Viral Respiratory Illness (Pediatrics) Flashcards
(37 cards)
COMMON COLD
Organism/season dependent
Rhinovirus: colder months
Adenoviruses: all seasons
RSV: late fall-early spring
Influenza: fall-winter
Enterovirus: summer
Incubation: 5-7 days
URI symptoms + low grade fever
NO ANTIBIOTICS
<2yr: hydration, humified air
>2yr: PO antihis, decon, cough suppr.
ADENOVIRUS
< 2 yr old (daycare)
winter and spring
DROPLET
Incubation: 3-10 days
URI symptoms (pharyngitis*)
Dx: antigen detection, PCR, culture (depends on type)
Pharyngoconjunctival Fever: fever, pharyngitis, and conjunctivitis
Epidemic Keratoconjunctivitis: FB sensation, photophobia, swelling of conjunctiva/eyelids
Enteric Adenovirus (40/41): <4 yr old with short-lived diarrhea
no specific treatment exists; supportive therapy
PARAINFLUENZA
<5 yr old
fall season
Incubation: 2-7 days
Barking seal cough
Dx: clinical symptoms; PCR
Manage croup symptoms
PARECHOVIRUSES (HPeV)
before the age of 2-5yr + severe infection
summer-fall outbreaks
sepsis and meningitis*
transmission: fecal-oral, respiratory secretions
HUMAN METAPNEUMOVIRUS (hMPV)
<5 yr old
late autumn-early spring
Duration: shorter in hMPV than RSV
cough sore throat, acute wheezing
PCR (resp secretions)
no treatment available
INFLUENZA
H. influenzae (H1N1-A; B)
late fall-mid spring
Incubation: 2-7 days
Acute illness duration 2-5 days (several weeks in young children)
DROPLET TRANSMISSION
SYMPTOMS DEPENDENT ON AGE GROUP
Older children (same as adults): high fever, severe myalgia, HA, chills
Young children: GI symptoms
Infants (same as old people): sepsis-like illness, apnea, AMS, lethargy
Reye Syndrome (protracted vomiting, irrational behavior during flu season; varicella/ influenza
type B)
nasal swab / PCR test
supportive care + Tamiflu (5-day course given within 48 hr of symptom onset)
RSV
<2 yr old
late fall-early spring (jan-feb peak)
3-7 days duration (fever won’t correlate w/resp symptoms)
Recent URI + wheezing, cough, tachypnea, difficulty feeding, prolonged expiration
CXR: hyperinflation
nasal swab
symptomatic treatment; resp isolation; good handwashing; cohort RSV with RSV
*Ribavirin only needed for immunocompromised kids
*<6mo old w/elevated WBC and prominent cough – MUST RULE OUT
PERTUSSIS
NO NEED FOR: abx, decongestants, expectorants, albuterol, or systemic
corticosteroids (unless asthmatic or premature infant)
Acute Febrile
Pharyngitis
Older children
Incubation: 3-4 day
sore throat + abdominal
discomfort + VESICLE /
PAPULES on pharynx
WITHOUT EXUDATE
Acute Lymphonodular
Pharyngitis
Coxsackievirus
1-2 wks duration
Febrile + pharyngitis with
YELLOW-WHITE papules
WITHOUT ULCERS linearly
along posterior palate
Supportive treatment
Herpangina
Coxsackievirus A
4-5 duration
Acute fever + GRAYISHWHITE
vesicles WITH
ULCERS linearly along
posterior palate, uvula, tonsillar
pillars + abd pain +
dysphagia/drooling
Hand Foot & Mouth
Coxsackievirus
1-2 week duration
Vesicles/red papules on
tongue, hands, feet +
fever, sore throat
fever goes down à
roseola-like rash appears
Pleurodynia
“muscle disease”
Coxsackievirus B
1 week duration
Abrupt onset
unilateral or bilateral pain
(spasmodic/variable intensity) over the
lower ribs or upper abdomen + fever +
decreased thoracic excursion
analgesics, chest splinting
PNEUMOCOCCAL PNEUMONIA
s. pneumoniae
AOM, sinusitis, pneumonia, meningitis
clinical findings correlate with what their underlying condition is
