Pediatric Infectious Disease Flashcards
Why should augmentin be used as a second line to amoxicillin in kids?
Augmentin is amoxacillin/clauvunate
Clauvunate has a side effect of diarrhea, this should be avoided to decrease chance of dehydration
What is the most common etiology of conjunctivitis in kids?
Allergic
What are the etiologies of pediatric conjunctivitis?
- Bacterial: H. influenza, S. pneumonia, Chlamydia
- Viral: Adenovirus, HSV
- Allergic
What is the presentation of bacterial conjunctivitis?
Erythema, chemosis, itching, burning, macuopurulent exudate, matter in the eyelashes
What is the presentation of viral conjunctivitis?
Erythema, chemosis, tearing (bilateral); HSV unilateral photophobia, fever, nose lesions
What is the presentation of allergic conjunctivitis?
Stringy mucoid exudate, swollen eyelids and conjunctiva, itching, tearing, headache, rhinitis
What is the treatment for bacterial conjunctivitis?
Erythromycin ointment or polymyxin B/trimethoprim
*warm soaks, and no sharing towels/bedding
What are the two types of eye cellulitis?
- Periorbital cellulitis: anterior soft tissue of orbital septum
- Orbital cellulitis: over posterior orbital septum
What is the presentation of peri/orbital cellulitis?
- Proptosis, eye pain, decreased vision, limited extraocular motility think orbital cellulitis
Clinical Manifestations: fever, swelling, and erythema of surrounding tissues, deep red color of eyelid
What imaging should be ordered ASAP when peri/orbital cellulitis is on your differential?
CT scan
What is the treatment of peri/orbital cellulitis?
Orbital cellulitis: admission for IV abx
Periorbital cellulitis: Augmentin (90 mg/kg/day, BID) or Clindamycin (30-40 mg/kg/day in 3 divided doses)
What administration of antibiotics are typically preferred in treating otitis externa?
Drops
What is the treatment for otitis externa?
- Cortisporin 2 drops in ear every 3-4 hours for 5-7 days
OR
- Floxin 5 drops in affected ear BID for 7 days
What are the common etiologies of otitis media?
S. pneumonia
H. influenza
M. catarrhalis
What are the common presenting symptoms of otitis media?
- Ear pain
- Hearing loss
- Fever?
- Drainage?
What is the treatment for otitis media?
- Amoxicillin 90 mg/kg/day in divided doses (BID)
- Augmentin 90 mg/kg/day in divided doses (BID)
If PCN allergy: Emycin or Clindamycin with Bactrim
What is the treatment for non-allergic rhinitis?
Nasal sprays
What is the treatment for viral rhinitis?
Nasal saline, steam?
What is the treatment for influenza in pediatric patients?
Supportive, treat high risk immunocompromised with anti-virals
Tamiflu (suspension sizes 6 mg/ml or 12 mg/ml)
At what age is the influenza vaccine recommended to start?
6 months (first year is given as two doses one month apart)
How many days does a patient have to have persistent nasal congestion, without improvement in order to classy as sinusitis?
10 days
What is the treatment for sinusitis?
Amoxicillin/Amoxicillin-clauvulanate 90 mg/kg/day usually BID
What are the risk factors for thrush?
- Common in first weeks of life
- Inhaled steroids
- HIV infection
- Recent antibiotics
What is the treatment for thrush?
Oral nystatin
What type of virus is gingivostomatitis?
Herpes-1-virus
What is the presentation of gingivostomatitis?
Very sick, highly infectious
- 10+ ulcers of buccal mucosa, lips, and tongue
- May have fever, tender cervical nodes, inflammation
How is gingivostomatitis diagnosed?
HSV culture
What is the treatment of gingivostomatitis?
Symptomatic, if seen within 72 hours of onset can give acyclovir or magic mouthwash
Is headache and vomiting more consistent with a viral infection or strep infection?
Strep infection
What is the treatment of bacterial pharyngitis?
