Ch 40 PEDS infections: Viral, rickets, enteroviruses/parecho, Rashes (hand,foot,mouth) Flashcards by Michele Burr

What are common predisposing illnesses that can lead to bacterial respiratory infections?

(SOAP)

Otitis media
Sinusitis
Pneumonia
Acute otitis media/menigitis (bacterial CAP)

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Symptoms often found in a common cold include:

runny nose (rhinorrhea)
nasal congestion
sore throat
tearing
cough
sneezing
low-grade fever

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What pathogens frequently cause common cold symptoms?

Rhinoviruses
Adenoviruses
RSV
Parainfluenza
Human metapneumovirus
Influenza
Enteroviruses

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What are some expected outcomes of the common cold?

MAL

morbidity for 5 - 7 days
local mucosal swelling
altered local immunity (precursors for more severe illness, OM, pneumonia, sinusitis)

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T/F Prescribing antibiotics for the common cold may prevent complications and limit duration of purulent rhinitis

FALSE - antibiotics cannot PREVENT complications and will not LIMIT duration of purulent rhinitis

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How should the NP treat a child that is < 2 years old for the common cold?

Supportive measures such as:

hydration
humidified air
suctioning

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How should the NP treat a child that is over the age of 2 for the common cold?

PO antihistamines
PO decongestants
PO cough suppressants

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What treatments have no/limited effective reliability to improve symptoms for the common cold?

topical decongestants
Vitamin C
Zinc

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Childhood ______ is caused mostly from enteric adnoviruses in children less than 4 years old

diarrhea

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Adenovirus

What is the incubation period?
Early s/s?
Associated rash?
Lab test findings?

incubation: 4 - 5 days
early s/s: URI, cough, fever
rash: Morbilliform (petechial) resembles MMR
lab: leukopenia sometimes

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What viruses have an incubation period greater than 2 weeks (14 days)?

Mononucleosis

Rubella

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What specific adenovirus presents with fever, adenopahty, exudative tonsillitis, rhinitis, and influenza-like systemic illness findings? This is also the most common adenovirus disease.

Pharyngitis

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What specific adenovirus will have no lower respiratory symptoms, conjunctivitis associated with preauricular adenopathy, fever, pharyngitis, and cervical adenopahty?

Pharyngoconjunctival fever (viral pharynigitis)

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What two specific adenoviruses may present with a foreign-body sensation in the eye?

Pharyngoconjunctival fever

Epidemic keratoconjunctivitis

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What specific adenovirus presents with severe conjunctivitis, photophobia, swelling of the eyelids, and subconjunctival hemorrhage?

Epidemic keratoconjunctivitis

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On chest XRAY, bilateral peribronchial and patchy ground-glass interstitial infiltrates are present in the lower lobes. What should the NP suspect? What kind of virus may have caused this?

Pneumonia

adenovirus

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What are complications of adenovirus pneumonia? What serotype is unusually severe and fatal in children and adults?

Bronchiectasis (hard to clear mucus)
Bronchiolitis (inflammation)
Bronchiolitis Obliterans (inflammatory obstruction of the lung’s)

serotype 14

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What rash is absent in adenovirus?

kolpik spots

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What adenovirus serotypes are causes of short-lived diarrhea in afebrile children? What age range is this finding common in?

serotype 40 and 41

< 4 years old

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Any treatment specific for adenovirus illness?

What would you consider for the immunocompromised patient with severe pneumonia?

none!

IV IG for immunnocompromised patients

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What types of diagnostic tests can identify adenoviruses?

Viral culture - 48 hours
PCR - rapid
ELISA - diarrheal

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What viral infection presents as fever, cough, pharyngitis, malaise, congestion, pneumonia, and encephalitis in late fall to mid spring?

Influenza

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Influenza

What is the incubation period?
Early s/s?
Young children specific findings?
Older children specific findings?
Lab test finding?

incubation: 2 - 7 days
early s/s: sudden high fever, severe mylagia, headache and chills
young children: abdominal pain, fever, diarrhea, vomitting
older children: high fever/mylagia/HA/chills, dehydrating enteritis, adenopathy
lab: low leukocytes

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What specific diagnostic tools are preferred for influenza illness?

