Term
| Acute Upper Respiratory Tract infections |
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Definition
• Otitis media/externa • Sinusitis
• Pharyngitis
• Epiglottitis |
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Term
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Definition
• Bacterial organisms
- Strep pneumoniae
- Haemophilus influenzae • Moraxella catarrhalis
• Viral causes
• Direct otoscopy
• Clinical history alone is not predictive of disease |
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Term
| Diagnosis and Management of AOM |
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Definition
- Acutesigns/symptoms
- Presenceofmiddleear effusion
• Bulging of TM, decreased mobility, air-fluid level, otorrhea
- Signs/symptomsofmiddleear inflammation
• Erythema of the TM
• Distinct otalgia
• Different from otitis media with effusion |
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Term
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Definition
- OME may accompany viral URI, be a prelude to AOM, or be a
sequela of AOM but does not require antibiotics
- “Watchful waiting” for most children > 6 months
• Joint decision with parents with close follow-up in 48 hours
• If only one ear affected
• Must address pain
- Amoxicillin (80–90 mg/kg/day) should be prescribed for children
• < 6 months of age
• Any age with severe AOM (severe pain, > 48 hrs, temp > 39°C)
• 6–23 months with bilateral AOM
- Clinical response usually within 48–72 hours
- Amoxicillin-clavulanate, cephalosporins, other alternative therapies |
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Term
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Definition
Predominant organisms include: Pneumococcus, Moraxella catarrhalis, nontypable H. influenzae
• Thediagnosisofacutebacterialsinusitisis based on clinical criteria in children who present with URI symptoms that are either persistent (>10 days) or severe (temp >39C x3 days, or if URI gets better, then recurs).
• Imagingstudiesarenotrecommended.
• Treatment:
•-Amoxicillin (or Augmentin) is still the drug of choice despite increased antimicrobial resistance. |
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Term
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Definition
• Pneumococcus is the most common bacterial cause of otitis media and invasive bacterial illness in children (pneumonia, meningitis, skin and bone infections).
• Testing is done by culture of the site of concern and susceptibility testing to antibiotics is performed. |
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Term
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Definition
• Active immunization with pneumococcal conjugate vaccine (Prevnar-13) contains the 13 serotypes that account for the majority of invasive pneumococcal disease (OM, bacteremia, meningitis, pneumonia).
• 23-valent polysaccharide may be appropriate for high risk kids |
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Term
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Definition
• They are caused by Streptococcus
pyogenes (group A strep).
• The most common clinical manifestation is
acute pharyngitis.
• Other group A strep infections include skin infections, bacteremia, pneumonia, osteomyelitis, myositis, surgical wound infection, and endocarditis.
• Diagnose pharyngitis by throat culture. Several rapid diagnostic tests are available.
• Penicillin V or amoxicillin is the drug of choice.
• Treatment prevents sequelae.
• Sequelae may include rheumatic fever, post-infectious arthritis, post-strep glomerulonephritis, retropharyngeal, or peri-tonsillar abscess. |
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Term
| Respiratory Syncytial Virus |
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Definition
• All ages
• Most significant if underlying pulmonary or cardiac disease
• Most common cause of bronchiolitis and pneumonia in children under 1 year of age
• Direct contact with secretions
• Testing can be performed by rapid IFA
• Incubation period is about 5–8 days
• Antimicrobials, corticosteroids, or bronchodilators not recommended
• Treatment is supportive: oxygen for hypoxia
• Prevention:
- Palivizumab (Synagis): monoclonal antibody administered IM to susceptible children during RSV season |
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Term
| RSV Differential Diagnosis |
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Definition
• Croup or non-RSV bronchiolitis (caused by parainfluenza, adenovirus, human metapneumovirus, influenza, etc.)
