This document provides an overview of common pediatric infectious diseases. It discusses diagnostic labs such as CBC, CRP, and cultures that can help differentiate between bacterial and viral infections. It then summarizes several infectious diseases organized by pathogen, including enterovirus, HSV1/2, infectious mononucleosis, varicella, HIV, roseola, rubeola, mumps, fifth disease, parainfluenza, rubella, Lyme disease, MRSA, cat scratch disease, meningococcal disease, GABHS, and tuberculosis. For each disease, it describes transmission, clinical manifestations, diagnostics, and treatment approaches.

1. A S H L E Y M A R A S S D N P , C P N P , S A N E - A
Pediatric Infectious Disease Overview

2. ID Assessment and Diagnosis
 Labs
 CBC- bacterial vs viral
 Platelet count
 CRP
 Procalcitonin
 ESR
 Cultures

3. Enterovirus
 More than 100 serotypes including A, B, coxsackievirus, and echo virus
 Transmitted via fecal oral route, respiratory, and vertical
 Most common in the summer and fall
 Include hand foot and mouth, herpangina, pleurodynia, conjunctivitis,
myocarditis, pericarditis, viral meningitis, pancreatitis, orchitis, and
neonatal sepsis

4. HSV 1
 Clinical manifestations are determined by the age, port of entry, and
immune status
 Gingivostomatitis:
 Pharyngitis with erythematous vesicles, halitosis, lymphadenopaty
 Herpes Labialis:
 Clusters of vesicles that progress to crustiness – classic cold sore
 Hand or Finger:
 Deep vesicles
 Traumatic herpetic infection

5. HSV1

6. HSV 2
 Clinical manifestations:
 Vesicopustules and ulceration with edema
 Primary lesions: vaginal mucosa, labia, perineum, and penile shaft
 Secondary lesions: generally less severe
 Neonatal Infection
 Always symptomatic
 Severe disease

7. HSV2

8. HSV
 Treatment is supportive unless the condition is life-threatening

9. Infectious Mononucleosis
 Epstein-Barr virus and Cytomegalovirus
 Most common in adolescents and young adults
 Mode of transmission- close personal contact, fomites, pharyngeal
secretions, blood transfusions
 Diagnostics:
 CBC- > 10% Lymphocytes
 Monospot- 80% accurate
 Viral culture
 EBV specific core

10. Infectious Mononucleosis
 Clinical manifestations:
 Fever- moderate to high for 3 days to weeks
 Sore throat- very painful for 7 -10 days
 Lymphadenopathy- anterior and posterior cervical nodes
 Splenomegaly
 Hepatomegaly
 Skin rash
 Periorbital edema

11. Infectious Mononucleosis
 Treatment:
 Supportive
 Fluids and calories
 Steroids and acyclovir are not recommended in uncomplicated disease
 Over the counter pain meds
 Contact sports and strenuous exercise should be avoided

12. Mononucleosis

13. Varicella
 Primary illness with reactivation leading to shingles
 Transmitted via direct contact with the lesions, droplets, and airborne
transmissions
 Victims infected with Shingles are infectious and can cause primary
infection
 Secondary infections are rare and are generally mild compared to the
primary infection.
 Diagnostics:
 Viral culture
 VZV PCR testing and ELISA

14. Varicella
 Clinical findings:
 Prodrome: low grade fever, headache, occasional URI, headache, and abdominal pain
lasting 1-2 days
 Rash: begins on the scalp, face or trunk, pruritic lesions that progress to vesicles, that
crust over after 24-48 hrs. The scabs last 5- 10 days , but are no longer contagious.
Severe fever accompanies the rash. Rash appears in all stages in all mucosal tissue.
 Treatment:
 Supportive with antihistamines for itching and acetaminophen for fever
 Immunocomprimised patients – IV Acyclovir
 Monitor for Reye’s Syndrome