PCR*

Rapid culture technique

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What two other viral illnesses present similarly to influenza?

Parainfluenza | RSV

What should a NP rule out in a suspected influenza child with protracted vomitting or irrational behavior during flu season?

Rule out Reye Syndrome! *most common causes are varicella and influenza type B*

What are prevention methods for Influenza?

flu vaccine **can still get if allergic to eggs, consider inpatient vaccination setting**

What two medications can be considered as prophylaxis for Influenza? What are the age requirements and/or contraindications of those medications?

> 3 months = Oseltamivir (Tamiflu) > 5 years old = inhaled Zanamivir (NO ASTHMA/chronic pulmonary diseases) all antivirals need to be given 48 hours after symptom onset and for 5 days

A child under the age of five presents with an acute onset fever, nasal congestion, sore throat, a cough and inspiratory stridor. What viral respiratory illness is this?

Parainfluenza - Croup

There are four types of human parainfluenza viruses (HPIV). What are the types? Age specific and occurrence

Type 1 and 2 - croup causing, infect children < 5 years old and during fall type 3 is within the first 3 years of life (commonly 1 year old) type 4 is year-round and less pathogenic

Parainfluenza (Croup) What is the incubation period? Early s/s? (general and croup specific) Which type occurs most often? Lab tests?

incubation: 2 - 7 days early s/s: acute febrile URI, laryngitis, tracheobronchitis, croup, bronchiolitis (second most common) Croup specific s/s: barking cough, inspiratory stridor, hoarseness Type: Type 1 - croup, laryngitis, and tracheobronchitis Labs: PCR, conventional or rapid culture techniques, or direct immunofluorescence of secretions

What is the treatment for Parainfluenza (croup)?

no specific treatment; manage symptoms

A one year old child presents with diffuse wheezing, variable fever, cough, tachypnea, and is having a difficult time feeding. What do you suspect this child has?

RSV

What respiratory virus is the cause of lower tract illness in young children?

RSV

RSV What is the duration of illness? Early s/s? XRAY findings? Lab tests?

duration: 3 - 7 days (previously healthy children) classic s/s: bronchiolitis characterized by diffuse wheezing, variable fever, cough, tachypnea, difficulty feeding. Severe = cyanosis XRAY: hyperinflation (causing palpable spleen and liver) and peribronchiolar thickening Lab: real time PCR (too expensive), rapid antigen or ELISA

What is a differential diagnosis that should be considered in an infant < 6 months old with a prominent cough when RSV is suspected?

Pertussis

A child with suspected RSV presents to the ED. The NP found an elevated WBC on lab work. What differential diagnoses would this finding indicate?

Bacterial infection or Pneumonia

What treatment specific guidelines are suggested for RSV children that cannot maintain oxygen saturation, are very hypoxic or unable to eat due to respiratory distress?

oxygen therapy for oximetry reading < 90% | hospitalize any infant with poor feeding/hypoxia and give humidifed oxygen and NGT feedings

What treatments are NOT approved for children with RSV?

Antibiotics decongestants expectorants albuterol/salbutamol or epinephrine

What medication is approved for infants with RSV that also have significant anatomic or immunologic defects?

Ribavirin antiviral aerosolization therapy

What finding evolves later in childhood after a hospitalized infection with RSV?

wheezing

What precursor is found post RSV infection in infancy?

asthma

A child with a cough, coryza (inflammation of the nose), and sore throat presents in your office. What do you suspect this viral illness is?

Human Metapneumovirus Infection (hMPV)

What two other respiratory illnesses may occur in children that acquire hMPV before the age of two?

Bronchiolitis Pneumonia *dual infection with RSV may occur*

What is the preferred method of diagnosis for hMPV (human metapneumovirus)?

PCR on respiratory specimens

What is the definitive diagnosis of human coronaviruses?

PCR

Human Coronaviruses What is the incubation period? Manifestation of s/s? How can this group of viruses also present?

