Pediatric- ID Flashcards by Kelsey Johnson

What is an infection of the herpes virus that has 3 different stages of infections

Varicella- Zoster Virus

chicken pox

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What is the primary infection of varicella-zoster

chicken pox

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what is the latent infeciton of varicella-zoster

persists in dorsal root ganglia

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what is the reactivated infection of varicella-zoster

Shingles

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what are the peak ages for a chickenpox infection child before vaccine

5- 10 years old

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what are the peak ages for a chickenpox infection child after vaccine

10 - 14 years old

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What season is chicken pox usually arise

winter-spring

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How is varicella- zoster virus spread?
how many days from exposure to first symptom?
what are the first symptoms

respiratory droplets and direct contact with infected person

incubation period is 10-21 days then present with fever, malasie then the rash

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When is a person with Varicella-zoster virus contagious?

Highly contagious the first 2 days before the onset of the rash and are contagious until all the lesions have crusted over

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Key terms for this diagnosis- started with a fever, malasie then a rash on trunk that spread to face then arms. The rash will go through cycles and looks like a fluid filled vesicle on a erythematous base. Rash is markedly itchy

varicella-zoster or chicken pox
“teardrop on rose peatle”
fluid filled vesicles that ulcerate and crust over and heal

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If a patient is hospitalized for varicella-zoster virus what is the treatment

negtaive pressure isolation room

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If varicella-zoster rash is not typical and unsure of diagnosis what test can you confirm the diagnosis with?

PCR of vesicular fluid if atypical/ complicated presentation

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Treatment for varicella-zoster

NO asprin give IB or tyneol
cool baths
careful hygiene to prevent secondary infection
High risk for complications: Acyclovir

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What two infections often are commonly associated with Reye syndrome?

use of aspirin in a child
1. varicella-zoster
2. Influenza A & B

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How effective is the varicella vaccine?

85% overall

97% against mod-severe disease

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What is the most common complication of varicella-zoster

* secondary infection of Strep or staph 
Encephalilits 
pneumonia - adults
if pregnant = congenital defects or severe neonatal infection 
Shingles

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what are all the complications of varicella-zoster

secondary infection of Strep or staph 
Encephalilits 
pneumonia - adults
if pregnant = congenital defects or severe neonatal infection 
Shingles

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What is the treatment for a neonate with varicella-zoster

varicella-zoster Immunoglobumin ASAP !

VZIG

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Key terms for this diagnosis- vomiting, confusion, seizures, coma, rapidly progressing encepahlopathy with hepatic dysfuction

Reye syndrome

aspirin use in children

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key terms for this diagnosis- pre-eruption acute neuritis with fever, malaise and a rash in groups

shingles - zoster

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What are the complications of Zoster

shingles:
1. post-herpetic neuralgia
2. bacterial infections
3. ocular involvement
4. Ramsey hunt syndrome - major complication
5. aseptic mengitis

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key terms for this diagnosis- one sided face numbness, ear pain on the same side and a rash in the ear canal and auricle. Taste, hearing (ringing), lacrimation can also appear

Ramsey hunt syndrome - Herpes zoster oticus
a major disease after chicken pox infection
it is a polycranial neuropathy

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what nerves are affected with Ramsey hunt syndrome

cranial nerves: V, IX, X

5, 9 ,10

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Rubeola is also known as what

Measles

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What virus causes Rubeola

Paramyovirus

key terms for this diagnosis- highly contagious infection with high fevers, rash, cough, coryza (stuffy nose), conjunctivitis, and small white dots in the mouth

Rubeola Measles

Koplik spots are what? | show up in what disease ?

Rubeola Measles | small whiteish papules on the buccal mucosa opposite of the molars

Rash for what diagnosis- Macular rash that started on the head and face and spread down in 24 hours may be petechial or hemorrhagic. rarely on palms or soles

Rubeola Measles | can have Koplik spots in the mouth

What disease have to be reported to the health department ?

Rubeola - measles Mumps Rubella - German measles

What is the best testing for Rubeola - measles

PCR or | IgM serology

Treatment for Rubeola - measles

support hydrate, Tylenol for fevers 2 days of high-dose vitamin A (can decrease morbidity and mortality)

What are complications of Rubeola - measles

1. otitis media 2. Leukopenia 3. pneumonia 4. Encephalomyelitis

What virus causes Mumps?

Paramyxovirus

key terms for this diagnosis- painful tender swelling in the cheeks one side or both, mild fever, muscle aches, malaise and headaches

Mumps | parotitis

How long with the parotitis last in Mumps

1-3 days then subsides over the next week

What is the best testing for Mumps

PCR or | IgM serology

Treatment for Mumps

1. supportive | 2. warm or cold packs to the swelling

what are complications of Mumps?

