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Infections Related to Biologic Response Modifying Drug Therapy

Biologic response modifying drugs (BRMs) are substances that interact with the host immune system and modify it. BRMs include cytokines, chemokines, and antibodies that occur naturally in the body to protect against infections. Synthetic BRMs generally target or mimic natural cytokines or inhibitors—including tumor necrosis factor (TNF), interleukins (IL) 6, 12, and 23, and the receptors for IL 1 alpha (IL1α) and IL 1 beta (IL1β)—and…

Infectious Complications in Special Hosts

Acknowledgment The authors recognize previous contributions of Janet A. Englund and Jane L. Burns to this chapter. Sickle Hemoglobinopathy The decrease in splenic function in children with hemoglobin SS (Hb SS) disease results in increased susceptibility to fulminant bacterial infection, especially in early childhood. Since the recognition in the 1970s that rates of septicemia and meningitis due to Streptococcus pneumoniae were excessive in patients with sickle…

Infectious Complications of Cell-Mediated Immunity Other Than AIDS: Primary Immunodeficiencies

This chapter focuses on the infectious complications of primary immunodeficiencies in which lymphocyte-mediated or innate cellular immunity mediated by interferons (IFNs) is compromised. Genetic disorders of cell-mediated immunity that are mainly associated with hemophagocytic lymphohistiocytosis syndrome are discussed in Chapter 12 . Acquired autoantibody syndromes that result in infectious complications that mimic inherited immunodeficiencies are included, whereas inherited immunodeficiencies that mainly result in an autoimmune diathesis…

Infectious Complications of Dysfunction or Deficiency of Polymorphonuclear and Mononuclear Phagocytes

Acknowledgement Substantial material from E. Stephen Buescher’s chapter in Principles and Practice of Pediatric Infectious Diseases , fifth edition, has been used. Phagocytes perform critical roles in human host defense. Polymorphonuclear phagocytes (neutrophils, eosinophils, and basophils) defend against microbial invasion and contribute to various aspects of the inflammatory response. Mononuclear phagocytes (monocytes and macrophages) perform similar complementary functions in defense and cognate immunity. Despite their rarity,…

Infectious Complications of Complement Deficiency and Diseases of Its Dysregulation

Acknowledgement Substantial material from Dr. Michael Frank’s chapter in Principles and Practice of Pediatric Infectious Diseases, fifth edition, has been used and he is therefore granted appropriate authorship. Dr. Frank was a giant in the field of complement and a beloved mentor and scientist who sadly passed away in the summer of 2019. The collective term complement refers to a large group of plasma- and cell…

Infectious Complications of Antibody Deficiency

Primary antibody deficiencies are the most common inherited immunodeficiencies. Secondary antibody deficiencies are also increasingly common complications of some chronic diseases and pharmacotherapy. Antibody deficiency disorders are characterized by reduced or absent serum immunoglobulins, recurrent and severe infections caused by certain bacteria and viruses, and, in some cases, autoimmunity and an increased predisposition to cancer. Immunoglobulin (Ig) molecules consist of two identical light chains and two…

Evaluation of the Child With Suspected Immunodeficiency

Acknowledgment Substantial material from E. Stephen Buescher’s chapter in the previous edition has been used. Although primary immunodeficiency disorders are uncommon, referral for evaluation of these conditions in children with frequent infections is common. Epidemiologic studies show that children aged <2 years have an average of 5–6 acute respiratory tract illnesses per year, with a range up of to 11 or 12 per year. , Infections…

Clinical Syndromes of Device-Associated Infections

Acknowledgments The authors acknowledge substantial use of material from this chapter in the previous edition. The use of medical devices has increased dramatically over recent decades, with significant impact on the quality and duration of life in affected patients. In children, the most common temporary and permanent device infections involve intravascular catheters; cardiac devices, such as prosthetic valves, patches, vascular grafts, pacemakers, and ventricular assist devices;…

Healthcare-Associated Infections

A healthcare-associated infection (HAI) is defined as any infection not present or incubating at the time of the patient’s initial contact with a healthcare setting. Originally termed nosocomial, hospital-acquired, or hospital-onset infections, the scope of HAI has expanded as patients now receive medical care in a wide variety of healthcare settings. Many HAIs are preventable and thus should be targeted for aggressive infection prevention programs (see…

