Pediatric Infectious Diseases - Bacterial PDF

Pediatrics Infectious Diseases - Bacterial Dr. MSF I. PERTUSSIS any bacterial infections → only Whooping Cough...

Pediatrics Infectious Diseases - Bacterial Dr. MSF I. PERTUSSIS any bacterial infections → only Whooping Cough requested for patients that are Bordetella pertussis susceptible to sepsis or those with Pertussis Toxin localized infection Mode of Transmission: Others Include: PCR, DFA, Serologic o Close contact via respiratory secretions Testing o Highly communicable Treatment Incubation Period: 6-20 days You need to base your Antibiotics on the type of Seen more often in Adolescents and Adults (Index Case) organism as well as the age of the patient No lifelong immunity → you can have another bout of Most effective during the first 2 weeks of illness Pertussis unless you have your vaccination Infants 2 years of life Cardiac → Congestive Heart Failure Complications Bone Malformations (CHF) Neurosyphilis Coma Rhagades Correct Hydration and Electrolyte Signs and Hutchinson’s Triad Imbalance Symptoms o Interstitial Keratitis Antimicrobials for 3 Days: o Mulberry Molars a. Doxycycline Treatment o 8th Nerve Deafness b. Tetracycline Stigmata of Congenital Syphilis c. Cotrimoxazole 1. Saddle Nose d. Ciprofloxacin 2. Hutchinson’s Teeth Supportive Diagnostics and Treatment V. E. COLI INFECTION Diagnostic Tests: Serology - VDRL, RPR Diarrhea – different types based on strains Treatment: o ETEC – Enterotoxigenic E. coli o DOC: IV Penicillin G → Most are self-limited o Newborn: Aqueous Crystalline Pen G or Procaine Pen o EPEC – Enteropathogenic E. coli G o EAEC – Enteroaggregative E. coli o Children: Benzathine Pen G (IM); Alternative: o EIEC – Enteroinvasive E. Coli Erythromycin or Tetracycline → Resembles Bacillary Dysentery (in Shigellosis) III. SHIGELLOSIS because EIEC shares virulence genes with Incubation Period: 24 hours Shigella spp. o Toxin UTI (most common) Dysentery o Can be managed as an outpatient o Bloody Diarrhea with Fever, o EHEC – Enterohemorrhagic E. coli Signs and Abdominal Cramps, Rectal Pain, → Shiga-like Toxin Symptoms and Mucoid Stools → Shiga Toxin-Producing E. coli (STEC) Neurologic → Seizure, Confusion, Colitis with Bloody Diarrhea Hallucinations Dysentery History Hemolytic Uremic Syndrome (HUS) – 22% Signs and Laboratory: Symptoms of cases Diagnosis o Stool: Leukocytes, Stool Culture, o Microangiopathic Hemolytic Anemia Rectal Swab, Blood Culture in o Thrombocytopenia severely ill o Acute Renal Failure Septicemia, Seizure, HUS, History → undercooked beef or food, or Pneumonia Diagnosis street food HUS Triad: Stool Culture Complications 1. Microangiopathic Hemolytic Treatment Anemia Dehydration 2. Acute Renal Failure (Uremia) o Rehydration 3. Thrombocytopenia Severe Intractable Diarrhea Supportive o Cotrimoxazole 3-5 days Antibiotics (Cefixime, o Azithromycin Ceftriaxone, Ciprofloxacin, o Ciprofloxacin – for older children Azithromycin) UTI o Non-Admitted Patients: Cefixime o Amoxicillin Treatment o Admitted Patients: Ceftriaxone o Clavulanate o Older Children (>18 y/o): o Cotrimoxazole → do not give in patients with G6PD Ciprofloxacin or Azithromycin Deficiency → will lead to Hemolytic Anemia Ciprofloxacin – drug of choice for o Ampicillin-Sulbactam bloody diarrhea for all ages (WHO) Sepsis, Meningitis, Pneumonia (Invasive) Factors to consider when choosing o Ceftriaxone Antibiotics: o Cefotaxime 1. Age of the Patient Neonatal Sepsis / Meningitis 2. Clinical Disease o