251F Summer 2024 Pediatic Infections .pdf

251F Pediatric Infections Michelle Touw, MMS PA-C Summer QTR 2024 QTR 5 ID Betty Irene Moore School of Nursing 1 Objectives ▪ Identify the perinatal TORCH infections and understand the sequelae these infections will cause in newbo...

251F Pediatric Infections Michelle Touw, MMS PA-C Summer QTR 2024 QTR 5 ID Betty Irene Moore School of Nursing 1 Objectives ▪ Identify the perinatal TORCH infections and understand the sequelae these infections will cause in newborns ▪ Understand the effect of Zika virus infection and its sequelae after perinatal infection of the mother. ▪ Understand common and serious Infections in Newborns and initial screening and management of these infections ▪ Review common bacterial infections in children including, strep, staph, bartonella botulism, meningitis and tick-borne diseases. ▪ Review common viral infections in children and adolescents including varicella, measles, mumps, Epstein Barr Virus. ▪ Review of pinworm infection in children Betty Irene Moore School of Nursing 2 Betty Irene Moore School of Nursing 3 TORCH Infections Betty Irene Moore School of Nursing 4 Toxoplasmosis ▪ Intracellular protozoan parasite ▪ Ubiquitous in nature and human infection is widespread ▪ Cats ( felines ) reservoir – infective cysts passed in stool ▪ Most Human infections are asymptomatic and remain latent unless immune compromise occurs ▪ Pregnant women are exposure through Cat litter -also undercooked meat ▪ Infection during pregnancy can lead to transplacental infection of infant ▪ Proliferation of organism in brain, muscles, heart Betty Irene Moore School of Nursing 5 Congenital Toxoplasmosis Manifestations ▪ Pregnant woman typically will not have any symptoms during the pregnancy ▪ May develop lymphadenopathy ▪ Infection in 1st 6 mos gestation leads to congenital malformations. ▪ Intrauterine growth restriction- Low birth weight Betty Irene Moore School of Nursing 6 Congenital Toxoplasmosis treatment - ▪ Prevention! – Mothers should not change cat litter or eat undercooked food ▪ Mothers usually do not display symptoms of illness and there is not usually indication to treat the mother. – Most infants receive treatment postnatally – Confirm Toxo- ( r/o other causes) ▪ Treatment Regimen – Pyrimethamine + Sulfadiazine – Leucovorin ( for pts on pyrimethamine) Betty Irene Moore School of Nursing 7 ParvoVirus B19 – Congenital Effects Betty Irene Moore School of Nursing 8 Varicella Zoster Virus - Chicken Pox ▪ Highly contagious with attack rate of 90% of exposed unvaccinated adults ▪ Endemic in population - Outbreaks occur amongst susceptible in seasonal outbreaks in late winter early spring ▪ Onset up to 14 d after exposure with prodrome of fever, malaise, pharyngitis and loss of appetite ▪ Successive crops of pruritic vesicles ▪ Self limiting in healthy children – Symptomatic treatment, antihistamines ▪ High risk groups can be treated with antivirals ▪ COMPLICATIONS - rare – Skin and soft tissue infections, Encephalitis, Pneumonia, Hepatitis ▪ Vaccine available since 1995 – Live virus vaccine – contraindicated during pregnancy (immune compromised) Betty Irene Moore School of Nursing 9 Congenital Varicella ▪ Varicella infection in a pregnant woman who is not immune – NO Hx of prior infection – NO Hx of vaccination More concerning if infection occurs in 1st or 2nd trimester Vaccine CANNOT be given during pregnancy Betty Irene Moore School of Nursing 10 Rubella – German Measles ▪ Major cause of childhood exanthem ▪ Transmission via respiratory droplets ▪ Fever, sore throat, headache, pink eye ▪ Prominent lymphadenopathy – Occipital, cervical, post auricular ▪ Descending rash Face down body ▪ Clinical course often mild in children ▪ Rubella is part of the MMR vaccine Betty Irene Moore School of Nursing 11 Congenital Rubella Syndrome ▪ Dx: serology – screen in prenatal care ▪ IgG + indicates immunity ▪ If not immune mom needs to take precaution ▪ Maternal infection in 1st trimester can cause severe congenital defects ▪ Classic triad for Congenital Rubella Syndrome – Hearing impairment – Cataracts – Heart defects -50% patent ductus arteriosus ▪ Other features include developmental delay, microcephaly, jaundice ▪ Cannot administer MMR during pregnancy Betty Irene Moore School of Nursing 12 Cytomegalovirus (CMV) in Pregnancy ▪ CMV can be transmitted via urine, saliva, sexual secretions, blood, breast milk ▪ Infections in healthy adults are usually mild – Mono like syndrome (without pharyngitis) ▪ Up to 85% of women of child bearing age are seropositive ▪ Initial infection with CMV during pregnancy risks infecting fetus ▪ Congenital infection causes birth defects (placental transmission) ▪ Perinatal infection ( at birth/ breastmilk ) transmission – can cause disease but also most often asymptomatic ▪ Blood studies may show atypical lymphocytes ( owls eye inclusion) Betty Irene Moore School of Nursing 13 Congenital CMV effects on newborn ▪ Deafness ( a leading cause of this worldwide) ▪ Chorioretinitis ▪ Seizure, microcephaly, ID ▪ Baby born with “ blueberry muffin rash” ▪ Petechial rash ▪ No antiviral tx is shown to decrease fetal transmission Betty Irene Moore School of Nursing 14 Herpes Simplex Virus ▪ Most commonly exposure in the perinatal period (rarely in utero) – Active outbreak is indication for C Section ▪ Clinical manifestations 10 – 21 d after birth ▪ Newborns present with Sepsis like picture with fever – Skin- Eye Mucous Membranes ( SEM ) – Central Nervous System ( CNS) – Sepsis with fever, rash, hypotension, hepatosplenomegaly, lethargy ▪ Tx- High dose IV Acyclovir ( 60 mg/kg/d) up to 21 d Betty Irene Moore School of Nursing 15 Zika Virus ▪ Mosquito transmitted Flavivirus ( related to Dengue and West Nile) ▪ Carried by Aedes aegypti ( also aedes albopictus ) ▪ Initially described in Africa ▪ Occurrence Africa , SE Asia, PI, Americas and Caribbean ▪ Last known US continental transmitted cases 2016-2017 ( TX and FLA) ▪ Cases can also rarely be transmitted sexually Betty Irene Moore School of Nursing 16 Copyrights apply Betty Irene Moore School of Nursing 17  Clinical Manifestations ▪ Clinical manifestations in about only 20 % of patients ▪ Incubation 2- 14 d ▪ Mild symptoms of low grade fever, rash, arthralgia, conjunctivitis ▪ Rash- – Erythematous macules and papules – face, trunk extremities, palms, soles ▪ Infection in pregnant women can lead to microcephaly in the infant ▪ Diagnostics – – serum or urine PCR testing – Serologic IgM and IgG testing can be cross reactive with Dengue ▪ Management – – no effective therapy – Mosquito protection, condom use, screening of blood and tissue Betty Irene Moore School of Nursing 18 Copyrights apply Betty Irene Moore School of Nursing 19 Group B Strep ( streptococcus agalactiae) GBS ▪ Gram positive coccus frequently colonizes the GI and genital tracts ▪ Common cause of infection in newborns ▪ Passed to infant in utero or during rupture of membranes or vaginal birth ▪ Can also be transmitted mother to child after delivery ▪ Universal screening for GBS has led to decrease in incidence of disease ▪ Use of Intrapartum ABX ▪ Still racial disparities ( possibly correlates with rates of premature birth rate) ▪ Early Onset day 0-6 ▪ Late Onset > 6 d up to 3mos low incidence Clinical manifestations in infants – Bacteremia – Meningitis Betty Irene Moore School of Nursing 20 Trends in GBS incidence Betty Irene Moore School of Nursing 21 Copyrights apply Betty Irene Moore School of Nursing 22 Infections in Neonates ( 100.4 ( 38 C) – Rectal Temperature reading – Prompts neonatal sepsis work up ( blood cultures, LP) ▪ E Coli UTI – presents with fever = most common Bacterial Infection – GBS second most common ▪ Neonates with HX of Viral infections at birth have increased risk for Bacterial Infections ( HSV, Varicella) ▪ Other viruses that can cause disease in neonates ( influenza, enterovirus, RSV) ▪ Risk Factors include – Prematurity 38 C Betty Irene Moore School of Nursing 24 Infections in Infants - > 28 days old ▪ Fever >100.4 ( 38C) ▪ UTI’s common ▪ Viruses ▪ Bacteria > Invasive Bacterial Infections (IBI) ▪ Low threshold for sepsis work up Betty Irene Moore School of Nursing 25 Clostridium Botulinum - Botulism ▪ Spores found in soil –contaminate food – GI ingestion ▪ Neurotoxin inhibits Acetylcholine release ▪ Toxin release leads to hypotonia and flaccid paralysis ▪ Clinical symptoms – mild symptoms may be difficult to ID in infants – Mild: dry mouth, double vision, N/V – Severe: flaccid paralysis ▪ Foodborne – usually home canned, some other food outbreaks ▪ Dx- detection of toxin in stool ▪ Prevention- Heating food > 100C, acid environment, or storage