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Peds Blueprint: Infectious Disease

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What is Tetanus?
Infection caused by Clostridium tetani spores which are ubiquitous in soil. The spores germinate in wound where the bacteria produce a neurotoxin which interferes with neurotransmission at spinal synapses of inhibitory neurons.
What are clinical features of tetanus?
Uncontrolled spasm and exaggerated reflexes
Pain and tingling at site of inoculation
Jaw and neck stiffness, dysphagia, and irritability
Trismus
Tx for tetanus?
Tetanus immune globulin given IM
Bed rest, sedation, and mechanical ventilation
PCN
Mortality is high
What is Diphtheria?
Infection caused by Corynebacterium diphtheriae which is transmitted via respiratory secretions.
What are clinical features of diphtheria?
Rhinorrhea
Upper airway and bronchial obstruction
Gray membrane which covers the tonsils and pharynx with mild sore throat, fever, and malaise <--- MC presentation
Myocarditis
Tx for diphtheria?
Horse serum antitoxin which is obtained from the CDC
Removal of gray membrane via laryngoscopy
PCN or erythromycin
Isolation - need three negative cultures to be documented before released
Contacts should be treated
What is Pertussis?
AKA Whooping cough. Infection caused by Bordetella pertussis - a Gram negative pleomorphic bacillus.
Clinical features of pertussis?
3 stages:
Catarrhal stage - insidious onset of sneezing, coryza, loss of appetite, and malaise with a hacking cough which is worse at night.

Paroxysmal stage - spasms of rapid coughing fits followed by deep, high-pitched inspiration (the whoop).

