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Pedi - notes on comm. diseases

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Pharyngitis
Inflammation of the pharynx and surrounding lymphoid tissue Viral or bacterial (Group A beta hemolytic streptococci (GABHS)–serious complications including rheumatic fever and glomerular nephritis)
Viral Pharyngitis
Gradual onset Sore throat – reaches peak on the 2nd or 3rd day) Erythema and inflammation of pharynx and tonsils Fever (usually low grade) Hoarseness, cough, rhinitis, conjunctivitis, malaise, anorexia (early) Cervical lymph nodes enlarged and tender Usually lasts 3-4 days
Bacterial Pharyngitis
Abrupt onset (may be gradual in children < 2) Sore throat usually severe Erythema and inflammation of pharynx and tonsils Fever (usually high 103-104) begins early in illness and lasts 1-4 days Abd. Pain vomiting, headache Cervical lymph nodes enlarged Usually last 3-4 days If strep treated with penicillin for 10 days or erythromycin if allergic to pen Noninfectious after 24 hours of penicillin treatment Acetaminophen, warm salt water gargles
Tonsillitis (general info)
Inflammation and infection of the two palatine tonsils May be viral or bacterial Rare before 3
Tonsillitis S/S
Similar to pharyngitis Tonsils may appear bright red or cover with white exduate or cryptic plugs Difficulty swallowing Mouth breathing and mouth odor
Tonsilitis Dx evaluation
Throat culture (takes 1-2 days for results) Rapid Strep test(20% incidence of false negative)
Tonsilitis Tx
Antibiotics if bacterial, may return to school after 24 hrs. of antibiotics Tonsillectomy
Otitis Media (general info)
One of the most common childhood illnesses Refers to infection or blockage of the middle ear Generally described as Acute OM (sudden onset with short duration) or OM with effusion (presence of fluid – effusion – behind the tympanic membrane Etiology: bacterial - Streptococcus pneumoniae, H-influenzae Viruses (RSV and influenza) and allergies often predispose them to infection Peak incidence 6-12 months (onset within first year increases risk of recurrent disease
Otitis Media (risks)
Day care Use of pacifier after 6 months Environmental smoke exposure Bottle-feeding (putting child to bed with bottle, also causes tooth decay Allergies/URI’s
S/S Acute OM
Bulging, opaque, red, non-mobile TM Drainage (usually yellowish green, purulent, and foul smelling, indicates perforation of TM) Fever, irritability, fussy, rub or hold affected ear, rolls head side to side, loss of appetite OM with effusion
S/S OM with effusion
Dull gray or yellow; retracted TM with decreased mobility; air bubbles may be visible through tympanic membrane Tinnitus – popping sounds Hearing loss, difficulty communicating
Otitis Media TX
Antibiotics prescribed for children 6mos. or younger Wait 72 hours for spontaneous resolution in otherwise healthy infant or child 6 mos.- 2 years antibiotics for those with severe symptoms (fever and severe ear pain Antibiotics – Amoxcillin (Augmentin) 10-14 days If recurrent placed on prophylactic antibiotic tx. up to 6 months Tubes (myringotomy)
Varicella (Chicken pox) Infectious period
1-2 days before onset of rash until all lesions are dried (5-7) days
Varicella (Chicken pox) Incubation period:
10-21 days
Varicella (Chicken pox) Transmission:
primary secretions of respiratory tract or skins lesions
Varicella (Chicken pox) S/S
Fever, malaise, anorexic 24-48 hours prior to rash Macular rash – usually starts on trunk, scalp and then extremities (develops in crops over 3-4 days, goes from rash, to teardrop vesicles, pustular then dry and develop crust Zoster (shingles) - found in primary infection of varicella where the varicella-zoster virus enters the sensory nerve and dorsal root ganglia and establishes an infection. Presents with pain and tenderness along involved nerve and surrounding skin for 2 weeks prior to rash
Varicella (Chicken pox) Complications