• Pneumonia (viral or bacterial—including pertussis, chlamydia pneumonia)
• Foreign body aspiration
• Bronchitis
• Asthma/reactive airway disease |
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Term
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Definition
• Usually viral (adenovirus, RSV, influenza, parainfluenza)
• Bacterial causes include pneumococcus, group A strep, staph aureus
• May need to consider uncommon causes such as TB if history reveals risk |
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Term
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Definition
- Outpatient:highdoseamoxicillinorAugmentin (amoxicillin-clavulanate) or a cephalosporin
- Hospitalized:
• IV ampicillin
• IV cephalosporins (Cefuroxime, Ceftriaxone)
- Concernforatypicalorganisms:
• Mycoplasma (azithromycin)
• Resistant strep pneumococcus or staph (vancomycin) |
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Term
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Definition
• #1 cause of severe acute gastroenteritis (vomiting and diarrhea) among children worldwide
• Vaccine very effective
• Tests include EIA and latex agglutination assays
• Treatment is supportive |
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Term
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Definition
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Term
| Salmonella Non-Typhi Infections |
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Definition
• Mainreservoirisanimals(poultry,livestock, reptiles, pets) and food products (fruits, veggies, eggs, dairy, beef)
• Canalsobetransmittedthroughwater
• Incubationperiodis6–48hours
• Onlyneedtotreatwithantibioticsif<1yearof age, immunocompromised, or severe/invasive disease
- Concern for increased resistance or increased risk for asymptomatic carriage with antibiotic use in mild cases |
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Term
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Definition
• Very low infectious dose needed
• Watery diarrhea progressing to mucoid or bloody stools
• Incubation period is 3–7 days
• Can be cultured in stool
• Treat with azithromycin if patient is in daycare or requires hospitalization |
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Term
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Definition
• Primary infection results in varicella (chickenpox)
• Member of the herpesvirus family
• Spreads by direct contact and occasionally airborne
• Symptomatic re-infection is uncommon
• Immunocompromised patients at risk for disseminated disease
• Incubationperiodabout 14–16 days (range 10–21 days)
• Vesicularfluidcanbetested for diagnosis or acute/convalescent serum antibody
• Routinetreatmentwith acyclovir not recommended
• Childrenmayreturntoschool once lesions have crusted |
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Term
| Varicella Vaccine (Varivax) |
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Definition
• Live-attenuated
• First dose 12–15 months, second dose 4– 6 years
• Current vaccine is over 95% effective in preventing moderate or severe disease
• 1–4% vaccinated patients develop a mild varicella-like disease |
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Term
| Roseola (Exanthem Subitum) |
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Definition
• MostcausedbyHHV-6 (human herpesvirus 6)
• Feverischaracteristically high and persists for several days. Fever is followed by erythematous rash lasting hours to days
• About20%childrenexhibit a nonspecific febrile illness
• Mostchildrenare seropositive by age 4
• Diagnostic tests not done routinely • Mainly a clinical diagnosis
• Treatment is supportive
• Prognosis is excellent |
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Term
| Fifth Disease (Erythema Infectiousum) |
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Definition
• ParvovirusB19
• Symptomsmayincludefeveranda distinctive rash. Illness is nonspecific and may precede the rash by up to a week
• Othermanifestationsinclude: asymptomatic illness, mild respiratory tract illness, atypical rashes, arthralgia/arthritis (in adults), and transient aplastic crisis in patients with hemolytic anemias |
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Term
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Definition
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Term
| Rocky Mountain Spotted Fever |
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Definition
• CausedbyRickettsiarickettsii
• MostcasesoccurApril–Sept.
• CarriedbytheAmericandog tick (Dermacentor variabilis) and Rocky Mountain wood tick (Dermacentor andersoni)
• Ahistoryoftickbitemaynot be present
• Acute/convalescenttiters,PCR
• Systemic small vessel vasculitis with a characteristic rash
• Fever, severe headache, nausea, vomiting, anorexia, myalgias
• Abdominal pain and diarrhea
• Untreated illness can result in CNS, cardiac, renal sequelae
• DIC and shock, may lead to death
• Treatment decisions should be based on epidemiologic and clinical clues, and should never be delayed while waiting for confirmation by laboratory results.
• Doxycycline is drug of choice for all ages. |
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Term
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Definition
• Caused by Borrelia burgdorferi
• Transmitted by tick bite
• Clinical manifestations
- Early localized (erythema migrans, flu-like illness)
- Early disseminated (multiple EM, carditis, meningitis)
- Late (arthritis, neuroborreliosis)
early:
• Erythema migrans rash
• Fever, malaise, headache, stiffness, myalgias may accompany rash
• Clinical diagnosis (early testing may give a false negative test) |
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Term
| Lyme Early Disseminated Disease |
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Definition
• Multiple erythema migrans—most common usually 3–5 weeks after initial tick bite
• Cranial nerve palsies, meningitis, conjunctivitis
• Carditis—heart block (unusual in kids) |
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Term
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Definition
• Recurrent arthritis usually pauciarticular
• Affects mainly large joints (knees)
• CNS disease can occur rarely in this stage |
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Term
| Lyme Epidemiology, Diagnosis, and Management |
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Definition
• Incubation period is 7–14 days.
• Early disease should be diagnosed clinically.
- IgG and IgM antibodies can be tested (EIA) for disseminated disease.
- Western immunoblots used to corroborate positive results.
• Doxycycline is drug of choice for >8 years in early localized disease.
- Amoxicillin is drug of choice <8 years.
