in late fall to mid spring?
Influenza
Influenza
What is the incubation period? Early s/s? Young children specific findings? Older children specific findings? Lab test finding?
incubation: 2 - 7 days
early s/s: sudden high fever, severe mylagia, headache and chills
young children: abdominal pain, fever, diarrhea, vomitting
older children: high fever/mylagia/HA/chills, dehydrating enteritis, adenopathy
lab: low leukocytes
What specific diagnostic tools are preferred for influenza illness?
PCR*
Rapid culture technique
What two other viral illnesses present similarly to influenza?
Parainfluenza
RSV
What should a NP rule out in a suspected influenza child with protracted vomitting or irrational behavior during flu season?
Rule out Reye Syndrome!
most common causes are varicella and influenza type B
What are prevention methods for Influenza?
flu vaccine
can still get if allergic to eggs, consider inpatient vaccination setting
What two medications can be considered as prophylaxis for Influenza? What are the age requirements and/or contraindications of those medications?
> 3 months = Oseltamivir (Tamiflu)
> 5 years old = inhaled Zanamivir (NO ASTHMA/chronic pulmonary diseases)
all antivirals need to be given 48 hours after symptom onset and for 5 days
A child under the age of five presents with an acute onset fever, nasal congestion, sore throat, a cough and inspiratory stridor. What viral respiratory illness is this?
Parainfluenza - Croup
There are four types of human parainfluenza viruses (HPIV). What are the types? Age specific and occurrence
Type 1 and 2 - croup causing, infect children < 5 years old and during fall
type 3 is within the first 3 years of life (commonly 1 year old)
type 4 is year-round and less pathogenic
Parainfluenza (Croup)
What is the incubation period?
Early s/s? (general and croup specific)
Which type occurs most often?
Lab tests?
incubation: 2 - 7 days
early s/s: acute febrile URI, laryngitis, tracheobronchitis, croup, bronchiolitis (second most common)
Croup specific s/s: barking cough, inspiratory stridor, hoarseness
Type: Type 1 - croup, laryngitis, and tracheobronchitis
Labs: PCR, conventional or rapid culture techniques, or direct immunofluorescence of secretions
What is the treatment for Parainfluenza (croup)?
no specific treatment; manage symptoms
A one year old child presents with diffuse wheezing, variable fever, cough, tachypnea, and is having a difficult time feeding. What do you suspect this child has?
RSV
What respiratory virus is the cause of lower tract illness in young children?
RSV
RSV
What is the duration of illness?
Early s/s?
XRAY findings?
Lab tests?
duration: 3 - 7 days (previously healthy children)
classic s/s: bronchiolitis characterized by diffuse wheezing, variable fever, cough, tachypnea, difficulty feeding. Severe = cyanosis
XRAY: hyperinflation (causing palpable spleen and liver) and peribronchiolar thickening
Lab: real time PCR (too expensive), rapid antigen or ELISA
What is a differential diagnosis that should be considered in an infant < 6 months old with a prominent cough when RSV is suspected?
Pertussis
A child with suspected RSV presents to the ED. The NP found an elevated WBC on lab work. What differential diagnoses would this finding indicate?
Bacterial infection or Pneumonia
What treatment specific guidelines are suggested for RSV children that cannot maintain oxygen saturation, are very hypoxic or unable to eat due to respiratory distress?
oxygen therapy for oximetry reading < 90%
hospitalize any infant with poor feeding/hypoxia and give humidifed oxygen and NGT feedings
What treatments are NOT approved for children with RSV?
Antibiotics
decongestants
expectorants
albuterol/salbutamol or epinephrine
What medication is approved for infants with RSV that also have significant anatomic or immunologic defects?
Ribavirin antiviral aerosolization therapy
What finding evolves later in childhood after a hospitalized infection with RSV?
wheezing
What precursor is found post RSV infection in infancy?
asthma
A child with a cough, coryza (inflammation of the nose), and sore throat presents in your office. What do you suspect this viral illness is?
Human Metapneumovirus Infection (hMPV)
What two other respiratory illnesses may occur in children that acquire hMPV before the age of two?
Bronchiolitis
Pneumonia
dual infection with RSV may occur
What is the preferred method of diagnosis for hMPV (human metapneumovirus)?
PCR on respiratory specimens
What is the definitive diagnosis of human coronaviruses?
PCR
Human Coronaviruses
What is the incubation period?
Manifestation of s/s?
How can this group of viruses also present?
