Peds: L10 Dz of childhood - ID

What is passive immunity

Serum immune globulin -> temporary immunity with Ab

Ex: immunity from mother (via placenta or breastmilk)

What is active immunity

Abs from prior infection (natural immunity) or from a vaccine

One of the most effective preventative health measures

Immunization

Declines by more than 90%

Direct transmission

- passed straight from one infected person or animal to another

- person to person

- droplet

Indirect transmission

- passed between people who never had direct contact

- fecal-oral

- airborne

- fomites

Fomites

an inanimate object that serves as a vehicle to pass an infx dz from an infected person to a healthy person

Vector transmission

- another organism carries the disease

- ex. mosquitoe

where to check temp for fever in infants

check rectal temp

Bacteremia infections fever in infants

Group B streptococcus [GBS], Escherichia coli, and Listeria monocytogenes in neonates; and Streptococcus pneumoniae, Haemophilus influenzae type b [Hib], nontyphoidal Salmonella, and Neisseria meningitidis in 1- to 3-month-old infants

UTI bug for fever in infants

e coli

bacterial diarrhea fever in infants

Salmonella, Shigella, E. coli

fever in infants

often only poor feeding and fever (≥38C/100.4F)

When should febrile infants be admitted

Febrile infants

Workup for fever in infants

full sepsis workup if ill appearing or

If well appearing and 29-60 days old for fever in infant

Admitted but slower workup

- CBC

- Inflammatory markers!! (procalcitonin, CRP, Absolute neutrophil count)

- CMP

- UA

- Cx

- Blood cx

- point of care - flu, rsv, covid

If well appearing and 29-60 days old for fever in infant

Lumbar punction

If well appearing and 29-60 days old for fever in infant

- CSF

- PCR

- HSV swab

- blood PCR

Inflammatory markers can be used for risk stratification- in older kids >29 days old can be used to determine if

LP needed

Also to consider with febrile infant admitted (4)

- CXR

- COVID

- Influenza

- RSV

tx for fever in infants < 2mo

Treat any recognizable infection

tx for fever in infants < 2mo if no source found

- broad-spectrum IV antibiotics (ampicillin +3rd generation cephalosporin or gentamicin)

- If toxic appearing- don't delay abx

tx for fever in infants < 2mo if HSV concern

Acyclovir

define exanthem

- rash on outside of body

- Skin eruption caused by viral infections

Viral exanthems: Measles =

rubeola

Are measles contagious?

Highly contagious

measles can live for up to ___ hours in airspace after infected person leaves

2

measles: type of virus

Single stranded RNA virus (paramyxoviris)

Transmission measles

droplet and airborne spread

Incubation period of measles

6-21 days (mean 13 days)

Prodrome of measles

- 2-4 days

- Fever, malaise, anorexia then the 3 Cs

- Kolpik spots

Measles: the 3 Cs

conjunctivitis, coryza, and cough

What is pathognomonic for measles?

Kolpik spots

Exanthem measles

- 2-4 days after fever onset

- Red maculopapular rash- starts on the face/head and spreads down

- Blanching lesions early on- not later

- Resolves after 5-6 days

how long can measles persist

cough can persist for 1-2 weeks

Should you report measles?

REPORTABLE - contact health department

3 samples needed for dx of measles

1.Serum sample for measles immunoglobulin (Ig)M

2.Throat or nasopharyngeal swab for viral culture

3.Urine sample for viral culture

Tx for measles

- SUPPORTIVE

- Antipyretics, fluids

- Vitamin A if severe

tx if

Ribavirin

Vax for measles

MMR

Viral exanthems: Rubella =

German measles or "3-day measles"

Rubella (german measles) transmission

Direct or droplet spread, vertical transmission

Clin pres Rubella (german measles)

- Acute onset of generalized maculopapular rash

- +/- pruritus

- Starts on the face and spreads to trunk and extremities (spares palms and soles)

- Usually lasts about 3 days

- Forchheimer spots

- Minimal systemic symptoms

- Maybe low-grade fever, coryza and lymphadenopathy

Forchheimer spots

rose colored spots on the soft palate

Incubation Rubella (german measles)

14-18 d

Dx Rubella (german measles)

- REPORTABLE

- Serum IgM Ab for rubella

Tx Rubella (german measles)

- Supportive

- Antipyretics, fluids

Vax Rubella (german measles)

MMR

Viral exanthems: Roseola =

exanthem subitem or sixth disease

Roseola infantum most often caused by

Human Herpesvirus 6 (HHV-6)

Transmission of roseola infantum

saliva or droplets

Clin pres roseola infantum

- Incubation period 6-9 days

- 3-5 days of fever

- High fever (104F)

