Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Core Tutorial in Pediatric Infectious Diseases for Third Year Medical StudentsInfectious Disease Emergencies,?,How would you evaluate this patient?,A sixteen-year-old girl presents with fever and lower abdominal pain but denies urinary urgency or frequency.She is sexually active and uses condoms infrequently.,?,How would you evaluate this patient?,A sixteen-month-old presents with a history of nasal discharge for the past week presents with a swollen,red eye and fevers to 103,0,F.,Learning Objectives,Be able to recognize an infectious disease emergency,Understand the age-appropriate approach to diagnosis and initial management of infectious disease emergencies,Be familiar with various agents with bioterrorism potential,Bacteremia and Sepsis,Bacteremia=Presence of pathogenic bacteria in the blood of mildly or moderately ill child,Incidence peak at age 6 to 18 months,See“Fever tutorial for complete discussion of work-up and management,Sepsis=Bacteremia with serious systemic illness,Pathogens,birth to 2 months:Group B Streptococcus,E.coli,older infants:Strep.pneumoniae,N.meningitidis,Group A Streptococcus,S.aureus,Salmonella,Risk factors,neoplasia,immunodeficiency syndromes,immunosuppressive therapy,asplenia,sickle cell disease,Sepsis,Signs and Symptoms,fever,tachycardia,tachypnea,hypotension,metabolic acidosis,thrombocytopenia,leukocytosis(leukopenia with overwhelming infection),Work-up,CBC,blood culture,coagulation studies,electrolytes,LFTs,BUN and creatinine,Treatment,fluids,vasopressors;close monitoring in ICU,age 2 months ceftriaxone or cefotaxime+/-vancomycin,Meningococcemia,Neisseria meningitidis,Peak incidence is first year of life,40%in age 40%,Work-up,Culture blood,CSF,skin lesions,CSF antigen testing(latex agglutination),Meningococcemia,cont,Treatment,Penicillin G if susceptible(most are but start with third generation cephalosporin until sensitivities are known),Supportive care,Prevention,chemoprophylaxis of contacts,rifampin,ceftriaxone,ciprofloxacin,vaccine,A/C/Y/W135,Meningitis,Incidence peak at age 6 to 24 months,Cerebrospinal fluid normal values vary with age,Meningeal signs(neck stiffness,Kernigs sign and Brudzinskis sign)may be absent in young infants,Most common bacterial pathogens vary with age:,Neonate:Group B,Strep,E.coli,L.monocytogenes,Older infants and children:,S.pneumoniae,N.meningitidis,H.influenzae,Meningitis,cont,Colonization(nasopharynx)resulting in bacteremia can lead to hematogenous seeding of meninges;also can have direct extension from a parameningeal focus(i.e.,sinusitis),Work-up,CBC,electrolytes,BUN,creatinine,glucose,coagulation studies,blood culture,CSF analysis:cell counts,protein,glucose,gram stain and culture,Management,ABCs,monitoring,supportive care,age 1 month;vancomycin and ceftriaxone or cefotaxime,Other CNS Infections,Encephalitis,viral,bacterial,post-infectious,non-infectious,treatment depends on etiology,Subdural empyema,immediate surgical drainage,Brain abscess,antibiotics,steroids,management of elevated intracranial pressure,frequently requires surgical drainage,Orbital cellulitis,I.V.antibiotics and frequent evaluation by ophthalmologist with consideration of surgical drainage,Epiglottitis,Common etiology was,H.influenzae,type b prior to the introduction of vaccine,Other etiologies:,Strep.pneumoniae,Strep.pyogenes,Staph.aureus,Incidence was highest in age 3 to 6 years but with vaccine incidence has declined dramatically,Presentation is toxic-appearing child with fever,drooling,stridor,tachycardia,tachypnea,and a preference for sitting up leaning forward,This is a true emergency and can progress rapidly to complete airway obstruction especially if the child is disturbed,If epiglottitis is suspected priority is control of the airway before any other intervention or diagnostic evaluation,Epiglottitis,cont,Infection leads to edema of epiglottis,spreads to aryepiglottic folds,arytenoids,and entire supraglottic larynx,Work-up and treatment after securing airway,Work-up,WBC(leukocytosis with left shift),blood culture,epiglottis culture,lateral neck film(“thumb sign),Treatment,ceftriaxone or cefotaxime,close observation in ICU,Bacterial Tracheitis,Bacterial complication of viral laryngotracheobronchitis,Pathogens:,Staph aureus,Strep pyogenes,H.influenzae,Strep pneumoniae,;rarely,M.catarrhalis,anaerobes,As viral infection wanes,abrupt worsening of symptoms with new fever and stridor,Toxic-appearing,agitated,Priority is establishment of an artificial airway,Work-up and management:see Epiglottitis,Retropharyngeal Abscess,Potential space between anterior border of cervical vertebrae and posterior wall of esophagus,Group A,Strep,anaerobes,Staph.aureus,Age 5 years(peak 10-19 years),Perforation in one-third of cases;more common in age 6 years,Mid-abdominal pain initially,then RLQ pain,Fever,anorexia,nausea,vomiting,rebound tenderness,Psoas and obturator si