Ampicillin + Aminoglycoside 3. Etiologic Factor of the Disease VI. TETANUS You do not need to wait for the Clostridium tetani results of the Blood Culture or CBC to Anaerobic Spore-Formers, Neurotoxin give Antibiotics Soil, Dust, Human and Animal Feces, Source Unsterile Suture, Rusty Instruments Mode of Spores introduced into an area of Transmission injury or wound Page 2 of 13  Pediatrics Infectious Diseases - Bacterial Dr. MSF Neonates → cut umbilical cord with Treatment unsterile scissors Neutralize Toxin from diffusing (Passive Immunization) Traumatic Birth → patients born A. Antitoxin outside the hospital (e.g., taxi, o Tetanus Immunoglobulin (TIG) Human or Equine tricycle) a. Infants – 500 units Unimmunized Mothers b. Children and Adults – 3000-6000 units Portal of Entry Older Child → contamination of B. Alternative wound o Anti-Tetanus Serum o Dental Caries, Otitis Media, C. Active Immunization Penetrating Wounds, Illicit Drug o 7 days old – 100,000 u/kg/day IV q6h Hypersympathetic state due to blocked inhibitory neuron C. Alternatives Clinical Forms o Erythromycin o Tetracycline (>8 years old) Usually at 3-10 days old after delivery Wound Care / Debridement o Signs and Symptoms: a. Difficulty in sucking, stiff jaw, Supportive excessive crying (irritable) → o Airway, Seizures, Nutrition hoarse to strangled Good Nursing Care b. Opisthotonos, Apnea, Prevention and Control – Tetanus Prophylaxis Post Injury Neonatal Tetanus → an “inexcusable” disease Paralysis, Constipation, or Tetanus Urinary Retention Non- Immune, Immune, → Delay in the passage of Type Immune Booster >10y Booster 5y Most Common Td + TIG / TT/Td Prone None if 15,000/mm with positive blood culture → 3. Signs of Dehydration increased likelihood of Bacteremia Self-limiting but may persist in debilitated malignancy Capsular Antigen Detection and Steroid Therapy o Latex Diagnosis o ELISA Isolation by Culture Treatment Stool Exam: Drug of Choice o Pus Cells o Penicillin G IV o PMN Leukocyte Mucus → 50,000-300,000 units/k/d o RBC Alternative Typhoid Fever o Ceftriaxone Bacteremia without Focality → S. typhimurium o Cefotaxime Enteric Fever → S. typhi o Meropenem Clinical Manifestations: Allergic to Penicillin o Fever for more than 1 week o Erythromycin 1st Week (Non-Specific) o TMP-SMX (Trimethoprim-Sulfamethoxazole) o Headache Prevention o Ileus o 13 Valent Conjugated Pneumococcal Vaccine o Constipation o >2 years – Polysaccharide Vaccine o Diarrhea Special Indications o Abdominal Pain o At least 2 weeks before Splenectomy, Cancer Course of 2nd Week Chemotherapy and Radiotherapy Disease o Rose Spots X. PSEUDOMONAS o Bradycardia Pseudomonas aeruginosa o Organomegaly o Gram (-) rod, strict aerobe (Hepatosplenomegaly) Endotoxin, Exotoxin A, Exoenzyme S 3rd Week Important cause of nosocomial infection in children o Intestinal Perforation with Cystic Fibrosis, Neoplastic Disease, Extensive o Hemorrhage Burns, Prolonged Broad-Spectrum Antibiotics → In endemic areas, persistent fever even in absence of immunocompromised classic manifestation → Consider Typhoid Fever Can be Community Acquired CBC Endocarditis o Leukopenia with Lymphocytosis Pneumonia o Occasionally Anemia and CNS Infection Leukocytosis in the presence of Chronic Mastoiditis Pyogenic Abscess Osteomyelitis Isolation of Salmonella (Culture) Clinical Diseases Septic Arthritis o Blood → 1st Week – highest positivity UTI → During or after 4th week – GIT Infection Diagnosis lowest Ecthyma Gangrenosum o Urine o Wound with blue