54 terms

Common Acute Pediatric Illnesses

1. Describe the etiology, clinical presentation, diagnostic evaluation, and management for the following acute illnesses: a. Gastroenteritis - viral, bacterial and protozoal b. Kawasaki Disease 2. Describe the etiology, clinical presentation, and management of the following viral exanthems: a. Varicella b. Rubella c. Measles (Rubeola) d. Mumps e. Fifth disease f. Roseola 3. Discuss the diagnostic evaluation and management of chronic/recurrent abdominal pain of childhood. 4. Discuss the prognosis…

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In developed countries ~ 60% of acute viral gastroenteritis cases in children < 2 yrs old is caused by ___
rotavirus (winter months)
normal course of rotavirus
Vomiting x 3-4 days, diarrhea 7-10 days with dehydration common
diarrhea assoc with severe abdominal pain, may present similar to appendicitis.
acute gastroenteritis associated with raw eggs and may cause systemic illness
profuse, rapidly dehydrating diarrhea
E. coli 0157:H7
caution with E. coli 0157:H7
risk of HUS (Hemolytic Uremic Syndrome) with antibiotic treatment
acute gastroenteritis uncommon in US; assoc with swine, contaminated food.

may present as appendicitis-like picture in older children. lasts 3 days to 3 weeks.
Yersinia enterocolitica
acute gastroenteritis associated with daycare outbreaks; foamy, foul smelling, copious diarrhea
Giardia lambia
acute gastroenteritis assoc with high fever, seizures, high WBC.
course of shigella
Incubation 1-7 days (usually 2-4)
Most self limited 48-72 hours
tx shigella
Tx recommended for dysentery, severe disease or to prevent spread:
ceftriaxone, azithromycin, fluoroquinolone - shortens duration, prevents spread
ampicillin, TMP/SMX if susc
Complications of Campylobacter Convalescence
acute Guillain-Barre syndrome, reactive arthritis, Reiter syndrome (arthritis, urethritis, and bilateral conjunctivitis) and erythema nodosum
tx Campylobacter
erythromycin, azithromycin or doxycycline x 5-7 days: shortens duration and prevents relapse
cause of typhoid fever
salmonella with bacteremia
pts with salmonella & which comorbid condition MUST be treated?
sickle cell
tx salmonella
if non-invasive, NO tx (prolongs carrier state)
if < 3 mo; bacteremic; sickle cell or immunosupp: cefotaxime or ceftriaxone or azithromycin; (ampicillin or TMP/SMX if susc)
assocaited with daycare outbreaks
Giardia lambia protozoa
tx of Giardia
Metronidazole 15 mg/kg/24 hr / TID x 5 days Furazolidine 8 mg/kg/24 hr / QID x 7-10 days
Albendazole 15mg/kg once a day x 5-7 days
presentation of ameoba diarrhea
abdominal cramping, diarrhea or dysentery, espcially with history of travel.
tx ameoba diarrhea
Tx: Metronidazole: 35-50 mg/kg/24 hr TID x 10 days
tx yersinia
if non-invasive or non-immunocomp, no tx;

TMP/SMX, cefotaxime, FQ, or doxy if immunosuppressed or invasive infection.
red cracked lips, lymphadenopathy, and fever
Kawasaki Disease - A vasculitis affecting small and medium sized vessels classically associated with red mucous membranes
etiology of Kawasaki Disease
unknown, possibly a bacterial toxin.
most commonly affects age 6 mo-4 years (peaks at 12 months)
presentation / dx criteria for Kawasaki Disease
Clinical dx based on fever > 5 days plus any four:
conjunctival injection
red mucous membranes (lips)
cervical lymphadenopathy
rash (morbilliform, maculopapular, or scarletiniform swelling of hands & feet with red, edematous palms and soles)
peeling of fingers and toes (usually 11-25 days after onset of illness)
major concern with Kawasaki Disease
Coronary arteries in 1/3 within 6 weeks; can result in aneurysms
Can lead to narrowing of vessels and MI; mortality 1-2%
tx Kawasaki Disease
Echo to assess for coronary aneurysms initially and throughout treatment

IVIG in the 1st 10 days of illness: ↓ risk coronary aneurysms: single dose 2 g/kg over 10-12 hours

Aspirin as anti-inflammatory and antiplatelet to ↓ risk thrombosis
Fever, papulovesicular rash spreads face/scalp → trunk/extremities. Papules, vesicles, and crusts in various stages.
varicella (chicken pox)
complications of varicella
pneumonia, encephalitis, Reye's syndrome, superinfection with staph and strep, dehydration.
cough, coryza (acute rhinitis), fever, conjunctivitis, koplick spots (white spots on buccal mucosa).

