Key respiratory tract infections in children

Diagnosis
Laryngotrach
eitis (croup)

Classic Pathogen Presentation

Parainflue
6mo-3yo
nza virus
Barky coughing, stridor, hoarse
voice
Steeple sign on AP neck XR
Tx: Steroids to reduce subglottic
edema. Nebulized racemic Epi for
stridor at rest

Epiglottitis

Bronchiolitis

Most

Haemophil
us
influenzae
Respirator
y Syncytial
Virus

Treatment

Unvaccinated children
Sore throat, dysphagia, drooling,
tripod positioning
<2 yo
Wheezing, coughing

Common Cause of Acute Bacterial Rhinosinusitis:

30%: Strep Pneumononiae
30% Haemophilus influenza
10% Moraxella catarrhalis

Pseudomonas aeruginosa is common in nosocomial sinusitis, esp in

immunocompromised patients with nsasal tubes and catheters.
Staph aureus- rare cause of acute bacterial rhinosinusitis in children.
Pertussis
Clinical Phases

Diagnosis
Treatment
Prevention

Pathogenesis

Cararrhal: 1-2 wks. Mild cough, rhinitis

Paroxysmal: 2-6 wks. Cough with inspiratory whoop, posttussi
Emesis.
Convalescent: wks to months. Symptoms resolve gradually.
Pertussis culture or PCR testing of the nasopharynx
Lymphocyte-predominant leukocytosis
Macrolides (azithromycin, clarithromycin)
Acellular pertussis vaccine: DTap (5 doses) during infancy and
early childhood. The Tday (tetanus toxoid-reduced diphtheria
toxoid-acellular pertussis) booster is given during adolescence (
18) and during each pregnancy due to waning immunity
Croup (laryngotracheitis)
Parainfluenza viral infection

Epidemilogy
Clinical Features

Treatment

inflammation of larynx & trachea

6 months to 3 years
Fall, early winter
Inspiratory stridor
Barky seal like cough
Hoarse voice
Mild (no stridor at rest): corticosteroid
Moderate/severe (stridor at rest):
corticosteroids + nebulized epinephri

-Herpangina: Caused by Coxsackie virus(which also causes hand-foot-mouth dz)Herpangina: vesicles on the hard palate. It generally does not produce a diffuse
rash after antibiotic administration.
-Adenovirus: coryza, pharyngitis, tonsillitis, and conjunctivitis.
-EBV: infectious mononucleosis. Fever fatigue and exudative pharyngitis and
cervical LAD. A polymorphous, maculopapular rash develops after administration
of amoxicillin. Patients should avoid sports for >= 3 weeks for risk of splenic
rupture

Sepsis/Meningitis
-GBS sepsis in term infants
-E. coli sepsis in preterm infants
S/S of sepsis: Decreased PO, irritability, hyper/hypothermia, resp distress, vomiting,
jaundice
Bacterial meningitis: will see hypotonia and full/bulging fontanelles, nuchal rigidity,
and seizures
Neonatal evaluation; CBC, Blood and CSF cultures. Then, give empiric systemic
antibiotics: ampicillin/gentamicin.
Neutrophilia with a left shift (bands of >700 or a bad to total neutrophil count ratio
>0.16) indicates sepsis from bacterial infection.
Meningococcal meningitis- occurs in age 3 years to adolescence. 75% present with
petechial rash that appear within 24 hours of the infection.
Septic Arthritis:
Birth to 3 months: Staph, GBS, gram negative bacilli
Antibiotics to kill staph and gram negative: Naf or Vanc PLUS gentamycin or
cefotaxime

Older than 3 months: Staph, GAS, Strep pneumoniae

Antibiotics: Naf, clinda, cefazolin, or vanc
Lab findings: Elevated WBC, ESR & CRP, Synovial fluid WBC>50,000 ceels
Initial management: arthrocentesis, blood and synovial fluid cultures, and empiric
antibilitic therapy
Infections of the hearts:
Acute rheumatic fever: Group A Strep pharyngitis self resolves, but get 10 day
course of PO penicillin.
Coxsackievirus is the most common organism responsible for pericarditis and
mycocarditis. Also causes vesicular pharyngitis (herpangina) in young children.
Group A strep infections:
1. Scarlet fever:
-caused by GAS that produces erythrogenic exotoxins
-illness follows a strep pharyngitis, wound infection, burn, skin infection.
-Incubates 1-7 days. Initial symptoms: pharyngitis, abdominal pain, toxicity,
fever/chills
Within 12-28 hours, rash appears on neck, axillae, and groin. The rash has a
sandpaper like feeling.
-Pharynx is red, swollen, and possibly covered with gray-white exudates.
-Area around the mouth is more pale circumoral pallor
-At end of first week, desquamation begins in the face and progresses down
Tx is Penicllin V. Erythromicin, clinda, and 1st gen cephalosporin

