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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…

Infection Related To Bites

In the United States, it is estimated that 5 million bites occur every year, 90% of which are dog bites. Dog bites alone result in approximately 335,000 emergency department visits (42% among children <14 years of age), 13,000 hospitalizations, and 20 deaths annually (mostly children). Dogs, cats, and humans account for >90% of non−insect-related bite injuries, with rabbits and rodents responsible for most of the remainder.…

Infections Related to Burns

In 2019, unintentional injury was the leading cause of death in children aged 1–18 years of age in the US, accounting for approximately one-third of all deaths. Of these deaths, burns were the seventh leading cause in children <1 year, the fifth leading cause in children 1–4 years of age, and the third leading cause in children 5–9 years old. Overall, the population incidence of nonfatal…

Infection Related To Trauma

Acknowledgments The author acknowledges substantial use of material from this chapter in the previous edition. Trauma is a major cause of pediatric morbidity and mortality, and a significant contributor to this disease burden is secondary infection. The etiologies of trauma-related infection tend to be bacterial, introduced into an injury either from sources already present in the host (e.g., the skin, or sinuses in a basilar skull…

Preseptal and Orbital Infections

The practitioner frequently has the opportunity to manage the child for whom the chief complaint is a “swollen eye” ( Fig. 84.1 ). Some children have trivial or self-limited disorders, but others can have sight- or life-threatening problems. Noninfectious causes of the swollen eye can often be distinguished from infectious causes by a detailed history of the onset and progression of the eye swelling. Infectious causes…

Endophthalmitis

The term endophthalmitis is applied to bacterial or fungal infection involving intraocular tissues (retina, uveal tract, or lens) or fluids (vitreous or aqueous). Two broad categories of infectious endophthalmitis are distinguished. Exogenous infection results from introduction of organisms into the eye through a surgical or traumatic penetrating wound; endogenous (or metastatic) infection is caused by organisms that enter the eye through the bloodstream. Both categories of…

Infective Uveitis, Retinitis, and Chorioretinitis

Uveitis refers to any intraocular inflammation. Anterior uveitis is characterized by inflammation of the iris and ciliary body (iridocyclitis). Intermediate uveitis includes inflammation of the pars plana and vitreous (pars planitis, vitritis). Posterior uveitis features inflammation of the retina and choroid (retinitis, choroiditis). Uveitis is an uncommon disorder in childhood; among affected children, the anterior form is more common than the posterior form. Table 82.1 summarizes…

Infective Keratitis

Infective keratitis is an uncommon but important infection because it has the potential to cause blindness. It can be caused by a wide variety of microorganisms. Most children with corneal infections come to medical attention because of a painful red eye. Distinguishing infectious keratitis from other causes of red eye accurately and promptly is extremely important. Etiology Herpes Simplex Virus Keratoconjunctivitis caused by herpes simplex virus…

Conjunctivitis Beyond the Neonatal Period

Acknowledgment The author acknowledges substantial use of material from previous editions by Avery Weiss. Conjunctivitis is the most common infectious disease of the eye in childhood. It is useful to separate conjunctivitis into acute infection (abrupt onset, lasting less than 10–14 days) and chronic infection (insidious onset, often persisting for several weeks, months, or even years). Most cases of acute conjunctivitis are self-limited and can be…

Conjunctivitis in the Neonatal Period (Ophthalmia neonatorum)

Ophthalmia neonatorum is defined as conjunctivitis occurring within the first month of life. It is the most common eye disease of neonates, with an incidence ranging 1.6%–12%. Incidence is directly related to the prevalence of sexually transmitted infections (STIs) in adults. One hundred years ago, Neisseria gonorrhoeae was the most common pathogen and a major cause of blindness among children. With the advent of Credé prophylaxis…

Transient Synovitis

Acknowledgments The authors acknowledge the contribution of K. Gutierrez to this chapter in prior editions. Transient synovitis (TS) is a self-limited inflammation of the synovium, usually of the hip joint. TS is a common cause of acute onset of limping in childhood. Synonyms for this condition include toxic synovitis, observation hip, irritable hip, and benign aseptic arthritis. Etiology And Epidemiology The cause of TS is unknown.…