Viral Respiratory Illness (Pediatrics)

Question 1

COMMON COLD

Answer 1

Organism/season dependent
Rhinovirus: colder months
Adenoviruses: all seasons
RSV: late fall-early spring
Influenza: fall-winter
Enterovirus: summer
Incubation: 5-7 days
URI symptoms + low grade fever
NO ANTIBIOTICS
<2yr: hydration, humified air
>2yr: PO antihis, decon, cough suppr.

Question 2

ADENOVIRUS

Answer 2

< 2 yr old (daycare)
winter and spring
DROPLET
Incubation: 3-10 days
URI symptoms (pharyngitis*)
Dx: antigen detection, PCR, culture (depends on type)
Pharyngoconjunctival Fever: fever, pharyngitis, and conjunctivitis
Epidemic Keratoconjunctivitis: FB sensation, photophobia, swelling of conjunctiva/eyelids
Enteric Adenovirus (40/41): <4 yr old with short-lived diarrhea
no specific treatment exists; supportive therapy

Question 3

PARAINFLUENZA

Answer 3

<5 yr old
fall season
Incubation: 2-7 days
Barking seal cough
Dx: clinical symptoms; PCR
Manage croup symptoms

Question 4

PARECHOVIRUSES (HPeV)

Answer 4

before the age of 2-5yr + severe infection
summer-fall outbreaks
sepsis and meningitis*
transmission: fecal-oral, respiratory secretions

Question 5

HUMAN METAPNEUMOVIRUS (hMPV)

Answer 5

<5 yr old
late autumn-early spring
Duration: shorter in hMPV than RSV
cough sore throat, acute wheezing
PCR (resp secretions)
no treatment available

Question 6

INFLUENZA

Answer 6

H. influenzae (H1N1-A; B)
late fall-mid spring
Incubation: 2-7 days
Acute illness duration 2-5 days (several weeks in young children)
DROPLET TRANSMISSION
SYMPTOMS DEPENDENT ON AGE GROUP
Older children (same as adults): high fever, severe myalgia, HA, chills
Young children: GI symptoms
Infants (same as old people): sepsis-like illness, apnea, AMS, lethargy
Reye Syndrome (protracted vomiting, irrational behavior during flu season; varicella/ influenza
type B)
nasal swab / PCR test
supportive care + Tamiflu (5-day course given within 48 hr of symptom onset)

Question 7

RSV

Answer 7

<2 yr old
late fall-early spring (jan-feb peak)
3-7 days duration (fever won’t correlate w/resp symptoms)
Recent URI + wheezing, cough, tachypnea, difficulty feeding, prolonged expiration
CXR: hyperinflation
nasal swab
symptomatic treatment; resp isolation; good handwashing; cohort RSV with RSV
*Ribavirin only needed for immunocompromised kids
*<6mo old w/elevated WBC and prominent cough – MUST RULE OUT
PERTUSSIS
NO NEED FOR: abx, decongestants, expectorants, albuterol, or systemic
corticosteroids (unless asthmatic or premature infant)

Question 8

Acute Febrile
Pharyngitis

Answer 8

Older children
Incubation: 3-4 day
sore throat + abdominal
discomfort + VESICLE /
PAPULES on pharynx
WITHOUT EXUDATE

Question 9

Acute Lymphonodular
Pharyngitis

Answer 9

Coxsackievirus
1-2 wks duration
Febrile + pharyngitis with
YELLOW-WHITE papules
WITHOUT ULCERS linearly
along posterior palate
Supportive treatment

Question 10

Herpangina

Answer 10

Coxsackievirus A
4-5 duration
Acute fever + GRAYISHWHITE
vesicles WITH
ULCERS linearly along
posterior palate, uvula, tonsillar
pillars + abd pain +
dysphagia/drooling