Amoxicillin 90 mg/day BID/TID x 10 days
What are complications associated with bacterial pharyngitis?
- Rheumatic fever
- Glomerulonephritis
- Lemierre syndrome
- Tonsillar abscess
What is Lemierre Syndrome?
A complication of bacterial pharyngitis in immuno-compitent individuals that present with septic thrombophlebitis or internal jugular
*May lead to a PE
What is the treatment for peritonsillar cellulitis/tonsillitis?
Usually start with IV or oral antibiotics for 12-24 hours; EENT or ED referral for drainage if no improvement or worse
What is the highest incidence of Mononucleosis?
15-25 years
What are some complications associated with mononucleosis?
Splenic rupture, hepatitis
What are the clinical manifestations of mononucleosis?
Malaise, anorexia, fever, exudative pharyngitis, anterior and posterior nodes, splenomegaly, or hepatomegaly
What is the characteristic sign on x-ray in croup?
Steeple Sign
What are the clinical findings of croup?
Barking cough, stridor, low grade fever, cough, drooling
What is the treatment for mild croup?
Barky cough with or without stridor, with agitation
One dose of steroids then d/c home with return precautions
What is the treatment for moderate croup?
Barky cough AND stridor at rest, with or without increased WOB
Steriods, nebulized epinephrine with observation minimum 3 hours
What is the treatment of severe croup?
Barky cough AND stridor at rest, PROMINENT increased WOB
Steroids, nebulized epinephrine with observation min 3 hours, reassess and likely admission
What are the 4 D’s of Epiglottitis?
Drooling-Dysphagia-Dysphonia-Distressed respiratory efforts
What is seen on x-ray with epiglottis?
Thumb sign on lateral neck x-ray
What vaccine has dropped the cases of epiglottis dramatically?
Hib vaccine
What are the clinical manifestations of coxsackie disease?
Fever followed by rash; characterized by vesicles or red papules on tongue, oral mucosa, hands and feet
What are Koplik spots?
Highly characteristic of Measles
Tiny white spots on the inside of the mouth
What are the 3 C’s of Measles?
Cough, coryza, and conjunctivitis
What glands become inflamed with mumps?
Parotid Glands
What is the etiology of rotavirus?
Virus transmitted via fecal-oral route
Peaks in winter months, 3-15 months of age
What is the treatment for rotavirus?
Fluid replacement and supportive measures
Are anti-diarrheal medications effective in treating rotavirus?
No
What is the presentation for pinworms?
Intense perianal itching overnight
What is the treatment for pinworms?
Mebendazole 100 mg once orally, repeat in 2 weeks
Wash linens
Treat entire household
A previously healthy 8-year-old girl presents with a fever, sore throat, and swollen cervical lymph nodes. On examination, she has tonsillar exudate and tender anterior cervical lymphadenopathy. Her rapid streptococcal antigen test is positive. What is the most likely diagnosis, and how should this patient be managed?
Strep A Pharyngitis
Amoxicillin or penicillin for 10 days
A 6-year-old boy presents with a fever, sore throat, and a swollen neck. On physical examination, you note bilateral cervical lymphadenopathy, tonsillar exudate, and a red rash on his cheeks. What is the most likely diagnosis?
What is the most common infectious agent?
Infectious mono
EBV
A 3-year-old child presents with a fever, cough, and tachypnea. On physical examination, you note inspiratory crackles and decreased breath sounds on the right side. What is the most likely diagnosis?
a. Croup
b. Bronchiolitis
c. Pneumonia
d. Asthma
Pneumonia
A 10-year-old child presents with fever, sore throat, and a “strawberry tongue.” On examination, you note cervical lymphadenopathy. What is the most likely diagnosis?
a. Strep throat (streptococcal pharyngitis)
b. Mononucleosis (Epstein-Barr virus)
c. Scarlet fever (Group A Streptococcus)
d. Hand, foot, and mouth disease
Scarlet Fever (Group A Streptococcus)