• Early disseminated and late disease:
- Oral antibiotics for multiple erythema migrans and uncomplicated Lyme arthritis or facial nerve palsy.
• For persistent arthritis, carditis, or meningitis/encephalitis, use IV ceftriaxone. |
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Term
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Definition
• In bacterial meningitis, typically see elevated CSF white cell count, low glucose, elevated protein, and may see elevated opening pressure, bacteria on gram stain.
• In aseptic (viral) meningitis, may see elevated white cell count, but glucose and protein may be normal. |
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Term
| Meningitis Differential Diagnosis |
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Definition
• Viruses(enterovirus,HSV)
• Bacteria(age-dependent, organisms including GBS, E. coli, Listeria in newborns, S. pneumo, meningococcus in children)
• Arboviruses(WestNile, Eastern Equine, St. Louis encephalitis)
• Rickettsia(Lyme,RMSF) |
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Term
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Definition
• Neisseriameningitidisgram-negative diplococcus with at least 13 serogroups
• Incubationis1–10days
• A,B,C,Y,andW-135mostcommontypesthat cause systemic disease
• Vaccine contains A, C, Y, and W-135. MCV4 (Menactra) now routinely administered to children 11–12 years,
pre-college, military, some overseas travelers |
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Term
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Definition
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Term
| Complications of Meningitis |
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Definition
- Most patients with viral meningitis (aseptic meningitis) recover fully.
- Up to 30% bacterial meningitis may have sequelae that could include:
• Deafness
• Eyesight difficulty
• Behavioral problems
• Learning disabilities
• Permanent neurologic damage |
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Term
| Pediatric Gastrointestinal Disease symptoms |
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Definition
Vomiting
Expulsion of refluxed gastric contents from mouth
Regurgitation
Reflux of gastric contents into the mouth
Gastroesophageal Reflux Disease (GERD)
Symptoms or complications that may occur when gastric contents reflux into esophagus or oropharynx |
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Term
| Pathogenic Factors in GERD |
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Definition
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Term
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Definition
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Term
| Differential Diagnosis of Vomiting |
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Definition
• GI obstruction
• Infection
• Allergy
• Metabolic abnormality
• Intracranial lesion
• Renal abnormality |
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Term
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Definition
• Infantilehypertrophicpyloricstenosis(IHPS)isa condition of hypertrophy of the pylorus, with elongation and thickening, eventually progressing to near-complete obstruction, of the gastric outlet.
• Itoccursinapproximately3in1,000livebirths.
• Itismorecommoninmales(4:1to6:1).
• Approximately30percentofcasesoccurin firstborn children.
• The classic presentation of IHPS is the 3 to 6-week-old baby who develops immediate postprandial, non-bilious, often projectile vomiting and demands to be re-fed soon afterwards (a “hungry vomiter”).
• In the past, patients were classically described as being emaciated and dehydrated with a palpable “olive- like” mass at the lateral edge of the rectus abdominus muscle in the right upper quadrant of the abdomen.
• Laboratory evaluation classically showed a hypochloremic, metabolic alkalosis resulting from the loss of large amounts of gastric hydrochloric acid, the severity of which depended upon the duration of symptoms prior to initial evaluation.
• The diagnosis is made by ultrasound examination of the abdomen.
• Treatment:
- Surgery (pyloromyotomy) |
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Term
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Definition
• This is usually diagnosed in the neonatal period.
• Patients present with symptoms of distal intestinal obstruction: bilious emesis, abdominal distension, and failure to pass stool.
• The diagnosis can be suggested by a delay in passage of the first meconium (greater than 48 hours of age).
• Affected children may also present initially with enterocolitis, a potentially life threatening illness in which patients have a sepsis-like picture with fever, vomiting, diarrhea, and abdominal distension, which can progress to toxic megacolon. |
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Term
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Definition
• It is the most common cause of intestinal obstruction in infants between 6 and 36 months of age.
• Typically, patients develop the sudden onset of intermittent, severe, crampy, progressive abdominal pain, accompanied by inconsolable crying and drawing up of the legs toward the abdomen.
• The episodes become more frequent and more severe over time.
• Vomiting may follow episodes of abdominal pain. Initially, emesis is non-bilious, but it may become bilious as the obstruction progresses.
• A sausage-shaped abdominal mass may be felt in the right side of abdomen. As symptoms progress, increasing lethargy develops, which can be mistaken for other illnesss.
• Classic triad: abdominal pain, currant jelly stool, palpable abdominal mass (<50%).
• In up to 70 percent of cases, the stool contains gross or occult blood.
• In infants, intussusception may present as lethargy, with or without vomiting or rectal bleeding.