Rash appears on day 3:
Erythematous mac/papular rash
starts around neck, face and ears, descends to arms/chest, then to lower extremities and feet over 2-3 days
Measles (Rubeola)
complications of measles
pneumonia, otitis media, encephalitis
Fever, malaise, parotitis.
pain w/ eating or drinking and ear pain. Parotitis starts unilateral and spreads to other side over few days.
complications of mumps
meningitis, encephalitis, orchitis in pubertal or postpubertal males.
Mild URI, low grade fever
Mac/papular rash on Day 1: forehead to face, trunk, extremities, fades over 2-3 days
arthralgias, LAD in post auricular, post cervical, and occipital.
Rubella (German Measles)
presentation of congenital rubella infection
'blueberry muffin baby'
catarracts and microcephaly.
fever 103-105 for 3-4 days
small pink mac/papular rash on trunk & neck after defervescence.
Roseola (exanthem subitum)
caused by Human herpes virus 6 & 7
mild URI, low grade fever, headache
1 week later: "slapped cheeks" and lacy reticular rash on neck, trunk and extremities
Fifth Disease (erythema infectiosum)
Parvovirus B19
(may also be asymptomatic)
complications of fifth disease
arthritis, anemia, fetal hydrops
mgmt for 1st-6th disease
avoid antibiotics, especially in Roseola which presents with rash after fever clears, to avoid false reporting of drug allergy.
Recurrent Abdominal Pain Differential
Functional Abdominal Pain- 90%
IBS - relieved w/defecation, mucousy stools, bloating, constipation/loose stools alternate
Non-ulcer dyspepsia - epigastric, vomiting, early satiety
Abdominal migraine - midline, paroxysmal, facial pallor
Lactose intolerance
Crohn's disease - diarrhea, FTT and delayed puberty; occl oral or perianal ulcers
Celiac disease - FTT, abnormal stools, irritability, abdominal distension
Warning signs "Red Flag" Abdominal Pain
Bilious emesis
Growth failure
Pain awakening child from sleep
Weight loss
Blood in stools or emesis
Location away from umbilical area
lab workup for recurrent abdominal pain
CBC, ESR, Amylase, Lipase
Possible KUB
Abdominal ultrasound: liver, bile ducts, gallbladder, pancreas, kidney, ureters
3 day trial of lactose free diet or gluten free diet
presentation of functional abdominal pain
daily or near daily peri-umbilical pain, not associated with or relieved by defecation. No pathology on PE or history.
prognosis of functional abdominal pain
~ 50% of patients will have rapid resolution
~ 25% of patients will have resolution over next several months
~25% of patients will continue or have recurrence in adulthood as IBS, non-ulcer dyspepsia or cranial migraine
(treatment is reassurance only)
causes of genu varum
Common up to age 3
DDX: Rickets and Blount's disease (infantile tibia vara)
Blounts : asymetrical, predominantly African American, Xray shows beaking of proximal medial tibial epiphysis
prognosis of genu valgum
Common between 2-7 yrs; usually resolves
mgmt & prognosis of toe-walking
Common age 1-3 yr
Check for tightness of Achilles , mild Cerebral Palsey, or Duchenne's
name 3 causes of in-toeing
metatarsus varus: adduction deformity of highly mobile forefoot. passively correctable.

medial tibial torsion: tibia not rotated laterally fully. occurs in toddler, but usually self corrects within 5 years.

anteversion of femoral neck: femoral neck at hip is twisted foreward more than usual. Presents in childhood. Usually corrects by 8 y.o.
signs/symptoms of acute otitis media
ear pain or pulling, fever, irritability.
bright red TM, bulging w/ occasional perforation and purulence in the canal.
most common cause of otitis media
viral is most common:
RSV, rhinovirus, coronavirus, parainfluenza, adenovirus, enterovirus.

may be bacterial: S pneumo, non-typable H flu, moraxella catarrhalis, Group A strep.
treatment for otitis media
always give antibiotics if under 6 months.
Abx if certain of diagnosis in 6 mo to 2 years.
If over 2 years and non-severe, observe only.
Amoxicillin (high dose - 80-90mg/kg/day) in 2 or 3 doses.
Augmentin or Cefdinir if resistant.
treatment for recurrent otitis media
myringotomy tubes.
prevent by not smoking, no bottle propping, breast feed, possible prophylactic abx.
cause of otitis media with effusion
persistent fluid, usually no infection.

tx w/ myringotomy tube to prevent developmental delay.
cause of otitis externa
"swimmer's ear" from H2o changing the pH in ear canal, break in skin surface/dry or eczema, foreign body.

pathogens = Pseudomonas is most common. also enterobacteriacea, proteus species, fungi.
otitis externa treatment
topical drops x 7 to 10 days:
polymyxin B/neomycin/hydrocortisone.

prevent with acetic acid and alcohol wash.