Question 11

Hand Foot & Mouth

Answer 11

Coxsackievirus
1-2 week duration
Vesicles/red papules on
tongue, hands, feet +
fever, sore throat
fever goes down à
roseola-like rash appears

Question 12

Pleurodynia
“muscle disease”

Answer 12

Coxsackievirus B
1 week duration
Abrupt onset
unilateral or bilateral pain
(spasmodic/variable intensity) over the
lower ribs or upper abdomen + fever +
decreased thoracic excursion
analgesics, chest splinting

Question 13

PNEUMOCOCCAL PNEUMONIA

Answer 13

s. pneumoniae
AOM, sinusitis, pneumonia, meningitis
clinical findings correlate with what their underlying condition is
sepsis: high fever, >15,000 WBC
pneumonia: above symptoms + tachypnea, localized chest pain, localized/diffuse rales
pneumococcal meningitis: fever + high WBC, irritability, lethargy, neck stiffness (older kids)
Diagnosis / Treatment dependent on underlying cause
sepsis: mild - ceftriaxone; severe: add vanc
pneumonia: infants >1mo = ampicillin, PCN G, cefs; mild pneumonia >1mo: amoxicillin
pneumococcal meningitis: vanc+cefotaxime

Question 14

H. INFLUENZAE

Answer 14

h. influenzae
acute epiglottitis, septic arthritis, cellulitis
DROPLET ISOLATION
Prevention of h.influenzae: HiB vaccine series
Diagnosis / Treatment dependent on underlying cause
Requires hospitalization and 3rd generation cephs (cefotaxime / ceftriaxone)
h. influenzae meningitis: vancomycin + cephalosporin IV for 10 days; dexamethasone (given
immediately after dx, continue for 4 days to reduce incidence of hearing loss)
*Pregnant women CANNOT receive Rifampin to reduce colonization of HiB

Question 15

CHLAYMDIA TRACHOMATIS

Answer 15

Few days – 16 weeks of age
watery, mucopurulent, to blood-tinged discharge and conjunctival injection
Pneumonia (complication): onset 2-12 weeks with staccato cough, afebrile,
tachypnea
Dx: conjunctival/resp specimen
systemic abx are required: AZITHROMYCIN
TEST THE MOTHER AND MOTHERS PARTNER
*Erythromycin ointment post-birth DOES NOT PREVENT THIS!

Question 16

PERTUSSIS

Answer 16

Bordetella pertussis
Insidious onset with 3 stages (catarrhal, paroxysmal, convalescent)
HIGHLY COMMUNICABLE
prodromal catarrhal stage: (1-3 weeks) mild cough, WITHOUT FEVER
paroxysmal stage: persistent staccato, paroxysmal cough ending w/ high-pitched inspiratory whoop
convalescent stage: slowly resolving cough over weeks-months
ELEVATED WBCs
Dx: PCR or culture nasopharyngeal secretions
Start tx in prodromal phase (if you can)
Infants <1mo: AZITHROMYCIN r/t risk of PYLORIC STENOSIS
Infants >1mo: clarithromycin
Prevention: vaccinations (immunity wanes @ 5-10 yr post-vaccine)
DTaP (infants/children) / Tdap (preteens, teens, adults
*High suspicion of pertussis: treat & don’t wait till results come back!

Question 17

The common cold, what is most often the cause?

Answer 17

Answer: depends on seasons; rhinoviruses: colder months; adenoviruses: all seasons; RSV: late fall-early spring (jan-feb peak); influenza
virus: fall-winter; enterovirus: summer cold

Question 18

With the common cold (generally speaking), how long do you expect to see symptoms for?

Answer 18

Answer: 5-7 days

Question 19

T of F: antibiotics can prevent complications of the common cold and limit duration of purulent rhinitis

Answer 19

Answer: False; ANTIBIOTICS WILL NOT PREVENT COMPLICATIONS OF THE COMMON COLD and DO NOT LIMIT
DURATION OF PURULENT RHINITIS!