• In young infants, intussusception is more often caused by a pathological lead point, such as Meckel diverticulum or a duplication cyst. |
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Term
| Intussusception—Pathophysiology |
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Definition
| Telescoping of ileum into colon -> ileum compressed venous congestion -> swelling -> arterial compression -> ischemia -> bloody stools |
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Term
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Definition
• In an otherwise healthy child, constipation may result simply from an episode of painful defecation, difficulties during the period of toilet training, inattention to the urge to defecate because of involvement in other activities, or discomfort with toilet facilities in school.
• When no underlying cause is identified by history and physical examination, a favorable response to treatment support the diagnosis of functional constipation.
Treatment
• Patient education
• Regular bowel training
• Enema or polyethylene glycol
• Softening of stool with lactulose, high fiber, or mineral oil
• Continue until regular bowel pattern for several months |
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Term
| acute gastroenteritis in children |
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Definition
acute diarrhea- presence of 3 or more loose, watery stools within 24 hrs
dysentery- bloody diarrhea, visible blood and mucous present
presistent diarrhea- episodes of diarrhea lasting more than 14 days |
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Term
| acute gastroenteritis in children organisms |
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Definition
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Term
| Non-infectious Causes of acute gastroenteritis |
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Definition
• Errors in feeding (wrong formula, wrong dilution)
• Food intolerance
• Inflammation of the gut
• Celiac disease
• Gut surgery
• Mucoviscidosis
• Infections outside digestive |
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Term
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Definition
• This is the leading cause of severe, dehydrating gastroenteritis among children.
• One-third of diarrhea hospitalizations and 500,000 deaths worldwide each year.
• Nearly all children in both industrialized and developing countries have been infected with rotavirus by the time they are 3–5 years of age. Neonatal infections are a common occurrence, but are often asymptomatic.
• The incidence of clinical illness peaks in children between 4 and 23 months of age.
• Rotavirus is associated with gastroenteritis of above- average severity.
• Fecal–oraltransmission
• Suddenonsetofwaterydiarrheaandvomiting with little abdominal pain
• Self-limitinginhealthyindividuals
• 1–6dayduration
• Seasonal
- Temperate climates: “winter gastro” - Tropical climates: summer peak
• Treatment:symptomatic
The initial clinical evaluation of the patient
should focus on:
• Assessing the severity of the illness and
the need for rehydration
• Identifying likely causes on the basis of the history and clinical findings |
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Term
| organisms for acute gastroenteritis and where they come from |
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Definition
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Term
| time of onset of acute gastroenteritis and organism |
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Definition
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Term
| acute gastroenteritis eval |
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Definition
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Term
| acute gastroenteritis labas |
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Definition
• CBC
• Inflammatory tests
• Stool analysis of leucocytes
• Stool cultures
Measurement of serum electrolytes is only required in children with severe dehydration or with moderate dehydration. (Hypernatremic dehydration requires specific rehydration methods—irritability and a doughy feel to the skin are typical manifestations and should be sought specifically.)
• TestssuchasBUNandbicarbonateareonlyhelpful when results are markedly abnormal.
• Anormalbicarbonateconcentrationreducesthe likelihood of dehydration.
• Nolabtestshouldbeconsidereddefinitivefor dehydration. |
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Term
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Definition
• Rotavirus: in 1998, a rotavirus vaccine was licensed in the U.S. for routine immunization of infants. In 1999, production was stopped after the vaccine was causally linked to intussusception in infants.
• Currently, two vaccines have been approved: a live oral vaccine (RotaTeqTM) made by Merck for use in children, and GSK’s RotarixTM. |
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Term
| Minimal or No Dehydration acute gastroenteritis treatment |
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Definition
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Term
| Mild to Moderate Dehydration acute gastroenteritis treatment |
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Definition
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Term
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Definition
• Severe dehydration (≥10%)
• Ileus or intestinal obstruction
• Unable to tolerate (persistent vomiting)
• Signs of shock
• Decreased LOC (level of consciousness) or unconscious
• Unclear diagnosis
• Psychosocial situations |
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Term
| Severe Dehydration acute gastroenteritis treatment |
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Definition
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Term
| gastroenteritis organism and treatment |
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Definition
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Term
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Definition
• Loperamide is the agent of choice for adults (4–6
mg/day; 2–4 mg/day for children > 8 y)
- For mild to moderate traveler’s diarrhea (without clinical signs of
invasive diarrhea)
• Inhibits intestinal peristalsis and has mild antisecretory properties
• Should be avoided in bloody or suspected inflammatory diarrhea (febrile patients)
- Significant abdominal pain also suggests inflammatory diarrhea (This is a contraindication for loperamide use.)
• Loperamide not recommended for use in children < 2 years old |
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