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713: ID wk 2

713: infectious diseases wk2

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 cellulitis Retropharyngeal abscess Mononucleosis Pharyngitis Tonsillitis Epiglottitis- drooling Leukemia Lymphoma Tracheitis
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.
Created by: JennRN