green pus and → First 2 weeks grape-like odor o Stool and Bone Marrow Culture Blood, CSF, Urine, Lung Aspirate → Throughout the course Carbenicillin, Ticarcillin, Widal Test – NOT Recommended Treatment Gentamycin, Tobramycin, Amikacin, o Low Sensitivity and Specificity Ceftazidime Immunologic XI. SALMONELLOSIS (GASTROENTERITIS) o EIA, Typhoid Dipstick, PCR Common and widely distributed food-borne disease Good Prognosis unless Complicated Gastroenteritis Typhlitis, Cerebral Thrombi, CNS, S. enteritis Complications Renal, Heart S. typhi (Present Name: Salmonella Groups Rare in children enterica serovar Typhi) Supportive S. choleraesuis o Hydration Contaminated Food and Drink (Street o Nutrition Food, Uncooked Food) Treatment Source Antibiotics Meat o DOC: Chloramphenicol – 50-100 Poultry Products mkd q6hr → do not give to other Page 6 of 13  Pediatrics Infectious Diseases - Bacterial Dr. MSF children because it may cause Direct Contact Aplastic Anemia Vaginal Secretion during childbirth Mode of Alternatives Sexually transmitted Transmission o Cotrimoxazole In children, you have to rule out o Ampicillin Sexual Abuse Suspected Resistant PROM o Ceftriaxone Gonococcal Premature Delivery o Ciprofloxacin (>18 years) Amniotic Amnionitis XII. ANAEROBIC INFECTIONS Syndrome Can cause: Neonatal Sepsis and Normally present in skin, vagina, mouth, and colon Meningitis Pathogenic → altered barrier, compromised viability 2-5 days after birth Premature Rupture of Membrane Ophthalmia Part of newborn care to give o Significant PROM: 18 hours Neonatorum prophylaxis Peritonitis or Septicemia with obstruction and/or Most often asymptomatic in females perforation Males are usually symptomatic → Urethritis Necrosis near mucosal surface Clinical Uses Conjunctivitis, Pharyngitis, Arthritis, Foul smell gas in tissue Proctitis, Meningitis, Endocarditis Appropriate Debridement and Signs and Treatment Extends to the Perihepatitis → Fitz Antibiotics Symptoms Hugh Curtis Syndrome Botulism Hematogenous → Skin and Joints C. botulinum (neurotoxin) Gram Stain → Gram (-) Diplococci o Food-borne Botulism (home canned preserved food) Diagnosis Culture → Thayer Martin o Infant Botulism (honey with spores) Test for Concomitant STI o Wound Botulism (infected traumatized wound) Treatment Vomiting, Ocular, Pharyngeal Paresis Clinical Treatment Regimen - Dose Depends on: Paralysis in Diaphragm and other Manifestations o Neonatal or Beyond Adolescence respiratory muscles → Death o Non-Disseminated or Disseminated Floppy Infant General weakness and hypotonia o Uncomplicated or Complicated “Flaccid Preformed toxin blocks release of Ach Ceftriaxone Paralysis” o Recommended in children Diagnosis Toxin Bioassay, EMG Cefotaxime Supportive o Gonococcal Ophthalmia Treatment Antitoxin (not available) o Scalp Abscess Antibiotics o Disseminated Infection in the Newborns Food Poisoning Cefixime C. perfringens (Enterotoxin) o Uncomplicated infections Mode of Ingestion of contaminated food Beyond neonatal period, treat for C. trachomatis Transmission Fluoroquinolone Abdominal Pain o Contraindicated in pregnant, nursing women, 4-20-fold rise mortality o Ciprofloxacin: 500 mg PO single dose (>18 y/o) Virulence of Organism o Other Options: o Non-toxigenic strains have better outcome a. Azithromycin: 10 mg/kg single dose (max. 500 Laryngeal Location of Membrane mg) o Worst complication b. Contact Tracing, Public Education, Number of Platelets: Meningococcal Vaccine o 150,000-450, 000 XV. DIPHTHERIA o