Clinical Syndromes of Infection in Children With Cancer

Approximately 20%–30% of pediatric cancer patients with fever and neutropenia have a clinically or microbiologically proven site of infection. Table 98.1 summarizes documented infections identified in three large clinical trials of empirical antibiotic therapy administered to patients admitted to the National Cancer Institute for fever during episodes of neutropenia. TABLE 98.1 Documented Sites of Infection in Patients With Cancer, Fever, and Neutropenia Site or Type of…

Risk Factors and Infectious Agents in Children With Cancer: Fever and Granulocytopenia

Infection remains a major cause of morbidity in children with cancer. Fever and neutropenia are among the most common complications of cancer therapy in children. The use of empiric antimicrobial regimens in this patient population began with the observation that febrile, neutropenic patients with cancer who had potentially fatal infections could not be distinguished from those who had less serious or noninfectious illnesses and has since…

Infections in Hematopoietic Cell Transplant Recipients

Hematopoietic stem cell transplantation (HCT) has broad indications in pediatrics, including treatment of cancer, primary immunodeficiency syndromes, bone marrow failure syndromes, hemoglobinopathies, and an assortment of genetic conditions, including inborn errors of metabolism and nonmalignant conditions such as osteopetrosis. Patients undergoing HCT have increased risks for infections that are somewhat predictable based on the acquired immune deficiencies that occur after HCT. Etiologic Agents Patients who have…

Infections in Solid Organ Transplant Recipients

Solid-organ transplantation (SOT) is an accepted therapy for end-stage disease of many organs. As transplants are increasingly common, an expanding number of immunosuppressed children are at risk for developing infection after transplantation. This chapter will help establish a framework regarding the approach to this patient population. Predisposition To Infection Factors predisposing to infection after SOT can be divided into those that exist before transplant and those…

Healthcare-Associated Infections in the Neonate

Acknowledgements The authors would like to acknowledge Laura Sass and M. Gary Karlowicz for their extensive work on the previous edition of this chapter. Healthcare-associated infections (HAIs) represent a major cause of morbidity and mortality for infants cared for in the neonatal intensive care unit (NICU). Improved obstetric and neonatal care delivery and a focus on effective infection prevention strategies have reduced HAIs, but improved survival…

Viral Infections in the Fetus and Neonate

Neonates, like older children and adults, are subject to viral infections acquired by horizontal routes, such as those due to influenza, rotavirus, and enteroviruses. In addition, mother-to-child transmission (MTCT) is a unique route for vertical spread of viruses in the in-utero and perinatal periods (transplacentally, during birth, or postnatally from breast milk). The ability of cytomegalovirus (CMV), herpes simplex virus (HSV), human immunodeficiency virus (HIV), and…

Bacterial Infections in the Neonate

Description of Pathogens Neonatal sepsis accounts globally for approximately 3 million cases annually with a mortality of between 11% and 19%. These figures are derived from several high-income and a few low-income countries, thus, the true impact is significantly higher. The mortality rate in resource-rich countries also is substantial, estimated at 5%–10%. Neonatal sepsis is characterized by systemic signs and bloodstream infections (BSIs) occurring in the…

Clinical Approach to the Neonate With Suspected Infection

Historically, infection has been a major contributor to neonatal morbidity and mortality. Progress in disease prevention in recent decades has reduced the burden of bacterial infection to the third-most common cause of neonatal death world wide and fifth most common in the United States, but the world-wide burden of neonatal sepsis is still estimated at 3 million cases per year, with a mortality rate of 11%–19%.…

Tickborne Infections

Ticks are obligate blood-sucking arthropods that transmit a variety of pathogenic organisms, including bacteria, viruses, and protozoa. Along with mites, ticks are arachnids of the subclass Acari. They comprise more than 800 species in two major families within the suborder Ixodida. Hard-bodied ticks (family Ixodidae) are distinguished from soft-bodied ticks (family Argasidae) by the presence of a dorsal sclerotized plate or scutum. A third family, the…

Infections Related to Pets and Exotic Animals

Contact with animals can provide significant educational and emotional benefits for children and adults. However, exposure to pets in the home and animals in public settings poses potential risks to children, including allergies, injuries and transmission of pathogenic organisms. Risks can be minimized or prevented by knowledge and use of educational materials, regulations, and guidelines developed for this purpose. , Pediatricians, other healthcare personnel (HCPs), and…