Question | Answer |
Roseola | Acute benign childhood disease. Hx prodromal febrile illness (3day). Defervescence & faint pink maculopapular rash. Ass with resp or GI symptoms. |
Transmission of Roseola | Resp secretions, spreads during fibril phase of illness. 12-30% get disease
80% by 1 yr of age have HHV6 antibodies
99% by 4 yr of age are seropositive |
Roseola Hx | History of high fever (40 C), rapid defervescence and rash
Rash fades within few hours to 2 days
14% will have prodromal symptoms of listlessness and irritability
68% will have diarrhea
50% will have cough |
Presentation of Roseola | Alert, non toxic appearing. 98% will have fever and rash; Pink macules 2-5 mm. Lesions are discrete, blanche
Involves trunk, back. May have halo around lesion. Lymphadenopathy, Periorbital edema
Nagayama spots.
Etiology:HHV6 virus |
Etiology Roseola | HHV6 virus |
Differential Diagnosis of Rash & presentation of a pt with Roseola | Sepsis
Erythema Infectiosum
Measles
Pneumonia
Drug eruption |
Treatment of ROseola | symptomatic care only |
Erythema Infectiosum | 5th’s Disease
Childhood condition that is benign, characterized by slapped cheek and lacy exanthem. Frequency-outbreaks are common
Peak incidence winter and early spring
Females slightly more affected
70% of all cases are in 5-15 year olds |
Erythema Infectiosum clinical presentation | Biphasic illness
Prodromal symptoms about 1 week post exposure and last 2-3 days
Headache, fever, st, pruritus, coryza, abdominal pain
These symptoms precede a period of 7-10 of being asymptomatic, them the typical exanthem occurs |
Rash is erythema infectiosum | Rash occurs in 3 phases
Bright red slapped cheek appearance
In 1-4 days a erythematous, maculopapular rash on arms, extensor surfaces and trunk
Finally fades to a lacy pattern as confluent areas clear. Palms and soles are spared |
Etiology of erythema infectiosum | Human parvovirus B 19 |
Differential diagnosis of pt presenting with erythema infectiosum | Hand foot and Mouth
Measles
Roseola
Scarlet Fever
Drug eruption
Allergic reactions |
Treatment of erythema infectiosum | Symptomatic care
Children are not infectious and may attend daycare or school |
Hand foot mouth disease | Viral syndrome with a distinct exanthem
Vesicular lesions on the anterior mouth
Exanthem on the hands and feet in association with fever
Peak incidence in summer and fall
High fever
More common in children <5 years of age |
hand foot mouth dx Hx | Incubation is 3-6 days
Prodrome
Fever
Malaise
Anorexia |
Physical presentation of hand foot mouth disease | Yellow ulcers surrounding by red halo characterize the oral lesions
Exthanem involves palmar, plantar and interdigital surfaces of hands and feet
May be pruritic
In infants may appear on buttocks and thighs
Rash is self limiting, lasts about 3-6 days |
Etiology of hand foot mouth dx | Coxsackievirus A16 |
Differential diagnosis of pt with hand foot mouth disease | Differential Diagnosis: all vesicular
Herpes simplex
Measles
Tick borne diseases
Varicella |
Treatment of hand foot mouth dx | Symptomatic care
Maintain hydration! Popsicles –what ever they want
Benadryl/Maalox mixture- coats throat (+ viscous lidocane = magic mouth wash)
Minimize contact with oral and respiratory secretions for 2 weeks |
Sinusitis | Inflammation/infection of 1 + paranasal sinuses. Normal drainage obstructed: Acute, Sub acute, Chronic.
5-10% URI’s in kids related to sinusitis
Rare in children less than 1 year of age. In day care get 10+ colds/yr. Estuation tubes horizontal |
Sinusitis Hx & presentation | Nonspecific:daytime cough and persistent nasal discharge, sore throat, irritable, fatigue. Fever, headache, and facial pain are all RARE in pediatrics. May present with persistent cold. Nasal congestion, purulent rhinorrhea: color is meaningless. > 10 d |
URI or sinusitis? | Depends on how long symptoms have been preent |
Physical presentation in sinusitis | Fever is rare
Erythema and edema to turbinates
May see purulent discharge and post nasal drip- must say “ah to depress tongue” |
Causative presentation in sinusitis | Streptococcus pneumoniae
Haemophilus influenzae
Moraxella catarrhalis
Staphylococcus aureus
Very similar to OM- secondary to straight estuation tubes |
Differential diagnosis for sinusitis symptoms | URI
Otitis Media
Cough Variant Asthma (not necessarily wheezing – rather cough) day time vs night cough
Allergic Rhinitis -
Dental infections |
Rx for sinusitis | Decongestants
Nasal and oral
Antibiotics (need to know what is sensitive in geogratph region )
Amoxicillin (40mg/kg/day) 65% strep Pneumo
Augmentin (35-40mg/kg/day)
Bactrim
Zithromax (10mg/kg/day) q day x 5 day |
Non prescription sinusitis tx | Symptomatic care
Push fluids
Avoid antigens, like smoke
Vaporizer
Pain relievers, Tylenol, Motrin
Warm compresses
Vic’s vapo rub just as effective as OTC
NS drops with suction <18mth |
Causative agents Pharyngitis | GABHS pharyngitis via respiratory secretions. group C streptococci, group G streptococci, Neisseria gonorrhea.
