Nelsons Flashcards
Common combinations of pathogens in pneumonia
Streptococcus pneumoniae and RSV or Mycoplasma pneumoniae
Peak age for viral pneumonia
2-5 years
Peak age for bronchiolitis
first year of life
Major viral pathogen in pneumonia
RSV
Top three common non-viral pathogens of pneumonia
S. pneumoniae, M. pneumoniae, C. pneumoniae
Most consistent clinical manifestation of pneumonia
Tachypnea
Temperature difference in viral vs bacterial pneumonia
Bacterial generally higher temp
Characterization of viral pneumonia in chest radiography
hyperinflation with bilateral interstitial infiltrates and peribronchial cuffing
Characterization of bacterial pneumonia in chest radiography
Confluent lobar consolidation
WBC count differences: bacterial vs viral pneumonia
Viral pneumonia:
WBC count may be normal or elevated but usually
NOT higher than 20,000/mm3
with a lymphocyte predominance
Bacterial pneumonia:
Often associated with an elevated WBC count in the range of 15,000-40,000/mm3
Predominance of granulocytes.
Treatment of pneumonia in a mildly ill patient (outpatient)
For mildly ill children who do not require hospitalization, amoxicillin is recommended. In communities with a high percentage of penicillin-resistant pneumococci, high doses of amoxicillin (80-90 mg/kg/24 hr) should be prescribed.
Therapeutic alternatives: cefuroxime axetil or amoxicillin/clavulanate.
For school-aged children and in those in whom infection with M. pneumoniae is suggested, a macrolide antibiotic such as azithromycin is an appropriate therapeutic choice.
The empirical treatment of suspected bacterial pneumonia in a hospitalized child
Parenteral cefuroxime (75-150 mg/kg/24 hr) is the mainstay of therapy when bacterial pneumonia is suggested.
If features suggest staphylococcal pneumonia (e.g., pneumatoceles, empyema), initial therapy should also include vancomycin or clindamycin.
Up to how many percent of patients with known viral infection may have co-existing bacterial pathogens?
30%
Typically, patients with uncomplicated community acquired bacterial pneumonia respond to therapy with improvement in clinical symptoms after how many hours?
48-72 hrs
In general, there should be radiographic evidence of improvement within 4-6 wk, but time to complete resolution varies depending on the etiologic organism.
Pneumococcal pneumonia? Chlamydial pneumonia? Mycoplasma pneumoniae? Legionella, Staphylococcal, Gram negatives? Viral pneumonia?
Pneumococcal pneumonias often require 1-3 mo for complete radiographic clearing. Similarly, chlamydial pneumonia can require 1-3 mo for complete resolution radiographically.
Mycoplasma pneumoniae tends to clear more rapidly, with radiographic improvement occurring within 2 wk to 2 mo.
Conversely, staphylococcal, Legionella, and enteric gram-negative pneumonias can take as long as 3-6 mo to resolve radiographically.
Children with viral pneumonia may have positive radiographic findings for many months.
Formerly known as mucocutaneous lymph node syndrome or infantile polyarteritis nodosa
Kawasaki Disease
Pathogenesis of kawasaki’s disease
vasculitis of the medium-sized blood vessels
Most important manifestation of Kawasaki’s Disease
Cardiac involvement
Percentage of untreated Kawasaki’s who get coronary aneurysms
25%
Diagnostic Criteria for Kawasaki’s Disease
Fever lasting for at least 5 days
Presence of at least four of the following five signs:
- Bilateral bulbar conjunctival injection, generally nonpurulent
- Changes in the mucosa of the oropharynx, including injected pharynx, injected and/or dry fissured lips, strawberry tongue
- Changes of the peripheral extremities, such as edema and/or erythema of the hands or feet in the acute phase; or periungual desquamation in the subacute phase
- Rash, primarily truncal; polymorphous but nonvesicular
- Cervical adenopathy, ≥1.5 cm, usually unilateral lymphadenopathy
Illness not explained by other known disease process
3 Clinical Phases of Kawasaki’s Disease
- The acute febrile phase
usually lasts 1-2 wk, is characterized by fever and the other acute signs of illness.
- The subacute phase
begins when fever and other acute signs have abated, but irritability, anorexia, and conjunctival injection may persist. The subacute phase is associated with desquamation, thrombocytosis, the development of coronary aneurysms, and the highest risk of sudden death. This phase generally lasts until about the 4th wk.
- The convalescent phase
begins when all clinical signs of illness have disappeared and continues until the erythrocyte sedimentation rate (ESR) returns to normal, approximately 6-8 wk after the onset of illness.
Repeat 2dEcho in Kawasaki’s disease is usually done at __ weeks after the onset of illness
6-8 weeks
Treatment during the acute phase of Kawasaki’s disease
Intravenous immunoglobulin 2 g/kg over 10-12 hr with aspirin 80-100 mg/kg/24 hr divided every 6 hr orally until 14th illness day
Treatment during the convalescent phase of Kawasaki’s disease
Aspirin 3-5 mg/kg once daily orally until 6-8 wk after illness onset
IVIG reduces the prevalence of coronary disease from ___% in children treated with aspirin alone to 2-4% in those treated with IVIG and aspirin within the first 10 days of illness.
20-25%
Syndrome that is characterized by acute noninflammatory encephalopathy and fatty degenerative liver failure.
This syndrome typically occurs after a viral illness, particularly an upper respiratory tract infection, influenza, varicella, or gastroenteritis, and is associated with the use of aspirin during the illness.
Reye syndrome
Giant aneurysms in Kawasaki’s disease measure >/= __mm
> /= 8mm