Incubation: 2 - 5 days for non-severe S/S: rhinorrhea, sore throat, cough, occasionally fever Present as: acute otitis media, trigger asthma exacerbation, and acute gastroenteritis

T/F Children with SAR-CoV-2 are severely symptomatic

FALSE! - children are asymptomatic or have milder s/s of fever, cough, myalgia, mild diarrhea, and abdominal pain

What complications may occur in children with SAR-CoV-2?

multiorgan dysfuntion (known as MIS-C)

What lab finding is present in symptomatic cases of SAR-CoV-2?

elevated procalcitonin

What viral respiratory illnesses are associated with enterovirus causes?

``` Acute febrile pharyngitis Herpangina acute Lymphonodular Pharyngitis Hand, food, mouth disease Pleurodynia (Bornholm disease, Epidemic Myalgia) ```

Enterovirus What is the incubation period? Early s/s? Associated rash? Lab test findings?

incubation: 2 - 7 days s/s: variable fever, chills, myalgia, sore throat Rash: variable - macular/maculopapular on trunk or palms, soles or vesicles or petechiae (H/F/M or pharyngeal) Lab: PCR

Parovirus (erythema infectiosum) What is the incubation period? Early s/s? Associated rash? Labs?

Incubation: 10 - 17 days (rash) s/s: mild, flu-like rash: maculopapular on cheeks "slapped cheek", forehead, chin, limbs, trunk, buttocks Labs: IgM-EIA, PCR

Acute Febrile Pharyngitis (enterovirus) presents with what findings in older children? Duration?

``` sore throat headache myalgia abdominal discomfort lasting 3 - 4 days ```

What presents on the pharynx in acute febrile pharyngitis (enterovirus)?

vesicles or papules on the pharynx without exudate

What enterovirus presents with an acute onset fever with posterior pharyngeal grayish white vesicles that quickly form ulcers? The child may also be drooling, vomiting and has dysphagia.

Herpangina

How long do the symptoms last with Herpangina?

4 - 5 days

What specific viruses are associated with Herpangina?

Coxsackie A viruses (epidemics) | Coxackie B/echovirus (sporadic)

What enterovirus presents with febrile pharyngititis with nonulcerative yellow-white posterior pharyngeal papules along the posterior palate?

Acute Lymphonodular Pharyngitis

What is the treatment of choice for acute lymphondular pharyngitis (enterovirus) and what is the duration of the virus?

Supportive treatment | 1 - 2 weeks

What clinical diagnosis would be suspected for a child with vesicles or red papules found on the tongue, oral mucosa, hands and feet, near the nails, and on the heals?

Hand-Foot-Mouth (enteriovirus)

What type of virus (strands) occur in Hand-Foot-Mouth?

Coxsackieviruses - A5, A10, A16

How long will the rash of hand-foot-mouth be present?

1 - 2 weeks, rash may appear when fever reduces, simulating roseola

What enterovirus presents as an abrupt onset of unilateral or bilateral spasmodic pain of variable intensity over the lower ribs or upper abdomen? What other symptoms by be present?

Pleurodynia (Bornholm Disease, Epidemic Myalgia) DISEASE OF THE MUSCLES! headache, fever, vomiting, myalgia, abdominal/neck pain, decreased thoracic excursion, and **friction rub**

What virus is associated with Pleurodynia (Bornholm disease, Epidemic Myalgia)? How long do symptoms last? (duration)

Coxsackie B 1 week duration

What treatment options would you consider for a child with Pleurodynia (Bornholm disease, Epidemic myalgia)?

Analgesics!!! | chest splinting - friction rub symptom

Nonpolio enteroviruses that are caused by _________ will present as what two cardiac involvement symptoms?

Coxsackieviruses - type B Myocarditis Pericarditis

What two lab findings are significant in acute myocarditis?

Elveated creatine phosphokinase | Troponin

Severe neonatal infection presents with what clinical manifestations?

``` fever rash pneumonitis meningo-encephalitis hepatitis gastroenteritis myocarditis pancreatitis myositits ```

What differential diagnosis should be included in an infant with severe neonatal infection with rash?

bacterial and herpes simplex infections necrotizing entercolitis heart or liver failure causes metabolic diseases

What specific lab findings will help diagnosis an infant with severe neonatal rash?

CSF mononuclear pleocytosis Enterovirus detection on RNA in stool or pharynx PCR in CSF, blood, or urine

Ch 40 PEDS infections: Viral, rickets, enteroviruses/parecho, Rashes (hand,foot,mouth) Flashcards

(71 cards)