Viral: rhinovirus, adenovirus, parainfluenza, coxsackievirus, coronavirus, echovirus, HSV, EBV, CMV |
Strep pharingitis Hx | Lymph nodes get swollen when payers patches get enflamed -> n/v
Fever sudden on set
not so many cold symptoms
Sex history (nesiseria g) |
Epidemiology of strep pharyngitis | 10% of all kids seen are seen for pharyngitis: 25-50% have GABHS, 20% long-term carriers of GABHS. Greatest incidence 5-18y. Younger than 2 years, most pharyngitis is of viral etiology, although GABHS rarely can occur in this younger age group. |
Clinical presentation & Hx pharyngitis | History of exposure to known carriers
Fever
Sore throat
Headache big with strep
Abdominal pain
Anorexia 2ndry to difficulty swallowing
Chills
Malaise |
Strep pharyngitis triad | Fever, h/a, abdominal pain/nausea . Sore throat usually primary complaint. |
Physical exam pharyngitis | ,Enlarged tonsils, Pharyngeal erythema
Tonsillar exudates with necrotic crypts,
Soft-palate petechiae, Tender cervical adenopathy, Fever, Miliform rash- peels when it clears. |
Differential Diagnosis for pharyngitis | Diphtheria
Mononucleosis
Epiglottis
Viral pharingitis
Peritonsillar abscess |
Lab eval for strep pharyngitis | Rapid strep test, plated 24hr strep test/ cx |
Rx for pharyngitis | Viral: antipyretics, analgesics, hydration. GABHS: Penicillin Amoxicillin, PCN VK
Erythromycin, Cephalosporin, Ceftin, Omnicef, keflex, Macrolides, Zithromax
(30-40mg/kg/day)OR amoxicillin |
When to tx pharyngitis | STRESS MUST TX 10 DAY OR GET RHEUMATIC FEVER W/WO TICK CHOREA . Early therapy may lead to a higher failure rate secondary to an inability to create an immune response to the infection. |
Peritonsillar abscess | Peritonsillar abscess (PTA) common infection of the head and neck region. Combinations of aerobic and anaerobic bacteria colonize the peritonsillar space- no tonsil behind in soft tissue. Begins superficially and progresses into the deep soft tissues |
Pathophys of peritonsillar abscess | The exact mechanism not known. Form between the palatine tonsil and its capsule, usually at superior pole. Believed to arise from an acute episode of tonsillitis, which then progresses to involve the soft tissues surrounding this area |
Epidemiology of peritonsillar abscess | USA: 30 cases per 100,000 persons per year, accounting for approximately 45,000 cases annually.
Peritonsillar abscess can occur in anyone aged 10-60 years. If it occurs at a younger age usually patient is immunocompromised |
Clinical presentation/hx peritonsillar abscess | Sore throat, which may be unilateral
Dysphagia- spitting into cup
Change in voice: ‘hot potato mouth’
Headache
Malaise Fever
Neck pain
Otalgia
Odynophagia |
Physical exam peritonsillar abcess | Mild/moderate distress, Fever, displacement of the tonsil & uvula, Erythema & exudate of tonsil, Tachycardia, Dehydration
Drooling, salivation, Trismus, Cervical lymphadenitis in the anterior chain, asymmetric tonsillar hypertrophy, voice change |
Etiology of peritonsillar abcess | Usually polymicrobial
Aerobic species found are Streptococcus species
Anaerobic species found are Prevotella species and Peptostreptococcus species |
Differential diagnosis of peritonsillar abscess | Peritonsillar cellulitisRetropharyngeal abscessMononucleosisPharyngitisTonsillitisEpiglottitis- drooling LeukemiaLymphomaTracheitis |
W/U of peritonsillar abcess | CBC with diff
leukocytosis
Rapid strep
May or may not be positive
Mono spot
Usually negative, Lateral neck film
Distortion of soft tissue
Cat scan head and neck
Useful if I/D has failed
Cannot open mouth
Child < years of age
Ultrasound -- NEED |
Procedures/Tx peritonsillar abcess | Hospitalization!!
ABC’s
Hydration
Antipyretics
Antibiotics
Penicillin areobic
Flagyl anarobic
Clindamycin
I&D , tonsillectomy, |
Allergic Rhinitis Epidemiology | 40% of children have some type of AR
Increases if child has a form of atopy- eczema dry skin sensitive skin |
Clinical Manifestations of Allergic Rhinitis | Mouth breathing
Snoring
Sniffing, Snorting, Sneezing
Nasal Congestion, itchy eyes |
Allergic Rhinitis physical exam | Allergic Salute
Dennies Lines
Allergic Shinners
Pale/blue boggy nasal turbinates |
Differential diagnosis of the symptoms of allergic Rhinitis | Cough variant asthma
Foreign body;- really bad smell- unilateral rhinarreha
Sinusitis
Adenoid hypertrophy
Structural disorder |
Diagnosis Allergic Rhinitis | Dx= H&P
Nasal swab for eosinophils (ENT)
IgE-
Rast test or allergy skin prick test- need to be exposed to something to have an allergic rxn (not anaphalatic – IgE rxn)
When do you do this?
4/5 yrs age |
Management of Allergic Rhinitis | AVOIDANCE of allergens
Wet dusting
Remove carpet, replace with hard wood
Mattress and pillow covers
No curtains, blinds only
Stuff animals |
Pharm management of Allergic rhinitis | best = oral antihistamines, intranasal corticosteroids. |