Secondary bacterial infection of lesions – staph & group A strep from scratching can result in impetigo CNS complications –encephalitis, convulsions, coma Reye’s syndrome Corneal involvement if lesions involved in the eye
Treatment
Symptomatic and supportive Contact isolation in hospital setting Antiviral med (acyclovir) for immunocompromised child who presents with varicella or zoster infections Varicella zoster immune globulin (VZIG) for children at high risk administered within 96 hrs of exposure
Varicella (Chicken pox) Treatment
Symptomatic and supportive Contact isolation in hospital setting Antiviral med (acyclovir) for immunocompromised child who presents with varicella or zoster infections Varicella zoster immune globulin (VZIG) for children at high risk administered within 96 hrs of exposure
Erythema Infectiosum (Fifth Disease) Causative agent:
Parvovirus 19
Erythema Infectiosum (Fifth Disease) Incubation:
4-21 days
Erythema Infectiosum (Fifth Disease) Infectious period
unknown (may extend from febrile stage to time rash first appears
Erythema Infectiosum (Fifth Disease) Transmission:
airborne, blood, and transplacental
Erythema Infectiosum (Fifth Disease) S/S
May first have nonspecific symptoms of headache, runny nose, malaise, fever Fiery red, edematous rash on cheeks (appearance that child has been slapped) 1-4 days after facial rash, lacy red rash appears on trunk and extremities (the rash fades and reappears) may last 2-29 days aggravated by exercise, warm bath, rubbing of skin and stress
Erythema Infectiosum (Fifth Disease) Complications
Caution for pregnant mom – risk for intrauterine infection (may cause fetal death during first trimester)
Exanthem Subitum (Roseola) Causative agent:
Human herpevirus 6 (HHV-6)
Exanthem Subitum (Roseola) Infections period:
unknown thought to extend from febrile stage to time rash 1st appears
Exanthem Subitum (Roseola) S/S
Sudden high fever, malaise, irritability, headache, vomiting, diarrhea In 3-5 days fever subsides and within hours or days a rash appears (classic) on neck/trunk and persists for 24-48 hrs. then fades
Exanthem Subitum (Roseola) Treatment:
No treatment as its viral, symptomatic treatment
Scarlet Fever (Scarlatina) Causative agent:
Toxin from Group A strep infection
Scarlet Fever (Scarlatina) Infectious period:
acute state until 36 hours after antibiotics
Scarlet Fever (Scarlatina) Transmission:
airborne or direct contact
Scarlet Fever (Scarlatina) S/S
Onset: abrupt fever, vomiting headache, abdominal pain, pharyngitis, and chills Within 5-6 days fever subsides and fine, red rash appears in axilla, groin, and neck Desquamation by end of the first week (starts on face and moves down trunk) White strawberry tongue (initially presents with white furry coat with red projecting papillae) by 4th day, white sloughs off leaving red swollen tongue (strawberry tongue)
Scarlet Fever (Scarlatina) TX
Pencillin (erythromycin if allergic to pen) to treat the strep
Scarlet Fever (Scarlatina) Complications
due to extension of strep infection (rheumatic fever and glomerluar nephritis)
Conjunctivitis (Pink Eye)
Inflammation of the conjunctiva May be viral, bacterial or allergic
Conjunctivitis (Pink Eye) Treatment
Prevent spread (viral and bacterial very contagious), good handwashing (don’t share towels) Antibiotic eyedrops/ointment – polymyxin, erythromycin (can go back to school after 24-48 hours on eye drops) also have antiviral eyedrops Antihistamines if allergic cause (zyrtec) Supportive – cool compresses
Fungal Candidiasis Thrush
White plaques on tongue, gums and buccal mucosa
Fungal Candidiasis Thrush Treatment
nystatin oral suspension also boil pacifiers, nipples and breastfeeding mothers may also need to be treated
Diaper candidiasis
Diffuse erythema to diaper area, including in skin folds
Diaper candidiasis Treatment
Lotrimin, nystatin cream – good hygiene
Tinea (Ringworm) (Fungal)
Skin infection caused by a group of fungi called dermatophytes Transmitted by person to person, by animals, or objects (combs, hats, shoes, etc.)
