Infectious Diseases Pt. 1 Flashcards
Important things to remember in peds acute care visits:
- Diet Hx
- Fluids
- Stooling
- Urine output
- deviations from usual activity
- Insomnia
- Behaviors out of character
Reasons that a Child Should be Excluded from Daycare/School
- Illness alters activity
- Illness that requires greater care than staff can provide
- Fever, lethargy, irritability, behavioral changes, persistent crying, sign of pain, trouble breathing
- diarrhea not contained by diapers or toilet use
- Vomiting more than 2x in 24hr
- Mouth sores with drooling
- MRSA with fever and/or behavioral changes
- Purulent conjunctivitis with fever
- Scabies before treatment
Reasons that Children Should NOT be Excluded from Daycare/School
- Yellow/green nasal discharge
- Nonpurulent conjunctivities without fever or behavioral change
- Exanthem without fever
- Fever less than 101 without other signs of illness
- Hepatitis carrier
- HIV
- Mits, if treated
- Scabies, if treated
Non-Polio Enteroviruses
- Coxsackie (Herpangina & hand, foot, and mouth disease)
- Echovirus
- Pleurodynia
- Acute hemorrhagic conjunctivitis
- Myocarditis
- Pericarditis
- Orchitis
- Aseptic meningitis
- Encephalitis
- Neonatal sepsis
Coxsackie
- Hand-Foot-Mouth disease
- Vesicles on hand, feet, mouth, low-grade fever
Herpangina
- Ulcers on oral mucosa
- HIGH fever
Pleurodynia
- sudden, Chest pain
- Aggravated by breathing
Non-Polio Enterovirus: Basics
- Incubation: 3-6d
- Fecal-oral/respiratory transmission
- Shed virus: 3wk for respiratory & 11wk GI
- S/S: Mild URI Sx; sore throat; N/V/D; anorexia, ABD pain; fever; HA; rash; myalgias; photophobia; red eye, tearing
- May have macular, papular, urticarial, vesicular, or petechial rash
- Vesicles and ulcers on tonsils, uvula, pharynx, and edge of soft palate
- nuchal rigidity
- Guillain-Barre type syndrome has been described
- Conjunctival erythema
- Cardiac collapse/CHF from myocarditis: vomiting, coughing, anorexia, fever/hypothermia, rash, jaundice, cyanosis, tachycardia, dyspnea
- pleural friction rub, wheezing, rales, rhonchi, stridor
Non-Polio Enteroviruses: Dx & Mgmt.
- Dx: No testing usually done, may do PCR from throat, stool, rectum, and blood; CBC usually NL
- Mgmt: Symptomatic treatment, prevention of spread
Enteroviruses: Polio - Basics
- Asymptomatic to CNS involvement
- Fecal-oral/respiratory transmission
- Consider in unimmunized children
- Dx of choice = viral culture from throat and stool; 2 samples taken 48hr apart
Hepatitis A Virus (HAV)
- Fecal-oral transmission; contamination of food or water
- Benign
- Incubation: ~25-50d
- Contagious: 3wk; 2wk before onset of jaundice & 1wk after
- Dx: Test IgM and IgG to know which hepatitis
HAV: Clinical Findings
- ** 2 Phases ***
1) Preicteric - fever, malaise, anorexia, vomiting, ABD complaints, no symptoms
2) Jaundiced: few days to months; appears shortly after onset of illness with dark urine and clay colored school - Not a chronic disease; full recovery expected but may relapse up to 6mo
HAV: Dx & Mgmt.
- Dx: IgM & IgG antibodies; LFTs
- Mgmt: Supportive therapy; exclude from school for one week after onset of symptoms
Hepatitis B Virus (HBV)
- Causes severe, chronic liver disease
- Transmitted through blood and body fluids
- NOT spread by fecal=oral route
- Can live up to 1wk in dried state
- Incubation = 120d
HBV: Clinical findings
- May present as asymptomatic seroconversion or fulminant disease and death
- Non-specific constitutional findings, i.e. fever nausea, ralgia, urtaria, rashes
- Icterus of skin and/or sclera
- Enlarged and tender liver
HBV: Dx and mgmt.
