Pediatric Infectious Disease Lecture Powerpoint Flashcards
Most common type of infectious illness in children
Upper respiratory infections, common viral colds are common because kids don’t have the acquired immunity, will frequently have 6-10/year
Symptoms of a URI (3)
- Fever, headache, malaise
- nasal stuffiness, sneezing, sore throat, cough
- nasal discharge initially clear and watery but soon thick and colored either yellow, white, or green, returns to watery before resolving
Color of snot and pathogen identification
Not indicative of anything
Unilateral foul smelling nasal discharge in child should raise suspicion for….
….foreign body obstruction
3 distinct criteria in diagnosis of acute bacterial sinusitis (differing it from a URI, only 6-7%)
- persistent symptoms (nasal discharge/congestion and or cough for >10 days without improvement)
- severe symptoms (temp >38.5 with purulent rhinorrhea for at least 3 days
- worsening symptoms after initial improvement, (worsening of nasal congestion, rhinorrhea, cough, and fever after a 3-4 improved period
Maxillary and frontal sinuses do not grow in anatomically until…
….7-8 years
Acute bacterial sinusitis treatment (1)
-amoxicillin with or without clavulanate
Common cold treatment options (2)
- supportive
- ipratroprium bromide (atrovent) may help
Common causes of acute pharyngitis (2)
- viruses (rhinovirus, influenza, etc)
- bacteria (GABHS, niesseria gonorrhoae, diptheria)
Clinical presentation of GABHS pharyngitis (5)
- sudden onset
- sore throat
- fever
- tonsillar hypertrophy
- strawberry tongue
Lab tests for GABHS (3)
- Rapid strep test (high sensitivity low specificity)
- throat culture follow up (doesn’t differentiate between acute strep and strep carriers)
- ASO titer in suspected rheumatic fever or acute glomerulonephritis
Erythromycin resistant GABHS and treatment option in PCN allergic patients (1)
Identified in some parts of the world, in patients that cannot tolerate B lactam antibiotics a good choice would be clindamycin
Retropharyngeal abscess definition
GABHS infeciton occurs in retropharyngeal space posterior to pharynx and can cause airway /swallow compromise and eventually progression to sepsis if left untreated, most common in 6 months to 6 years
Retropharyngeal abscess diagnostic study (2) and treatment
- x ray or CT
- Drainage and clindamycin (need gram + and - coverage)
Peritonsillar abscess definition
GABHS infection located in palatine tonsil, results in fever, dyspnea, trismus, and muffled potato voice, can spread to salivary glands
Peritonsillar abscess diagnostic study and treatment options (3)
-CT imaging
- Drainage
- PCN oral outpatient or IV
- alternatively clindamycin
Treatment failure of GABHS (3)
- noncompliant patient
- previously unknown carrier state
- inactivation by PCN resistant strain
Are follow up throat cultures necessary in GABHS patients?
No, noncontagious 24 hours after initiation of therapy unless continue to be symptomatic
2 most common causative pathogens of acute otitis media
H influenzae
S pneumoniae
Acute otitis media vs otitis media with effusion
Collection of fluid in middle ear alone without signs or symptoms of acute infection including changing coloration/opacification is otitis media with effusion, while acute otitis media has bulging** tympanic membrane with color change
Tympanography
A tool to look for middle ear effusion based on tympanic membrane compliance, in a normal eardrum it is tent shaped and peaks at 0, if the compliance is low and the tent is small this indicates high probability of effusion, if the tent peak is shifted negatively to the left this indicates eustachian tube dysfunction
Antibiotic therapy for acute otitis media is only recommended if the patient is ___ or ____
under 24 months, if the child worsens or fails to improve
1st and 2nd line treatment and 3rd line treatment for acute otitis media
- amoxicillin 80-90mg/kg/day in 2 doses
- amoxicillin-clavulanate (augmentin) 90mg/kg/day
- tympanocentesis
Croup presentation (3)
- barking cough
- subglottic narrowing on x ray
- preceding upper respiratory infection (ecvept in spasmodic croup)
epiglottitis
More severe emergency than croup and more rare in time sinc HIB vaccine, URI infection that doesn’t have stridor or prodrome, presents with characteristic thumb sign on x ray, progressive swelling (supraglottic stenosis), sore throat, drooling, with airway management being utmost priority
croup treatment options (6)
- comfort child - crying will make it worse
- humidified o2 up to intubation if severe
- racemic epi
- nebulized budesonide
- dexamethasone oral or im
- admit if moderate to severe
Epiglottitis treatment options (2)
- airway preservation
- ceftriaxone
Bronchiolitis 3 most common causative agents
- RSV
- human metapneumovirus
- parainfluenza virus
Bronchiolitis clinical presentation (3)
- chest x ray with lung hyperinflation and flattened diaphragm
- history of rhinorrhea and cough
- fine crackles on inspiration indicating lower lung infection
Bronchiolitis diagnosis (3)
- clinical diagnosis
- CXR in severe cases
- ABG’s to determine severity
Bronchiolitis hospitalization treatment options (4) (remember most mild cases can be handled outpatient)
- supportive care including o2
- nebulized racemic epi (used to be bronchodilators back in the day)
- ribavirin in severe RSV infection or immunocompromised
- antibiotics if concomitant otitis media
3 common findings of pneumonia
Fever, shallow respirations, cough
Foreign body aspiration management
Endoscopic removal with a rigid bronchoscope followed by corticosteroids if inflammation presents and same day discharge
Clinical signs and symptoms of pneumonia in children (6)
- cough day and night, often productive
- fever
- tachypnea
- retractions
- hypoxia and cyanosis
- crackles and wheezes
Pneumonia diagnostic studies (3)
- x ray in children who do not improve on initial antibiotic therapy (ground glass appearance)
- cbc with diff
- first morning sputum and culture
Pneumonia treatment options (chidren) (4)
- amoxicillin
- azithromycin (coverage against mycoplasm and chlamydia pneumoniae in teens!)
- macrolide or doxy
- fluorquinolones
Blood pressure dropping in a child with dehydration is a…
….late stage finding, children have excellent compensatory mechanisms
Lab tests for childhood diarrhea (4)
Normally not necessary but can get CBC, BMP, urinalysis, stool culture
Fluids not recommended for acute diarrhea in kids (7)
- tea
- juice
- cola
- chicken broth (just going to cause hypernatremia)
- sports drinks such as gatorade and powerade (not ideal, has some k and na+ and lower amount of sugar in it but not good)
- koolaid
- water alone!!! (want carb to sodium ratio between 1.2-3.1)
Carb to sodium ratio and base levels in commercial oral electrolyte solutions that are best for children and some products that meet this balance (2)
1.2-3.1, 30, pedialyte, infalyte,
gatorade gets to 13 CHO-Na, so its closer than not
Number 1 cause of viral childhood diarrhea
norwalk (norovirus), used to be rotavirus but then we got that sick vaccine yo
Degree of dehydration and corresponding signs and symptoms
1-3% not noticable
3-5% mild, thirsty and slightly dry
6-9% moderate, blood pressure starts to drop
>10% severe, skin cold clammy, tenting, etc
Treatment principles for diarrhea in children (4)
- most is self limiting
- replace fluid and electrolytes
- avoid fatty foods or foods high in simple sugars
- drinks made with unsweetened yogurt, unsweetened juice, mashed bananas, mashed potatoes, soda crackers, pretzels, beans, pastas, chicken, fish, eggs are all foods they can eat (go beyond the brat diet)
- small portions frequently every 3-4 hours
- avoid antibiotics, if its vira may cause harm, or may increase risk of hemolytic uremic syndrome