The convalescent stage - decrease in frequency and severity of paroxysms. Occurs at about 4 weeks after onset of cough
Diagnostic studies for pertussis?
Culture
PCR assays
WBC - lymphocytosis
Tx for pertussis?
Erythromycin
Supportive therapy
Close contacts should be treated as well
What characteristic disease does the Epstein-Barr virus cause?
Mononucleosis AKA "Kissing disease" because transmitted through saliva. Incubation period is several weeks.
Clinical features of Mono?
Incubation period of several weeks
FATIGUE
Fever, sore throat
Oral lesions (exudative pharyngitis, tonsillitis, gingivitis, soft palate petechiae)
POSTERIOR cervical lymphadenopathy
SPLENOMEGALY (50% of cases)
How do you diagnose Mono?
Monospot
Clinical presentation
EBV IgM antibodies
How do you treat Mono?
Symptomatic treatment - antipyretics, anti-inflammatories, antivirals
Avoid contact sports with splenomegaly for 1 month
Steroids
Counsel if abx are given - rash will develop
What is Mumps?
Infection caused by the Paramyxovirus. The incubation period is usually 14 to 18 days from exposure to onset of symptoms. Transmitted by respiratory droplets, direct contact, or fomites. Infants rarely get mumps due to passage of maternal antibodies.
Clinical features of Mumps?
PAROTITIS (bilateral in 70%)
Mandibular angle is obliterated
Stenson's duct may be erythematous with yellow discharge
Prodrome of low-grade fever, malaise, headache, myalgias, and anorexia
Complications from mumps?
Orchitis which could lead to infertility
Pancreatitis
Oophoritis
Aseptic meningitis
Diagnosis of mumps?
Clinical diagnosis if there is parotitis
Serology IgM testing
Tx for mumps?
Symptomatic - analgesics or antipyretics
Topical application of warm or cold packs to the parotid may also be soothing
IV fluids if dehydrated from N/V
What are two kinds of Herpes Simplex?
Type I causes lesions on face/lips (85% of US pop. are affected)
Type II causes lesions on genitalia. May be present as a neonatal HSV infection (25% of US pop affected)
Transmitted by skin to skin contact or sexual contact
Precipitating factors for herpes outbreak?
Sun exposure
Stress
Surgery
Fever
Viral infection
Clinical findings with initial infection of HSV-1?
Initial infection has higher rate of systemic signs/symptoms and longer duration of symptoms:
Abrupt fever, anorexia, listlessness, gingivitis.
Mucosa is red, swollen, friable
Vesicles appear on oral mucosa, tongue, lips which may rupture and coalesce to form ulcers and plaques.
After the primary HSV 1 infection, where does the virus become latent?
In trigeminal ganglion. 20-40% of adults will get recurrent episodes
How do you diagnose Herpes Simplex?
Clinical diagnosis
Tzank smear - will see "Multinucleated Giant Cells"
PCR - will show antibodies
Tx for herpes?
Local wound care and supportive therapy
Antivirals (Acyclovir, Valacyclovir)
What is Varicella?
AKA Chicken Pox
Caused by Varicella Zoster
Clinical features of Varicella?
Rash starts on head, neck, trunk, and spreads
Lesions appear in crops which crust after 3-5 days.
Child is contagious for 1 week
What are complications of Varicella?
Pneumonia
Encephalitis
How do you treat Varicella?
Symptomatic tx
NO ASA!
Consider Acyclovir in teens
When can a child go back to school with Varicella?
Once lesions have crusted over and they are afebrile
What is Influenza?
Caused by orthomyxovirus and transmitted through droplet nuclei. Occurs in epidemics and pandemics in the fall and winter. There are three strains: A, B, C. A is more capable of causing disease.
Clinical findings of influenza?
18-72 hour incubation period
ABRUPT fever, chills, malaise, muscle aches, substernal chest pain, HA, nasal congestion, nausea.
Associated coryza, dry cough, photophobia, eye pain, sore throat, pharyngeal injection, flushed face.
May be wheezes and rhonchi.
What is Reye syndrome?
Fatty liver with encephalopathy that may develop 2-3 weeks after influenza or varicella infection, especially if ASA is taken. Rarely occurs in patients over 18.
Diagnostic studies for the Flu?
Viral cultures taken from throat or nasal mucosa (Takes 3-7 days to return)
Rapid flu serology - 50-70% sensitive, 95% specific. Results are most accurate in the first few days.
CXR will show bilateral diffuse infiltrates
Tx for flu?
Supportive care -rest, analgesics, fluids, cough suppressants
Neuraminidase inhibitors: Oseltamivir (Tamiflu), Zanamivir inhalation (Relenza). Must be given within 48 hours of onset. Note that resistance to Tamiflu is on the rise.
Prognosis is good. Most recover in 1-7 days.
Prevention of Flu?
Trivalent or quadravalent vaccine yearly (must be at least 6 months)
Should be given Sep-Nov
Especially recommended for people >65
FluMist nasal spray is recommended for patients 2-49
Immunity occurs 2 weeks after receiving the vaccination
Contraindications to the flu vaccine?
Sensitivity to eggs
Acute febrile illness
Thrombocytopenia
Asthma (if getting flumist)
What is Hand-foot-and-mouth disease?
Caused by Coxsackie A-16 enterovirus. It's an infection that causes sores to form in the mouth, and on the hands, feet, buttocks, and sometimes the genitals.
Clinical features of hand-foot-and-mouth disease?
Vesicles on hands, feet, oral mucosa, and tongue
May have generalized scaletiniform rash
Coxsackie B may lead to myocarditis
Tx for hand-foot-mouth?
Self-limiting disease (lasts 3-5 days)
Hydration is key
Magic mouthwash and Tylenol for symptomatic treatment
Hand washing
What are the 6 childhood exanthems (rash-causing diseases)?
Measles (Rubeola)
Scarlet fever
German measles (Rubella)
Filatov-Dukes disease
Fifth disease (Erythema Infectiosum)
Roseola
What are clinical features of Measles?
AKA Rubeola
3 C's: Cough, Coryza (cold-like symptoms), Conjunctivitis
4 day fevers
KOPLIK's SPOTS- oral lesions that appear before the rash
Macular-papular rash in the hairline that spreads down over 3 days
How do you treat Measles?
Supportive care - Measles is self-limiting (lasts 7-10 days)
What is a rare complication of Measles?
Subacute sclerosing panencephalitis (SSP) - fatal encephalitis that occurs years after initial infection
What is Scarlet fever?
AKA "SCARLETINA". Most commonly affects children between 5 and 12 years of age. Caused by GAS which release erythrogenic exotoxin.
What are clinical features of Scarlet fever?
Classic symptoms: SANDPAPER rash in groin, axilla with DESQUAMATION (peeling) after 3-4 days.
Strep symptoms: Pharyngitis, fever
Bright red tongue with a "STRAWBERRY" appearance
How do you treat Scarlet fever?
PCN VK
What is German Measles?
AKA "RUBELLA"
Symptoms last 2-3 days
Half of patients with Rubella are asymptomatic
What are clinical features of German Measles?
Rash that starts on the face and spreads to the rest of the body (less intense than measles)
Low grade fever
Postauricular and occipital adenopathy
Aching joints, especially among young women.
FORCHEIMER spots (fleeting small, red spots on the soft palate) - can also be seen with measles and scarlet fever.
How do you diagnose Rubella?
Usually a clinical diagnosis
Can do paired sera - get a blood sample now and then in a week. This is usually done in immunocompromised patients.
How do you treat Rubella?
Symptomatic treatment
What is Erythema Infectiousum?
AKA 5th disease
Caused by Human Parvovirus B19
What are clinical features of Erythema Infectiosum?
Mild flu like illness
Rash at 10-17 days (not contagious with rash)
SLAPPED CHEEKS
LACEY arms and legs
Arthralgias in older patient
Can cause fetal death in 1st trimester
Treatment for Erythema Infectiosum?
Symptomatic tx
What is Roseola?
AKA Exanthem Subitum
Caused by human herpesvirus 6 (HHV-6)
Occurs in infants ages 6 months - 3 yo
What are clinical features of Roseola?
High, abrupt FEVER--->febrile seizures. Fever lasts 3-7 days.
Rash on face, neck, arms, legs (pinkish-red flat or raised rash which turn white when touched)
Defervescence (fever goes away) occurs before rash appears
What are signs/symptoms of Pinworms (Enterobiasis)?
Nocturnal anal pruritis
Abdominal pain
Worms or eggs on perineum or in stool
How do you diagnose Pinworms?
Tape test
O&P (ova and parasites stool test)
Clinical diagnosis
How do you treat Pinworms?
Mebendazole (Vermox)
Hand washing
What is the most common cause of congenital viral infection in the US?
CMV - can cause sensorineural hearing loss, vision loss, mental retardation, and enlargement of liver and spleen