- Lymphadenopathy

- Rash appears AFTER fever resolves

- Blanching macular or maculopapular rash

- Starts on the neck and trunk and spreads to the face and extremities

- Nonpruritic

- Lasts 1-2 days- but can resolve in 2-4 hrs

Do patients feel better when rash appears for roseola infantum

YES

Dx roseola infantum

Clinical dx

roseola infantum Tx

- Supportive tx

- Antipyretics and fluids

Complications roseola infantum

Prevention

Febrile seizure

Hygiene

Viral exanthems: Erythema infectiosum =

"Slapped cheeks" or 5th disease

Erythema infectiosum caused by

Parovirus B-19

- Spring

- School aged children

Transmission of Erythema infectiosum

- Droplet or blood products

- Vertical transmission

Clin pres erythema infectiosum

- Incubation period 4-14 days

- Prodrome-fever, coryza, HA/N/D

- Rash

erythema infectiosum Rash after 2-5 days

"slapped cheeks": Erythematous malar rash with circumoral pallor

erythema infectiosum Rash after several days

Lacey, reticulated rash on trunk/extremities

- +/- pruritis

Do patients with erythema infectiosum feel better once rash appears?

Yes

tx for erythema infectiosum

- Supportive

- Antipyretics, fluids

Complications of erythema infectiosum

Typically benign and self limiting

Transient aplastic crisis if underlying hematologic issues

Hydrops-> fetal death

Viral exanthems: varicella =

chickenpox

Chicken pox caused by

Varicella zoster virus

- Herpesvirus

2 clinically distinct forms of chickenpox

Varicella (chickenpox) - Primary

Herpes zoster (shingles) - reactivated latent infection

Transmission of chicken pox

direct contact, droplet and airborne

Clin pres of chickenpox

- Incubation period 10-21 days

- Prodrome- fever, malaise, pharyngitis and anorexia

- Rash onset within 24 hours

- Pruritis!!!

Chickenpox rash

- Vesicular crops on an erythematous base

"dew drop on a rose petal"

- Trunk -> head and face +/- extremities

What to NOT give for chicken pox tx

NO ASPIRIN

Tx for chicken pox

- Antipyretics, cool baths, careful hygiene

- Antihistamines for itching

- Acyclovir -> if immunocompromised OR at risk for developing severe dz

Complications of chicken pox

Group A strep or staph soft tissue infx

Encephalitis, Reye syndrome, pneumonia

Chickenpox Prevention

Varicella vaccine

Reye Syndrome

- causes acute encephalopathy and liver dysfunction, typically following a viral illness

- associated with ASA use

Reye Syndrome sx (4)

- persistent vomiting

- lethargy, irritability, confusion

- seizures, AMS

- possible coma

Reye Syndrome dx (2)

- elevated liver enzymes and ammonia

- hypoglycemia

Reye Syndrome tx (3)

- supportive care

- ICU monitoring

- management of cerebral edema and metabolic abnormalities

hand foot and mouth disease caused by

Coxsackievirus

- Late summer and fall usually

Transmission of hand foot mouth

fecal oral

Clin pres hand foot mouth

- Incubation period 3-5 days

- +/- Prodrome- low-grade fever, mouth pain, V/D, anorexia

- Rash- usually resolves within 7 days

- May be uncomfortable or sore, but most do not complain of pain from rash

Hand foot mouth dz rash (4)

- Mouth- shallow oral erosions- painful

- Hands, feet, buttocks and extremities

- Not typically on face/trunk

- NOT typically ITCHY

Hand foot mouth dz dx

clinical, can do PCR

Hand foot mouth dz tx

- supportive

- fluids, ibuprofen/tylenol

Complication of hand foot mouth

dehydrated

Onychomadesis (shedding of the nail) - 3-8 weeks after sx onset

prevention of hand foot mouth

hygiene

What is mumps

single stranded RNA virus (Paramyxovirus)

Late winter to early spring, school aged children

Transmission of mumps

droplet, direct contact or fomites

Clin pres mumps

- Incubation period- 16-18 days

- Fever, headache, myalgia, fatigue and anorexia

- Followed by parotitis

U/L or B/L

- Can last up to ten days

parotitis

inflammation of the parotid gland

Mumps dx

oral or buccal swab RT-PCR or srum mumps IgM Ab

Mumps tx

- supportive

- analgesics, antipyretics

Complications of mumps (4)

- Orchitis or oophoritis

- Meningitis

- Encephalitis

- Deafness

Is mumps reportable?

Yes

Prevention of mumps

vax - MMR

What is lymphadenopathy (LAD)

enlargement of lymph nodes and occurs in response to wide variety of infectious, inflammatory, and malignant processes

What is Generalized LAD

enlargement of two or more noncontiguous lymph node groups

What is regional LAD

involves one lymph node group only

Clin pres LAD

enlarged lymph node

- note the exact location

- Note the consistency, size, shape, mobility, tenderness, warmth or fluctuance, firmness, and number of nodes

Initial workup if dx not clear or worrisome sxs for LAD

CBC ESR CRP

Further based on sxs

- Throat cx, monospot or EBV titers, skin lesion cx, blood cx, serology for B. henselae, TB, etc.