Decreased platelet count and Leukocytosis → Corynebacterium diphtheriae >25,000 o Exotoxin Treat Carriers o Aerobic, nonencapsulated, non-spore-forming, Complete or Boost Immunity of Close Contact mostly non-motile, pleomorphic, Gram (+) Bacilli Protection lasts at least 10 years Peak Incidence: 2-5 yrs Does not eliminate carriage of C. Mode of Transmission: diphtheriae in the pharynx, nose, Immunization o Direct or indirect contact from discharge or and skin secretions from lesions Infection does not always confer o Respiratory droplets immunity Typical PSEUDOMEMBRANE found in the Nose, DPT Nasopharynx, and Larynx o 2, 4, 6 months or thereafter Toxin below 6 years old o Blood, Cardiac, Muscles, Nerves, Kidneys dT or Td Vaccine Complications noted 10 days to 3 weeks after start of o Over 6 years old and those with illness severe reaction to DPT Diphtheria o Adult Diphtheria Toxoid and Pseudomembrane → Can be present in nasal, faucial, regular Tetanus Toxoid pharyngeal, and laryngeal areas XVI. HAEMOPHILUS INFLUENZAE INFECTIONS Absence of Bull Neck or Neck Haemophilus influenzae Bull Neck or oFastidious, Gram (-), pleomorphic, coccobacillus, Swelling DOES NOT rule out Neck Swelling that require Factor X (Hematin) and Factor V Diphtheria Barking Cough (common in URI), (Phosphopyridine Nucleotide) for growth Laryngotracheal o 6 Antigenic Serotypes: a, b, c, d, e, f Stridor, Dyspnea, Hoarseness Indolent, superficial, non-healing Invasive Infections → H. influenzae Type b, f Cutaneous ulcers with gray membrane on legs, Non-Typable → Non-encapsulated feet, and hands Upper Respiratory Tract Conjunctivitis, Aural, Vulvovaginal, Asymptomatic Colonization → patients Others Source Meningitis, and Endocarditis who are not immunocompromised can Systemic Manifestations/Complications be carriers 2nd Week of Disease Mode of Direct person-to-person contact, Myocarditis Tachycardia, Muffled Heart Sounds, Transmission droplet, young children ( Toxicity Standard) SE: Hepatitis o Nerve trunk size varies widely Phenazine dye Diagnosis o Nodular or fusiform nerve Antimicrobial and Anti-Inflammatory thickening has greater diagnostic Activity value than a palpable nerve that is Clofazimine Decreasing the incidence of reaction smooth and symmetrical states Borderline Leprosy SE: intense reddish-brown discoloration Lesions are greater in number but of the skin smaller in size than in tuberculoid For Reaction States: Borderline Small satellite lesions around older o Mild ENL Tuberculoid lesions → NSAID (BT) Less distinct margins → Thalidomide Thickening of ≥2 Superficial Nerves o Severe ENL Large number of asymmetrical → Corticosteroid distributed lesions ✓ Be careful in using Steroids Borderline Macules, papules, plagues, and nodules ✓ Weigh: benefit > risk Lepromatous co-exist XX. CHLAMYDIA (BL) Anesthesia is mild Species: Response to Therapy: 2-3 months o C. pneumoniae Lepromatous Leprosy o C. trachomatis Lesions are innumerable, confluent, and symmetric → Obligate intracellular pathogen Papules or Nodular → Diffuse thickening and infiltration Chlamydia Pneumoniae of the skin → the characteristic Leonine Facies A common cause of lower respiratory tract diseases, accompanied by loss of eyebrows and distortion of including Pneumonia in children and Bronchitis and earlobes Pneumonia in adults Anesthesia is less severe than in Tuberculoid but with Primarily a human respiratory pathogen symmetric Peripheral Sensory Neuropathy develops Hard to differentiate from other late in