1. Orchitis- epididymitis in adult males 2. oophoritis in girls is rare 3. deafness 4. aseptic meningitis 5. Meniingitis 6. Encephalitis

What virus causes Rubella

Togavirus

key terms for this diagnosis- post auricalr, post cervical, post occiptal lymphadenopathy with rash that started on face and spread to the body it is red maculopapular fine rash. Small red spots in mouth

Rubella - German measles

What are Forschheimer spots | what are the seen in ?

small red spots/petechiae on soft palate of mouth | Rubella - German measles

what is the best testing for Rubella - German measles

IgM serology

Treatment for Rubella - German measles

1. supportive

Complications of Rubella - German measles

1. Congenital rubella syndrome - SIGNIFICANT morbidity with eyes, heart and neurologic complications

What is another name for Roseola Infantaum

Sixth disease or Exanthem subtium

What virus causes Roseola Infantaum

Herpesvirus 6 - HHV-6 | less common HHV-7

key terms for this diagnosis- child is irritable but consolable and other wise alter and active with high fevers > 104 and lasts for 3-5 days then a rose colored rash appears on neck/chest and spreads to face and extremities

Roseola Infantaum | Sixth disease or Exanthem subtium

Treatment for Sixth disease

Roseola Infantaum Sixth disease or Exanthem subtium 1. supportive no vaccine against

Treatment for Roseola Infantaum

Sixth disease or Exanthem subtium 1/3 have febrile seizures rare to have meningitis or encephalitis maybe that's why we dont have a vaccine

What virus causes Erythema Infectiousum

Parovirus B19

what is another name for Erythema Infectiousum

Fifth Disease

Key terms for this diagnosis- common in spring time, fever, malaise, myalgia, headaches, sore throat, rash appears a week later in 3 statges starts on the face then goes to the trunk

Erythema Infectiousum- Fifth Disease

What are the stages of Erythema Infectiousum rash?

Rash appears about a week after cold symptoms 1. first appears on the face "slapped check" circumoral pallor 2. Maculopapular truncal rash 1-4 days later 3. lacy reticulated truncal rash a week later can be itchy can reocur with exercise, bathing, rubbing and stress

What is the best testing for Erythema Infectiousum

fifth disease | PCR or serology if atypical

Treatmetn for Erythema Infectiousum

supportive

complications of Erythema Infectiousum

aplatic crisis with underlying RBC disorder like sickle cell or thalassemia. Complication will have temporary stop in the production of RBC in bone marrow -virus has a high viral affinity for RBC that is why the rash lasts awhile

What virus causes Hand-foot-mouth disease

Cocksackie virus

what time of year is Hand-foot-mouth disease common in ?

Summer - early fall

key terms for this diagnosis- mild fever, mouth or throat pain will not eat, lesions in the mouth appear as a thin halo of erythema with an ulcer. A rash that is not itchy or painful on the hands, feet, butt, upper thighs and arms

Hand-foot-mouth disease

best testing for Hand-foot-mouth disease

not needed unless atypical or complicated

Treatment for Hand-foot-mouth disease

supportive | hydrate !!! the sores in their mouth are uncomfortable wont want to drink

complications of Hand-foot-mouth disease

1. dehydration | 2. rarely encephalitis, meningitis, flaccid paralysis

what temperature is considers a fever | what is a high fever

> 38 C 100.4F High fever > 40 C 104.0 F with serious infections neonates can be hpothermic

What are some good points to educated mom on fevers

infants/children ususally have higher body core temp >99F | flucuated up to 3 degress of body temp through the day especially late afternoon with activity

What is dangerous about fevers?

The dramatic change in temperature either high to low | or low to high can cause a febrile seizure

What age group is at higher risk for serious bacterial infections with a fever present

less than 3 months

What is the most common cause of a fever in <3 month old ?

UTI- E. coli

What are common bacteria to cause infection in <1 month old

Group B strep E. Coli Listeria

What are common bacteria to cause infection in 1-3 months old

Strep pneumonia Hamophilous influenza Nissera mengitidies

What do you do if you have a <4 weeks old or ill-appearing <3month old with a rectal temp >38C

``` Admit to hosptial to work up sepsis monitor for 36 hours NEED: 1. Blood cultures 2. Urine 3. CSF 4. CBC 5. CXR 6. Stool studies - fecal leukocytes or stool culture if diarrhea ```

Treatment for Fever in <3 month old

``` START ABX NOW 1. ampicillin + cefotaxime may add acyclovir vancomycin ```

If an infant is 29 days - 3 months well-appearing child with a fever they can be followed as outpatient if what criteria are met?

1. reliable follow up 2. WBC 5,000- 15,000 3. UA <10,000 obtain blood cultures, urine cultures, CXR can give Ceftriaxone IM need to follow up in 24 hours

what is the definition of Fever of unknown origin

temperature of >38 C lasting >14 days | without an obvious source despite testing and complete H&P

Fever of unknown origin- is most commonly caused by what ?

``` a common disease presenting as unusual most common are infectious inflammatory disease malignancy less often consider munchausen ```

What is the work up for a fever of unknown origin?

1. CBC with diff 2. ESR 3. LFT's 4. UA with culture 5. Blood cultures 6. CXR 7. ANA 8. RF 9. Serum complement

What is the most common cause of a seizure in 6months- 6 years

fever | occur in 4% of kids

What are the characteristics of typical febrile seizure

1. generalized - all over the body 2. less than 15 min 3. occurs once in 24 hours

Treatment for typical febrile seizure

do not require work up or any treatment | may reoccur in 50 % of kids

What are the characteristics of complex/atypical febrile seizure

1. focal feature - one part of body 2. > 15 min 3. reocurs in 24 hours 4. preexisitng neruo or development problem

Treatment for atypical febrile seizure

require more specific evaluation EEG MRI as outpatient consult pediatric neuro

Treatment for a seizure lasting > 5 min

1. IV benzo - diazepam or lorazepam | 2. if prolonged give rx for rectal diazepam

what is the prognosis of Febrile Seizures

very good only 2% higher risk than general population to develop epilepsy complex seizure has higher risk