15. Varicella

16. HIV: Human Immunodeficiency Virus
 35 million cases worldwide
 Africa carries 90% of the burden
 Rates increasing for 13-14 yr olds and 20-29 year olds
 50% of teen do not know they are infected
 Transmission to the infant
 In utero- 30%
 Intrapartum- 60%
 Postpartum- 15%

17. HIV
 Viral Load increases
 CD4 and T cell count decreases
 Symptoms:
 Lymphadenopathy
 Hepatosplenomegaly
 Failure to thrive
 Diarrhea
 Parotid swelling
 Bacterial infections (not as many in neonates)

18. HIV
 Testing
 Table 31-5
 Treatment
 Treatment goal- undetectable viral load
 Antiretrovirals x 3
 NNRTI and NRTI
 Newborn- Zidivudine prophylaxis protocol
 PrEP
 High risk for infection
 Daily two med regimen

19. Roseola (Exanthem Subitum)
 Also known as 6th disease
 Transmitted via oral, nasal, and conjunctival
 Occurs between 3 months and 3 years, but most commonly 6-18
months
 Diagnostics:
 CBC- decrease in WBC
 Follows a fever pattern
 Treatment:
 Supportive

20. Roseola (Exanthem Subitum)
 Clinical manifestations
 Sudden onset of fever (101-103)
 URI
 Lymphadenopathy
 Lethargy
 Injected conjunctiva
 GI complaints
 Reddened TM
 Fever breaks and rash appears
 Rash- diffuse, rose-colored maculopapular rash

21. Roseola

22. Rubeola (Measles)
 Associated with high morbidity and mortality world wide
 Transmitted via droplet, fomites, blood, urine
 Peaks in the winter and spring
 THIS IS A SERIOUS ILLNESS IN CHILDREN!!
 Only a 5% chance of contracting the virus after first vaccine and a 2%
chance after the second vaccine
 Reportable disease
 Diagnostics: IgM antibody level, viral culture from urine, blood,
nasopharyngeal secretions

23. Rubeola (Measles)
 Clinical manifestations:
 Prodromal: last 4-5 days, URI symptoms, low to moderate fever, along with the 3 C’s
of measles- cough, coryza, conjunctivitis
 Koplik spots- blue/white patches in the oral mucosa last 12-15 days
 Rash stage: begins the 3rd to 4th day of the illness with a high fever (can be as high as
105)
 Rash begins on the head, behind the ears then gradually moving to the face and neck
 Rash progresses downward- 1st 24 hrs- face, neck and arms; 2nd 24hrs- back, abdomen, and
thighs

24. Rubeola (Measles)
 Treatment
 Supportive- fluids, bed rest, antipyretics, warm, dark room
 Antibiotic treatment for secondary bacterial infections
 Complications
 Bacterial superinfections
 Myocarditis
 Black Measles
 DIC
 Enchephalitis

25. Rubeola

26. Mumps
 Viral disease with enlargement of one or more salivary glands,
including the parotid glands
 Transmitted via saliva and urine
 Most common during late winter and spring, but can occur anytime
 Diagnostics: Viral culture and IgM and IgG antibody

27. Mumps
 Clinical Findings:
 Prodromal: fever, headache, anorexia, neck pain, and lethargy
 Swelling stage: swelling of the parotid glands, pain, mild to moderate fever, swelling
usually last between 3- 7 days
 “Pickle sign”- assessment of pain by eating something sour
 Stensen’s duct- red and swollen
 Treatment
 Supportive
 NSAIDS or steroids for arthritic involvement

28. Mumps

29. Erythema Infectiosum (Fifth disease)
 Parvovirus B19
 Transmitted via vertical from mother to baby, respiratory secretions,
and blood
 Childhood disease- peaking between 5-15 yrs
 Occurs mostly in late winter and early spring
 Diagnostics: lab test are not usually indicated