Cat Bites
Microbiology
Management

Pasteurella multocida
Anaerobic bacteria
Copious irrigation & cleaning
Prophylactic
amoxicillin/clavulanate
Tetanus booster as indicated
Avoid closure

Impetigo
Non-bullous

Type
Microbiology
Clinical Features

Staph aureus
Group A Strep (S pyogenes)
Painful non-pruritic

Bullous

Staph aureus

Rapidly enlarging flaccid bu

pustules
Honey-crusted lesions
Treatment

with yellow fluid

Collarette of scale at periphery of
ruptured lesions
Limited skin involvement: Topical antibiotics (e.g. mupirocin)
Extensive skin involvement: Oral antibiotics (e.g. epehalexin,
dicloxacilin, clindamycin)

Acute Cervical adenitis in children

Location
Pathogen
Staph aureus
Unilateral
Step pyogenes
Anaerobic bacteria (e.g.
Prevotella buccae)
Baronella henselae

Bilateral

Mycobacterium avium
(nontuberculous
mycobacteria)

Adenovirus

EBV/CMV

Additional features
Pronounced Erythema,
tenderness
Dental caries
Periodontal dz
Papular nodular at site
cat scratch or bite (tak
weeks)
Gradual onset, nonten
MCC of subacute
unilateral LAD in youn
children. Onest is slow
Not tender.
Pharygoconjunctivits

Mono (fever, fatigue,

pharyngitis)

Staph/Strep are most common cause of acute unilateral lymphadenopathy:

<5 and affects submandibular nodes- large, tender, warm, erythematous.
Can progress to suppuration and abscess. Tx: clindamycin (tx MRSA and
Strep pyogenes)

Measles virus (Rubeola)

Transmission
Clinical Presentation

Prevention

Treatment

Airborne
Prodrome: cough, coryza,
conjunctivitis, fever, Koplik
spots
Maculopapular exanthema:
Cephalocaudal & centrifugal
spread. Spares palms/soles
Live attenuated measles
vaccine
Supportive
Vitamin A for hospitalized
patients

Vitamin A: Reduces morbidity and mortality rates for patients with severe measles
(e.g. those requiring hospitalization) through the promotion of antibody-producing
cells and regeneration of epithelial cells (e.g. in the gut, lungs, and retina)

Rubella (German Measles)

Clinical Presentation

Diagnosis
Prevention

Congenital: Sensorineural
hearing loss, cataracts, PDA
Children: Fever, cephalocaudal
spread of maculopapular rash
(spares palms and soles)
Adolescent/Adults: Same as
chlldren + arthralgias/arthritis
Serology
Live attenuated rubella
vaccine

Measles has higher fever (>40c/104 F) , cephalocaudal spread of the rash over
multiple days, and cervical rathen than posterior auricular or suboccipital
adenopathy. In addition, arthritis does not occur in measles.
-MC pathogen in CF infants and children is S. Aureus (in adults, it is pseudomonas)
-Tx lyme disease with oral amoxicillin or cefuroxime in children <8 years and
pregnant women. Doxy slows down bone growth in exposed fetuses and cause
enamel hypoplasia and permanent teeth staines. IV ceftriaxone for Lyme
meningitis and heart block.
-MCC of unilateral, acute lymphadenopathy is S. Aureas, followed by Strep in <5yo
-Peptostreptoccus (anaerobe) lymphadenitis is in children with hx of periodontal
disease
- Unilateral, chronic, nontender lymphadenopathy with/without violaceous color in
<5yo is Nontuberculous Mycobacteriam Avium-intracellulare
-Bilateral, subacute-chronic lymphadenopathy along with fever, pharyngitis, and
hepatosplenomegaly is EBV.
-Osteomyelitis in SS: MCC salmonella and staph aureus. Tx: ceftriaxone and
antistaph (oxacillin, vancomycin).
Septic arthritis:
Acute fever, joint pain, turbid synovial fluid, and neutrophil predominant
leukocytosis
Tx: emergency surgical drainage and IV antibiotics to prevent permanent
joint destruction