Question 20

What treatment is given to a patient with the common cold?

Answer 20

Answer: supportive care; (<2 yr. old: hydration, humidified air, suctioning; >2 yr. old: PO antihistamines, decongestants, cough suppressants);
vitC, zinc, topical decongestants – not shown to improve symptoms

Question 21

Parainfluenza: most often affects what age? When do you often see an outbreak?

Answer 21

Answer: <5yr old; fall outbreak

Question 22

What is the incubation period for parainfluenza (croup cause)?

Answer 22

Answer: 2-7 days

Question 23

How is parainfluenza diagnosed?

Answer 23

Answer: based on clinical symptoms *barking seal cough*; PCR<24hr result

Question 24

Human Metapneumovirus Infection (hMPV):

Answer 24

<5 yr old, occurs late autumn-early spring; cough sore throat, acute wheezing; PCR of resp
secretions; no treatment available; duration is shorter in hMPV than RSV symptoms

Question 25

Adenovirus:

Answer 25

< 2 yr old; winter and spring (daycare); DROPLET TRANSMISSION; incubation 3-10 days; URI symptoms; antigen detection,
PCR, culture (depends on type)

Question 26

Most common adenovirus disease?

Answer 26

Answer: Pharyngitis

Question 27

Patient presents with fever, pharyngitis, and conjunctivitis – what’s your diagnosis?

Answer 27

Answer: Pharyngoconjunctival Fever (secondary to adenovirus) – THIS HAS NO LOWER RESPIRATORY SYMP

Question 28

Patient presents with FB sensation, photophobia, swelling of conjunctiva/eyelids - what’s your diagnosis?

Answer 28

Answer: Epidemic Keratoconjunctivitis secondary to adenovirus

Question 29

<4 yr old with short-lived diarrhea. What’s your diagnosis?

Answer 29

Answer: enteric adenovirus (type 40/41)

Question 30

How is adenoviruses diagnosed?

Answer 30

Answer: viral culture (results in <48hr) or PCR

Question 31

How do you treat adenovirus?

Answer 31

Answer: no specific treatment exists; let it run its course / supportive therapy

Question 32

Parechovirus (HPeV):

Answer 32

severe infections in young children (sepsis and meningitis) before the age of 2-5yr; transmission is fecal-oral or from
respiratory secretions; summer-fall outbreaks

Question 33

Patient presents with sore throat, abdominal discomfort, 3-4 day duration, VESICLE / PAPULES on pharynx WITHOUT
EXUDATE. what is the diagnosis?

Answer 33

Answer: acute febrile pharyngitis secondary to enterovirus

Question 34

Patient presents with febrile, pharyngitis with NONULCERATIVE YELLOW-WHITE PAPULES ALONG POSTERIOR PALATE
1-2 wk duration

Answer 34

Answer: acute lymphonodular pharyngitis secondary to coxsackie virus

Question 35

Patient presents with vesicles / papules on tongue, oral mucosa, hands, feet, 1-2 weeks duration, fever sore throat, hand foot and
mouth: when fever goes down - a rash can appear simulating roseola

Answer 35

Answer: hand foot and mouth disease secondary to coxsackie virus

Question 36

Patient presents with acute onset of fever and posterior pharyngeal GRAYISH WHITE VESICLES that quickly form ULCERS
LINEARLY ALONG POSTERIOR PALATE, + abdominal pain, 4-5 day duration. what’s diagnosis?

Answer 36

Answer: herpangina secondary to coxsackie virus

Question 37

Patient presents with abrupt onset of unilateral or bilateral spasmodic pain of variable intensity over the lower ribs or upper
abdomen; HA, fever, decreased thoracic excursion. what’s your diagnosis?

Answer 37

Answer: pleurodynia secondary to coxsackievirus (normal CXR, 1-week duration); THIS IS DISEASE OF THE MUSCLES! Give potent
analgesic agents, teach chest splinting