30. Erythema Infectiosum (Fifth disease)
 Clinical Manifestations
 Prodrome: mild fever, headache, and URI symptoms
 Rash:
 Slapped cheek- 1st appearance and last 1-4 days
 Lacy maculopapular rash on the body that spreads to the extremities- can last 1 month
 Exacerbation occurs with heat, exercise, stress, etc
 Treatment
 No antiviral recommended
 IV IG for the immunocompromised

31. Fifth Disease

32. Parainfluenza
 Major cause of Croup
 Also causes bronchoilitis, bronchitis, and pneumonia
 Spread through direct contact
 Types 1-4
 Type 1 associated with Croup
 Diagnostics: Routine testing is not needed

33. Parainfluenza
 Clinical Manifestations
 Affect the upper airway
 Sore throat
 Fever
 Rarely a rash
 Treatment:
 Supportive
 Oxygen and suctioning may be required
 Good hand hygiene is very important for parent education

34. Rubella (German or 3-day Measles)
 RNA virus that can be congenital or postnatal
 Transmitted through nasopharyngeal secretions, transplacentally, or
fomites
 Vaccines have significantly decreased the occurrence
 Lifelong immunity following the disease
 Diagnostics: antibody testing, clinical assessment

35. Rubella (German or 3-day Measles)
 Clinical Manifestations:
 Prodrome: Inflammation of the mucous membranes in the airways
 Lymphadenopathy: 24 hrs before the rash appears, postauricular, posterior cervical,
posterior occipital, rarely splenomegaly
 Rash: Begins on the face and spreads to the trunk lasting around 3 days, possible
itching and fever
 Treatment
 Supportive
 Steroids and platelet transfusions for purpura

36. Congenital Rubella

37. Lyme Disease
 Borrelia burgdorferi
 Carried and transmitted via ticks
 Ticks must feed on the host for at least 36 hours to have a significant
risk for infection of the host with Bb
 Three USA areas have the highest rate of infection- New England and
mid-atlantic states, upper midwest, and the west

38. Lyme Disease
 Diagnostics:
 Clinical assessment and history
 Sero- testing will not be positive until 1 week following the bite
 ELISA/IFA
 Western Blot
 Clinical Manifestations:
 Stage 1- 1-2 weeks following the bite, erythema migrans, last for a few weeks but fades
even without treatment, fever, malaise, headache, arthralgia, and stiff neck

39. Lyme Disease
 Clinical Manifestations:
 Stage 2- disseminated disease- multiple skin lesions, infections of the eyes, bone,
heart, synovium, muscle, liver, spleen, CNS (7TH nerve palsy), last from weeks to years
 Stage 3- begins with arthritis, joints are red and swollen, CNS encephalopathy (rare),
memory impairment
 Treatment
 If the clinical picture meets the criteria, do not wait on sero-testing results to begin
treatment
 Amoxicillin 50 mg/kg/day for 14-21 days- younger than 8 yrs
 Doxycycline 100 mg 2x day for 14-21 days- 8 yrs and older

40. Lyme Disease

41. MRSA
 Must know the prevalence in your community as a Practitioner
 Most commonly found in the skin and soft tissue
 Has moved from only hospital-based to community-based, as well.
 Clues to MRSA: furuncle or boils with no drainage, redness, pain,
warmth, others in the family with skin infection, fails beta-lactam,
recent history of infection, pus, involved in contact sports, CF,
respiratory infection, and multiple lesions

42. MRSA
 Treatment (based on severity)
 Culture if lesion contains purulent drainage or I and D if larger than 5 cm- send for
culture and gram stain, sensitivity and D-test
 See page 492 Burns- Algorithm for treatment
 Some outpatient recommendations (Table 31.6):
 Clindamycin
 Doxycycline
 Minocycline
 Bactrim
 Linezolid

