peds82 Flashcards
reactive lymphadenitis
occurs in response to infections in the pharynx, teeth, and soft tissues of the head and neck
viral infections that can cause cervical lymphadenitis
EBV, CMV, and HIV, among others
kawasaki disease and cervical lymphadenitis
may present with cervical lymphadenitis (in fact, enlarged cervical lymph node is one of the diagnostic criteria)
toxoplasma gondii and cervical lymphadenitis
can cause a mono-like disease with cervical lymphadenopathy
how can structural lesions in the neck cause a cervical lymphadenitis
can become infected and drain to the lymph nodes in the neck
what do the lymph nodes in cervical lymphadenitis look like?
mobile, tender, warm, and enlarged, and the overlying skin is erythematous. Fluctuance may be present
management of cervical lymphadenitis
empiric antibiotics directed at strep and staph; initial treatment may include a first gen cephalosporin or an anti-steph penicillin for 7-10 days
parotitis
inflamm of the parotid salivary glands
etiology of parotitis
mumps and other viruses; bacterial parotitis
difference in presentation between bacterial and viral parotitis
viral has bilateral involvement; bacterial is unilateral
causes of bacterial parotitis
aka acute suppurative parotitis; caused by staph aureus, strep pyogenes, and M tuberculosis
clincial features of parotitis
swelling centered above the angle of the jaw and fever; exam of the pharynx may reveal pus expressed from stenson’s duct
most common cause of viral parotitis
mumps (before vaccination)
complications of acute suppurative parotitis
formation of an abscess anad osteomyelitis of the jaw
impetigo
superficial skin infection involving the upper dermis
causative organisms in impetigo
stap aureus and GABHS or strep pyogenes
clinical features of impetigo
honey colored crusted or bullous lesions are present, commonly on the face, esp around the nares; fever usually absent; infection is easily transmitted
management of impetigo
treatment may include topical mupirocin or oral antibiotics like dicloxacillin, cephalexin, or clindamycin
complications of impetigo
bacteremia, post-strep glomerulonephritis (tx of impetigo does not prevent this), and staph scalded skin syndrome (SSSS)
erysipelas
skin infection that involves the dermal lymphatics
causative organism in erysipelas
GABHS
clinical features of erysipelas
tender, erythematous skin with a distinct border. Face and scalp are common locations
management of erysipelas
systemic abx aganst GABHS
complications of erysipelas
bacteremia, post-strep glomerulonephritis, and necrotizing fasciitis
cellulitis
skin infection within the dermis
causes of cellulitis
staph aureus and GABHS
infected skin border in erysipelas vs cellulitis
in cellulitis border is indistinct
management of cellulitis
oral or IV abx (first gen cef or anti staph penicillins)
buccal cellulitis
unilateral bluish discoloration of the cheek of a young immunized child
causative agent in buccal cellulitis
HIB
what does a child with buccal cellulitis look like?
toxic, and blood cultures usually pos
management of buccal cellulitis
IV antibiotics against H influenza, usually a second or third gen cephalosporin; perform LP
perianal cellulitis
well-demarcated erythema involveing the skin around the anus
how might kids with perianal cellulitis present
constipation
cause of perianal cellulitis
GABHS
managmenet of perianal cellulitis
oral antibiotics (cephalaxin, dicloxacillin)
necrotizing fasciitis
potentially fatal form of deep cellulitis that extends into the muscle; pain and systemic findings out of proportion to physical findings;
causative organisms in necrotizing fasciitis
polymicrobial; may involve GABHS and anaerobic bacteria
therapy for necrotizing fasciitis
IV antibiotics and surgical debridement are essential components of therapy
staph scalded skin syndrome
staph aureus produces a toxin that caues fever, tender skin, and bullae; large sheets of skin slough off; Nikolsky sign is present
Nikolsky sign
extension of bullae when pressure is applied to the skin (skin pulls away w lateral pressure)
management of SSSS
good wound care and IV antibiotics against Staph aureus
scarlet fever
toxin-mediated bacterial illness that results in a characteristic skin rash
cause of scarlet fever
GABHS that produces an erythrogenic toxin
transmission of scarlet fever
large respiratory droplets or by infected nasal secretions
clinical features of scarlet fever
exanthem tha develops during any GABHS infection (impetigo, cellulitis, pharyngitis); before or during exanthem, fever, chills, often exudative pharyngitis
what does the exanthem of scarlet fever look/feel like?
begins on trunk and moves peripherally; skin is erythematous with tiny skin colored papules (“scarlitiniform”) and has texture of sandpaper; rash blanches; petechiae localized within skin creases in a linear distrib (Pastias lines)
pastia’s lines
petechiae are often localized within skin creases in a linear distribution; seen in scarlet fever;
desquamation of dry skin occurs as scarlet fever rash resolves
right; so do not worry if you see it
