2

COMMON PEDIATRIC CONDITIONS

STREPTOCOCCAL INFECTION
Tonsillopharyng Grp A Streptococcus in school age
itis
and teenagers
Streptococci
cause otitis media, mastoiditis,
sinusitis, pneumonia and empyema
Scarlet fever
strawberry tongue
Diagnosis?
-throat culture for pharyngitis
- ASO titer in Rheumatic fever
- titers to DNAse and
hyaluronidase
-AntiDNase best serology for
pyoderma
Complications? -Rheumatic fever,
-glomerulonephritis
-Hematogenous, local, lymphatic
extension of infection
Treatment?
-Penicillin, Penicillin V for strep
pharyngitis for 10 days
-Benzathin Penicillin, Erythromycin
PNEUMOCOCCAL INFECTION
Streptococcus
-major cause of lower respiratory
pneumoniae
tract infection, bacteremia, and
meningitis
Pathogenesis?
MOT-hematogenous or direct
extension into neighboring organs
S/Sx?
Bronchopneumonia
-fever, cough and nasal discharge,
productive copious purulent and
rusty colored sputum.
-Chest pain, difficulty of breathing
o CXR
-diffuse or focal pattern with
segmental or lobar involvement
o Acute
lethargy, poor activity and
irritability followed by vomiting,
bacterial
meningitis seizures, neck rigidity
o CSF
-cloudy fluid
-> 1000 cells/mm3
-predominance of pmn
- protein
-low sugar
Diagnosis
-isolation from the lungs, csf ,
trachea or middle ear aspirates,
blood and other body fluids
Treatment
- Pen G or Pen VK, Erythromycin,
1st generation cephalosporin,
chloramphenicol
MENINGOCOCCAL INFECTION
Causative
-Neisseria meningitidis-gram
Agent?
negative, biscuit-shaped
diplococcus
Prevalence?
occurs most frequently in children
from 2-5 years
S/Sx
-IP: 1-10days
-Upper respiratory infection
Acute meningococcemia-initially
as flu-like illness with fever,
malaise, chills arthralgia, headache,
GI complaints.
-Petechial, purpuric or
maculopapular lesions within hours
with hypotension, DIC, oliguria,
coma
-Acute Meningitis-seizures, fever
Diagnosis
-Blood culture, CSF, skin petechiae,
gram stain of petechiae
-Leukocytosis
-thrombocytopenia
-increased ESR and CRP
Differential
-Dengue

Diagnosis

Complications
Treatment

COMMON PEDIATRIC CONDITIONS

-Septicemia due to other gram
negative or gram positive organism
-Hypo-ischemic organ injury
-myocardial failure
-shock
-Penicillin G, Cefotaxime,
Ceftriaxone, Chloramphenicol
-vaccine
- Rifampicin

Prevention
Chemoprophyl
axis
HEMOPHILUS INFLUENZA INFECTION
Type B
-more invasive in neonates and
infants
Type F
-also cause invasive infection
Age
-most common in children 3 mos3yrs
Meningitis
- single most common cause of
bacterial meningitis in children 3
mos-3yrs
Acute
- in older children, peak age 2-4yrs
epiglottitis
Diagnosis
-Culture of CSF, blood, synovial
fluid, lung aspirate
-Antigen detection
-ELISA
Treatment
For invasive disease (meningitis,
epiglottitis) -high dose iv antibiotics
for 10-14 days
o Chloramphenicol
o Ampicillin
o Ceftriaxone
o Cefotaxime
o Dexamethasone
o For non-invasive disease
(otitis media, etc.)
o oral amoxicillin, coamoxiclav, oral
cephalosporin, macrolide
CHOLERA
Etiology?
Vibrio cholerae group 01; biotypesclassic El Tor, gram negative bacilli
IP: several hours to 5 days
Clinical
-Abrupt onset of diarrhea with
Manifestations
profuse watery stools, becoming
rice watery-like with flecks of
mucus, odorless or fishy odor.
-NO tenesmus
Diagnosis
Typical clinical features
-Identification of Vibrio cholerae in
stools and vomitus
-Serology
-Immunofluorescence
Treatment
-Fluid and electrolyte therapy
-Tetracycline
-Co-trimoxazole
MEASLES
Other Names
Rubeola, Morbilli
Etiology
measles virus, RNA virus 1serotype,
Morbillivirus
Incubation Period: 8-12 days
Mode of
direct contact with infectious
Transmission
droplet, airborne
Period of
1-2days before the onset of
Communicabilit symptoms up to 4-5days u
y
appearance of rash
Clinical
-Fever
Manifestations
-Coryza, Cough, Conjunctivitis
-rash: cephalocaudal,
maculopapular

COMMON PEDIATRIC CONDITIONS

-Kopliks spot
Diagnosis
- (-) measles IgM antibody
-Isolation of measles virus from
urine, blood or nasopharyngeal
secretions
Complications
-Otitis media
-Laryngotracheo-bronchitis
-Pneumonia-common complication
-Encephalitis-more common in
measles
-Severe conjunctivitis may lead to
corneal ulcerations and blindness
Treatment
Supportive measures:
-antipyretics, adequate nutrition
and fluid intake
-Vitamin A supplementation
-Antibiotics for complications like
pneumonia and otitis media
-Isolation: 4-5 days from the onset
of the rash in a healthy child and
for the duration of illness in
immune compromised patients
Control
Active immunization-live measles
measures:
vaccine is given to infants 6-9
months
-2nd dose at 12-15months as
MMR
DENGUE HEMORRHAGIC FEVER
Mode of
day biting female mosquitoes
Transmission
(Aedes aegypti)

ACUTE GASTROENTERITIS
MC cause
Virus (Rotavirus)
MC bacterial
E. coli
cause
2 primary
1. Damage to the villous brush
mechanisms
border of the intestine, causing
responsible for
malabsorption of intestinal contents
acute
and leading to osmotic diarrhea
gastroenteritis
are as follows:
2. Release of toxins that bind to
specific enterocyte receptors and
cause the release of chlorideions
into the intestinal lumen, leading to
secretory diarrhea
Signs and
Diarrhea
symptoms
Vomiting
or in urinary frequency
Abdominal pain
Presence of fever, chills,
myalgias, rash, rhinorrhea, sore
throat, cough
Changes in appearance and
behavior - weight loss, malaise,
lethargy
- irritability,
-changes in feeding
-childs level of thirst
Diagnosis
Baseline electrolytes
Bicarbonate
urea/creatinine
CBC and blood cultures
Fecal leukocytes and stool culture
Stool analysis for ova and parasites
Management
ORS
Zinc - To treat diarrhea
**WHO
recommends
supplementation
for
all

zinc
children

2
Common
Causes

Neonates

Adolescent
s; summerfall
epidemics
Adolescent
Infants

Nosocomial
pneumonia
Viral
Clinical
Manifestation

Viral
pneumonia
Bacterial
pneumonia

TREATMENT

COMMON PEDIATRIC CONDITIONS

younger than
gastroenteritis.

years

with

acute

PNEUMONIA
Streptococcus pneumoniae
Group B strep
Mycoplasma pneumoniae

Chlamydia pneumoniae
Chlamydia trachomatis
Gram-negative enteric
RSV Bronchiolitis
Tachypnea
crackles and wheezing
nasal flaring, and use of accessory
muscles is common
WBC count not higher than
20,000/mm
15,000-40,000/m
amoxicillin