- Dx
- HBsAg and anti-HBc IgM positive in acute infection
- Recovery from infection: HBsAg clearance and appearance of anti-HBs and anti-HBc-IgG
- Chronic infection: Presence of HBsAg for 6mo+
- LFTs
- Liver biopsy
- Mgmt.: specialists, interferon-alpha, lamividine
HCV
- Chronic, may be asymptomatic or severe
- Same risk factors as HBV
- Incubation ~45d
- Clinical findings: similar to HBV, except fulminant is uncommon
- Dx: HCV antibody, LFTs, Liver biopsy
- Mgmt.: specialists, nonpegylated interferon alpha-2b and ribavirin
HDV & HEV
- HDV: must have HBV to contract
- HEV: zoonotic transmission; very rare
Herpes Simplex Virus: HSV
- 2 forms: HSV-1 & HSV-2
- Both types are devastating to the newborn
- Incubation: 2d-2wk
HSV-1: Basics
- non-genital lesions of the mouth, eyes, lips, and CNS
- most common in 6mo-5yrs
- Causes gingivostomatitis
HSV-2: basics
- genital and neonatal infection
- Sexual activity
- Must r/o sexual molestation, especially when found in a very young child
HSV: Clinical Findings
- Eye findings (chorioretinitis, keratoconjunctivitis)
- Skin vesicles
- Encephalitis
- Disseminated disease up to 11d after birth with 90% mortality
Findings of Traumatic Herpetic Infection
- Oral, usually from trauma like teething; abrasion passed by orally infected person
- Vesicles appear at the site of the lesion
- Fever
- Lymphadenopathy
- Constitutional symptoms
HSV: Recurrent Infections
- The body NEVER eradicates the virus
- It lies dormant and recurrent infections are common as herpes labialis and herpes genitalis
HSV: Dx
- Viral cultures of the lesions or secretions (CSF)
- In infants cultures are taken from the skin, vesicles, mouth, nasopharynx, eyes, blood, rectum, and CSF
- MRI of the brain if encephalitis is suspected
HSV: Mgmt.
- Parental acyclovir in neonates
- Valtrex 12+yr 2g x 2doses 12hr apart for recurrences of oral HSV
- May use valtrex daily suppression therapy in recurrent genital herpes 500mg-1g q day
- Monitor for increased cervical risk with HSV-2 infections
Infectious Mononucleosis Syndrome: Basics
- Caused by Epstein-Barr Virus in 90% of cases
- Other viral causes include: CMV, toxoplasma gondii, adenovirus, viral hepatitis, and HIV
- Incubation ~30-50d
Infectious Mononucleosis Syndrome: Clinical Findings
- Lymphadenopathy: anterior and posterior
- Tonsillar hypertrophy: sore throat; very painful; wth exudate or ulceration
- Hepatosplenomegaly
- Fever
- Rashes: maculopapular, urticarial, scarletinaform and frequently occurs w/ampicillin
- Myalgia/arthralgia
- Conjunctivitis
- Gingivitis
- Serious: PNA, myocarditis, aseptic meningitis
Infectious Mononucleosis Syndrome: Dx
- CBC-diff
- Monospot
- EBV panel (core and capsule antibody testing
Infectious Mononucleosis Syndrome: Mgmt.
- Supportive
- Do NOT use steroids
- Avoid contact sports
Roseola Infantum: Basics
- 6th disease of exanthem subitum
- Spread via oral/nasal route
- USually seen in 6-24mo
- Incubation: 9-10d
Roseola Infantum: Clinical Findings
- Onset of fever: usually high for about 5-7d
- Not acting ill
- URI
- Mild conjunctivitis
- Fever disappears, then a diffuse, non-puritic, discrete pink, maculopapular rash appears; blanchable
Roseola Infantum: Dx and Mgmt.
- CBC w/low WBC count
- Mgmt.: Supportive
Varicella: Basics
- Spread by direct contact, droplets, airborne transmission
- Incubation period: 10-21d (~14d)
- Contagious 1-2d before rash and after all the rash is scabbed
Varicella: Clinical Findings
- Fever
- HA
- Anorexia
- URI Symptoms
- Rash: begins on scalp, face, or trunk with crops of very pruritic vesicles in a teardrop shape on an erythematous border that umbilicates and scabs at all different times during the disease
- Lesions may be everywhere: throat, mouth, vagina, anus
Varicella: Dx & Mgmt.