Incubation: 2 - 5 days for non-severe
S/S: rhinorrhea, sore throat, cough, occasionally fever
Present as: acute otitis media, trigger asthma exacerbation, and acute gastroenteritis
T/F Children with SAR-CoV-2 are severely symptomatic
FALSE! - children are asymptomatic or have milder s/s of fever, cough, myalgia, mild diarrhea, and abdominal pain
What complications may occur in children with SAR-CoV-2?
multiorgan dysfuntion (known as MIS-C)
What lab finding is present in symptomatic cases of SAR-CoV-2?
elevated procalcitonin
What viral respiratory illnesses are associated with enterovirus causes?
Acute febrile pharyngitis Herpangina acute Lymphonodular Pharyngitis Hand, food, mouth disease Pleurodynia (Bornholm disease, Epidemic Myalgia)
Enterovirus
What is the incubation period?
Early s/s?
Associated rash?
Lab test findings?
incubation: 2 - 7 days
s/s: variable fever, chills, myalgia, sore throat
Rash: variable - macular/maculopapular on trunk or palms, soles or vesicles or petechiae (H/F/M or pharyngeal)
Lab: PCR
Parovirus (erythema infectiosum)
What is the incubation period?
Early s/s?
Associated rash?
Labs?
Incubation: 10 - 17 days (rash)
s/s: mild, flu-like
rash: maculopapular on cheeks “slapped cheek”, forehead, chin, limbs, trunk, buttocks
Labs: IgM-EIA, PCR
Acute Febrile Pharyngitis (enterovirus) presents with what findings in older children? Duration?
sore throat headache myalgia abdominal discomfort lasting 3 - 4 days
What presents on the pharynx in acute febrile pharyngitis (enterovirus)?
vesicles or papules on the pharynx without exudate
What enterovirus presents with an acute onset fever with posterior pharyngeal grayish white vesicles that quickly form ulcers? The child may also be drooling, vomiting and has dysphagia.
Herpangina
How long do the symptoms last with Herpangina?
4 - 5 days
What specific viruses are associated with Herpangina?
Coxsackie A viruses (epidemics)
Coxackie B/echovirus (sporadic)
What enterovirus presents with febrile pharyngititis with nonulcerative yellow-white posterior pharyngeal papules along the posterior palate?
Acute Lymphonodular Pharyngitis
What is the treatment of choice for acute lymphondular pharyngitis (enterovirus) and what is the duration of the virus?
Supportive treatment
1 - 2 weeks
What clinical diagnosis would be suspected for a child with vesicles or red papules found on the tongue, oral mucosa, hands and feet, near the nails, and on the heals?
Hand-Foot-Mouth (enteriovirus)
What type of virus (strands) occur in Hand-Foot-Mouth?
Coxsackieviruses - A5, A10, A16
How long will the rash of hand-foot-mouth be present?
1 - 2 weeks, rash may appear when fever reduces, simulating roseola
What enterovirus presents as an abrupt onset of unilateral or bilateral spasmodic pain of variable intensity over the lower ribs or upper abdomen?
What other symptoms by be present?
Pleurodynia (Bornholm Disease, Epidemic Myalgia)
DISEASE OF THE MUSCLES!
headache, fever, vomiting, myalgia, abdominal/neck pain, decreased thoracic excursion, and friction rub
What virus is associated with Pleurodynia (Bornholm disease, Epidemic Myalgia)?
How long do symptoms last? (duration)
Coxsackie B
1 week duration
What treatment options would you consider for a child with Pleurodynia (Bornholm disease, Epidemic myalgia)?
Analgesics!!!
chest splinting - friction rub symptom
Nonpolio enteroviruses that are caused by _________ will present as what two cardiac involvement symptoms?
Coxsackieviruses - type B
Myocarditis
Pericarditis
What two lab findings are significant in acute myocarditis?
Elveated creatine phosphokinase
Troponin
Severe neonatal infection presents with what clinical manifestations?
fever rash pneumonitis meningo-encephalitis hepatitis gastroenteritis myocarditis pancreatitis myositits
What differential diagnosis should be included in an infant with severe neonatal infection with rash?
bacterial and herpes simplex infections
necrotizing entercolitis
heart or liver failure causes
metabolic diseases
What specific lab findings will help diagnosis an infant with severe neonatal rash?
CSF mononuclear pleocytosis
Enterovirus detection on RNA in stool or pharynx
PCR in CSF, blood, or urine