Tinea (Ringworm)
Erythema, round lesion, may look scaly, raised boarder, may or may not be pruritic Capitis – lesion on the scalp Corporis – lesion on the face, trunk, extremities Cruris – lesion involving groin region “jock itch” causes intense inflammatory reaction Pedis – lesion involving the feet “athelete’s feet (may become chronic) Unguium – infection involving nails or nail beds
Tinea (Ringworm) Treatment
Capitis – Oral griseofulvin for 6-8 weeks and selenium sulfide shampoo (Selsum Blue) Ketoconazole or Lamisil alterative choice for those who do not tolerate Griseofulvin Corporis – antifungal creams such a Lotrimin or Monostat (Miconazole) TI D x 1 week or until lesion improves Cruis – antifungal creams Lotrimin or Lamisil BID – loose clothing Pedis – antifungal crams BID until lesions improve – Lotrimin, Miconazole (Monostat or Micatin If no response or resistant – oral Griseofulvin x 1 month
Impetigo (bacterial)
Most common bacterial skin infection inchildren, usually secondary from another skin lesion (insect bite, scratch)
Impetigo (bacterial) Causative agent:
aures and/or group A strep
Impetigo (bacterial) Transmission:
Extremely contagious and spreads easily to other parts of the body and to other people
Impetigo (bacterial) S/S
Serous filled lesions that become pustular, later rupture leaving shiny, honey-crusted lesions with a scaly boarder. The lesion erodes and bleeds easily. Mildly puritic.
Impetigo (bacterial) Treatment
Topical (Bactroban, Neosporin) and oral antibiotics Wash with warm soapy water TID Good hand washing and careful hygiene May return to school after 24 hours of antiobiotics
Cellulitis
Bacterial infection of the sub q tissues and dermis usually from a break in the skin Causative agent: usually staph or strep
Cellulitis S/S
Area is usually red, hot, swollen and painful. May see red streaking of surrounding area from lymphangitis Child usually has fever, malaise and headache
Cellulitis TX
Antibiotics (IV or IM) Warm compresses Hospitalization for I&D may be indicated in some cases
Pediculosis (Lice)
Infestation of small, blood-sucking insects. Live only on humans, transmitted by direct contact with infected persons or objects (brushes, hats) Capitis – found on the scalp Corporis – found on the body Pubis – found in pubic hair (also called crab lice) seen in adolescents (maculae cerlae (blue spots) may be found on thighs and trunk in cases of heavy infestation. Dark brown spots on underwear and sheets are insect waste materials.
Pediculosis (Lice) S/S
Intense pruritus Visible nits or lice (lice can live only 48 hours off human host and nits are capable of hatching for 10 days)
Pediculosis (Lice) Treatment:
Killing the active lice – OTC preparation (RID or NIX) – initial tx and repeat 1-2 weeks For resistant strain may use Elimite (left on overnight with a shower cap) Removing nits – using find tooth nit comb Preventing spread or recurrence – treat and /or wash all linens, has, combs and brushes Cleaning of carpet, furniture
Scabies
Scabies or “itch mite” highly contagious Transmitted by close personal contact with infected persons (scabies mite cannot survive more that 3 days away from human skin) Major complication is impetigo from continued scratching
Scabies S/S
Intense puritus – worse at night, visible burrows, papules, vesicles, nodules more common on the wrist, finger webs, elbows, umbilicus, axillae, groin, and buttocks May develop secondary infection
Scabies Tx
Topical Elimite or Kwell (because risk of neurotoxicity do not use Kwell with children <2 years or pregnant women All contacts and family members should be treated even if asymptomatic Wash all linens, carpets or furniture
Dermatitis
Contact - Diaper Dermatitis Atopic – eczema Seborrheic – cradle cap After treatment with steroid, good skin care
Acne Vulgaris
Disorder of sebaceous hair follicles.
Acne Vulgaris TX:
Goal is to prevent scarring and promote positive self image Topical treatments – benzoyl peroxide (OTC) Retin A (RX) Oral antibiotics (Tetracycline, PCN, Erythromycin) Unresponsive to treatment – Accutane (risk teratogenic effect – oral conceptives for some females

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