- Dx: None, may take viral culture
- Mgmt.: relief of itching, acyclovir with immunocompromised or severe disease
- FYI: Shingles is a reactivation of the disease and victims of shingles are also infectious and can cause primary varicella illness
Influenza: Basics
- 3 Antigenic types: A, B, and C
- Type A and B are responsible for epidemic Dz
- Type C is sporadic and mild
- Type A is further classified into: H1N1, H1N2, and H3N2
- Peaks in winter months
- Younger children (6mo-2yr) have highest rates of hospitalizations
- Incubation: 1-4d, contagious 24hr before Sx
Influenza: Clinical Findings
- Sudden onset high fever
- HA
- Chills
- Cough
- Vertigo
- Sore throat
- N/V/D
- conjunctival injection
- PNA
- CHF
Influenza: Dx
- Rapid influenza testing from nasopharynx
Influenza: Mgmt.
- Tamiflu for 5d
- Supportive treatment
- Must check CDC website yearly for specific changes in treatment seasonally
Measles: Basics
- Rubeola
- Very serious associated w/significant morbidity
- Sources of infections include respiratory secretions, blood, and urine
- Incubation: 8-12d
Measles: 3 Stages of Clinical Manifestations
- Incubation period: no Sx
- Prodromal period: 1st sign of illness, lasting 4-5d with URI Sx: fever, cough, conjunctivitis, Koplik spots on the oral mucosa
- Rash stage: about the 4th day of illness as temp rises to 105, maculopapular rash starting behind the ears and forehead moving all over the body
Measles: Dx
- Measles IgM and then serial IgG antibodies
- Viral isolation from urine, blood, throat, and nasopharyngeal swab
Measles: Mgmt.
- Consultation with ID since reportable
Mumps: Basics
- Causes painful enlargement of the salivary glands
- Source of infection is salive
- Incubation period: 16-18d
Mumps: Clinical findings (2 Stages)
- Prodromal Stage: fever, HA, anorexia, neck pain
- Swelling stage: parotid glands swell 24hr after the prodromal stage; Stensen’s duct is red; orchitis can occur
Mumps: Dx and Mgmt.
- IgM and IgG titers
- Mgmt.: Supportive
Erythema Infectiosum (Fifth Disease): Basics
- Caused by parvovirus B19
- Spread by vertical transmission from mother to fetus, respiratory secretions; and percutaneous exposure to blood or blood products
- Seen in 5-15yr
- Secondary spread to household contacts 50%
- Incubation: 4-21d
Erythema Infectiosum: Clinical Findings (2 stages)
- Prodrome: mild fever; myalgia; HA; malaise; URI symptoms
- Rash: appears 7-10d after prodrome (2-3wk after exposure); communicable until rash disappears; 3 stages of rash
1) Appears as “slapped cheek; lasts 1-4d
2) lacy maculopapular eruptions on trunk; moves to arms, thighs, buttocks, sparing palms and soles; lasts one month
3) rash disappears
Erythema Infectiosum: Dx & Mgmt.
- Dx: not indicated, clinical diagnosis
- Mgmt.: self-limited; support
Parainfluenza: Basics
- Similar to influenza and mumps virus and is an important cause of croup, bronchiolitis, and PNA
- Incubation: 2-6d; can be shed for 4-7d before Sx onset
Parainfluenza: Clinical Findings
- 80% after upper airways
- Sore throat common in older children
Parainfluenza: Dx & Mgmt.
- Dx: Not needed
- Mgmt.: supportive, no vaccine available, no anti-viral treatment
Rubella ((German Measles): Basics
- Acute disease of childhood that occurs in two forms: post-natal and congenital
- Rubella is an RNA virus, humans are the only reservoir
- Vaccine limits # cases
- Incubation: 14-21d
- Period of infectivity: 3-8d after exposure
Rubella: Clinical Findings (3 stages)
1) Prodrome: fever, GI upset, Sore throat, eye pain, arthralgia (this stage often missed)
2) Lymphadenopathy: begins within 24hr; Postauricular, posterior cervical, and posterior occipital are primary nodes involved
3) Rash: an exanthem can appear in 20% just before the general rash that looks like a small rose-colored to reddish spots on the soft palate followed by exanthem of discrete papules that coalesce, lasting 3d