43. MRSA

44. Cat Scratch Disease (CSD)
 Bartonella henselae
 Chronic (> 3 weeks) lymphadenopathy
 90% caused by actual cat scratches
 Clinical Manifestations:
 Vesicular or pustule lesions
 Ulceration of the mucous membranes
 Axillary, cervical, submandibular, preauricular, epitrochlear, inguinal, and femoral
lymphadenopathy last 1-2 months normally
 Fever and overall illness

45. Cat Scratch Disease (CSD)
 Treatment
 Spontaneous recovery in 2-4 months
 Supportive treatment- antipyretics and analgesics
 Antibiotics used for systemic CSD
 Azithromycin
 Ciproflaxin
 Gentamycin
 Bactrim
 Clarithromycin

46. Cat Scratch Disease- Axillary Node

47. Meningococcal Disease
 N. meningitidis
 Transmitted via respiratory secretions via colonization
 Most common in the winter and the spring
 Risk increases in day cares, dorms, and military housing
 Teens have the highest mortality

48. Meningococcal Disease
 Clinical Manifestations:
 Occult bacteremia: febrile, URI or digestive tract symptoms, maculopapular rash
 Meningococcemia: fever, pharygitis, headache, conjunctivitis, photophobia,
weakness, myocarditis, seizures, maculopapular or petechial rash- may quickly
progress to septic shock- very scary!!!!
 Meningococcal Meningitis
 Treatment:
 IV antibiotics are started while waiting for the results of cultures! Do not wait!
 Penicillin, cefotaxime, ceftriaxone, dexamethasone

49. Meningococcal Disease

50. GABHS
 Not just Strep throat
 Only transmission is the respiratory tract
 Pharyngitis is most common between 5-15 yrs
 Skin infection is more common in children 12m to 4 yrs
 Diagnostics:
 Culture
 Rapid Strep- poor sensitivity- must follow with a culture

51. GABHS
 Clinical Manifestations- can present as any of the following illnesses:
 Pharyngitis
 Pneumonia
 Scarlet fever
 Skin infection
 Bacteremia
 Vaginitis
 Perianal cellulitis
 Necrotizing fasciitis
 Toxic shock

52. GABHS
 Treatment
 Penicillin V po and Penicillin G IM are the drugs of choice
 Bactrim and Tetracyclines should not be used
 Other acceptable modes of treatment include:
 Oral cephalosporins
 Macrolides
 Topical Mupirocin can be used for uncomplicated impetigo
 If multiple or traveling lesions occur- systemic antibiotics should be used
 Return to school when afebrile and 24 hrs following start of antibiotics
 More aggressive therapy is required for systemic disease

54. Tuberculosis
 M. tuberculosis
 Transmitted via droplet contamination
 Most common:
 Low-socioeconomic
 Poor nutrition
 Lack of access to care
 Crowded living arrangements
 Ethnic minority
 Foreign-born

55. Tuberculosis
 Clinical Manifestations
 Primary Pulmonary TB:
 Most children are asymptomatic when first tested
 Low-grade fever
 Cough
 Lethargy
 Night-sweats
 Erythematous nodules under the skin
 Enlarged lymph nodes
 Miliary TB
 Children under the age of 3
 Necrosis and multiple organ failure can occur

56. Tuberculosis
 Diagnostics:
 Culture
 Chest x-ray
 Tuberculin skin test
 Treatment:
 Isonozid (INH)
 Rifampin (RIF)
 Pyrazinamide (PZA)
 Corticosteriods for complicated percardial or pleural effusions

57. Fever without a Focus
 Excellent algorithm on page 505 in Burns
 This a very important topic in the primary care setting. Babies with
fever demand immediate attention!

58. Reference
 Blosser, C. G., Brady, M. A., & Muller, W. K. (2009). Infectious diseases
and immunizations. In C. E. Burns, A. M. Dunn, M. A. Brady, N. B.
Starr & C. G. Blosser (Eds.), Pediatric Primary Care (pp. 477-552). St.
Louis, MO: Saunders Elsevier.