sepsis: high fever, >15,000 WBC
pneumonia: above symptoms + tachypnea, localized chest pain, localized/diffuse rales
pneumococcal meningitis: fever + high WBC, irritability, lethargy, neck stiffness (older kids)
Diagnosis / Treatment dependent on underlying cause
sepsis: mild - ceftriaxone; severe: add vanc
pneumonia: infants >1mo = ampicillin, PCN G, cefs; mild pneumonia >1mo: amoxicillin
pneumococcal meningitis: vanc+cefotaxime
H. INFLUENZAE
h. influenzae
acute epiglottitis, septic arthritis, cellulitis
DROPLET ISOLATION
Prevention of h.influenzae: HiB vaccine series
Diagnosis / Treatment dependent on underlying cause
Requires hospitalization and 3rd generation cephs (cefotaxime / ceftriaxone)
h. influenzae meningitis: vancomycin + cephalosporin IV for 10 days; dexamethasone (given
immediately after dx, continue for 4 days to reduce incidence of hearing loss)
*Pregnant women CANNOT receive Rifampin to reduce colonization of HiB
CHLAYMDIA TRACHOMATIS
Few days – 16 weeks of age
watery, mucopurulent, to blood-tinged discharge and conjunctival injection
Pneumonia (complication): onset 2-12 weeks with staccato cough, afebrile,
tachypnea
Dx: conjunctival/resp specimen
systemic abx are required: AZITHROMYCIN
TEST THE MOTHER AND MOTHERS PARTNER
*Erythromycin ointment post-birth DOES NOT PREVENT THIS!
PERTUSSIS
Bordetella pertussis
Insidious onset with 3 stages (catarrhal, paroxysmal, convalescent)
HIGHLY COMMUNICABLE
prodromal catarrhal stage: (1-3 weeks) mild cough, WITHOUT FEVER
paroxysmal stage: persistent staccato, paroxysmal cough ending w/ high-pitched inspiratory whoop
convalescent stage: slowly resolving cough over weeks-months
ELEVATED WBCs
Dx: PCR or culture nasopharyngeal secretions
Start tx in prodromal phase (if you can)
Infants <1mo: AZITHROMYCIN r/t risk of PYLORIC STENOSIS
Infants >1mo: clarithromycin
Prevention: vaccinations (immunity wanes @ 5-10 yr post-vaccine)
DTaP (infants/children) / Tdap (preteens, teens, adults
*High suspicion of pertussis: treat & don’t wait till results come back!
The common cold, what is most often the cause?
Answer: depends on seasons; rhinoviruses: colder months; adenoviruses: all seasons; RSV: late fall-early spring (jan-feb peak); influenza
virus: fall-winter; enterovirus: summer cold
With the common cold (generally speaking), how long do you expect to see symptoms for?
Answer: 5-7 days
T of F: antibiotics can prevent complications of the common cold and limit duration of purulent rhinitis
Answer: False; ANTIBIOTICS WILL NOT PREVENT COMPLICATIONS OF THE COMMON COLD and DO NOT LIMIT
DURATION OF PURULENT RHINITIS!
What treatment is given to a patient with the common cold?
Answer: supportive care; (<2 yr. old: hydration, humidified air, suctioning; >2 yr. old: PO antihistamines, decongestants, cough suppressants);
vitC, zinc, topical decongestants – not shown to improve symptoms
Parainfluenza: most often affects what age? When do you often see an outbreak?
Answer: <5yr old; fall outbreak
What is the incubation period for parainfluenza (croup cause)?
Answer: 2-7 days
How is parainfluenza diagnosed?
Answer: based on clinical symptoms *barking seal cough*; PCR<24hr result
Human Metapneumovirus Infection (hMPV):
<5 yr old, occurs late autumn-early spring; cough sore throat, acute wheezing; PCR of resp
secretions; no treatment available; duration is shorter in hMPV than RSV symptoms