the course pneumonias Testicular Infiltration and Glomerulonephritis with Characterized by mild to moderate specific Anergy to Leprosy Bacillus can persists despite constitutional symptoms like fever, therapy → relapse Clinical malaise headache, cough and o Greater percentage of relapse Manifestation pharyngitis Severe: PE and Empyema Infection can trigger for Asthma Isolated from Middle Ear isolates → Otitis Media Page 12 of 13  Pediatrics Infectious Diseases - Bacterial Dr. MSF Rales and wheezes Conjunctivitis and Pneumonia in CXR appears worse than the patient’s Treatment infants: Erythromycin and clinical status → mild or diffuse Azithromycin involvement or lobar infiltrates with XXI. MYCOPLASMA INFECTION small pleural effusion Mycoplasma pneumoniae Clinical Laboratory Major cause of respiratory infection in school-aged Findings o CBC: Leukocytosis with left shift children and young adults but usually unremarkable Mode of Transmission → Normal WBC Count in Older o Large Droplet Spread Children: 5,000-10,000 IP: 1-3 weeks → Newborn: 9,000-30,000 Bronchopneumonia → most Tetracycline, Erythromycin (40mkfd common clinical form BID x 10d) Gradual onset of Headache, Malaise, Newer Macrolides Fever, Sore Throat o Azithromycin (10 mkd, D1 then 5 Progression to Respiration Tract mkd, D2-5) Symptoms like hoarseness and Treatment → For 5 days only cough o Clarithromycin (15 mkd div 2 x 10d) Clinical o Cough worsen the severity of the → For 10 days in 2 divided doses Manifestation symptoms is usually greater than Whenever Chlamydia infection is the suggested by the physical suspected, start with Bronchodilators signs which appear later in the to prevent Asthma diseases Varies o Can trigger wheezing (similar to Coughing may persist after therapy Chlamydia) Prognosis o Also start in giving Individualize the patients (patients with asthma, family history of atrophy) bronchodilators Chlamydia Trachomatis Subdivided into 2 Biovars: o Lymphogranuloma Venereum (LGV) Lecture o Trachoma (Human Oculogenital Diseases) References Nelson 21st Ed Most prevalent STD causing: @carrot_MD Trans o Urethritis in men o Cervicitis and Salphingitis in women o Conjunctivitis and Pneumonia in infants Preventable cause of Blindness o Follicular Conjunctivitis → Scarring → Entropion (eyelid turning inward) → lashes abrade the cornea (occurs years after the active disease) WHO (2 of 4 of the criteria) o Lymphoid Follicles on the upper tarsal conjunctivae o Typical Conjunctival Scarring Diagnosis o Vascular Pannus (ingrowth of tissue from limbus → Cornea) o Limbal Follicles Confirmed by Culture Give prophylaxis as part of the newborn care Refer to an Ophthalmologist Genital Tract Infection Urethritis, Epididymis, Cervicitis, Salphingitis, and Proctitis Mucoid Discharge NOT PURULENT like Gonorrhea Isolation of organism NAAT (Non-Culture Method, Nucleic Diagnosis Acid Amplification Test) → high specificity and sensitivity (detecting 2- 10% greater than culture) Azithromycin, Doxycycline, Erythromycin, Levofloxacin Start the patient with Macrolides Treatment whenever you entertain Chlamydial Infection Older Children: Levofloxacin Pneumonia Develops in 10-20% of women with active untreated infection 25% of infants with NP infection develops Pneumonia Onset: o 1-3 months of age o Insidious with persistent cough Tachypnea (increased RR) and absence of fever; rales, wheezes uncommon Eosinophilia >400 cells/mm3 Associated with minimal interstitial or alveolar infiltrates Page 13 of 13