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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.…

Diskitis

Diskitis is an inflammatory process involving the intervertebral disks and the end plates of the vertebral bodies. It is associated with characteristic clinical and radiologic findings, but information about diskitis is derived primarily from case reports and retrospective studies of small numbers of patients. Diskitis has been reported under a variety of other names, including spondylodiskitis, pyogenic infectious spondylitis, spondylarthritis, acute osteitis of the spine, intervertebral…

Infectious and Inflammatory Arthritis

Infectious arthritis in children can be caused by bacteria, viruses, or fungi. Pyogenic arthritis is characterized by a purulent inflammatory response, usually caused by a bacterial infection. Reactive (inflammatory) arthritis is inflammation of one or more joints that can result from a response to infection elsewhere in the body or from a systemic inflammatory or autoimmune disorder. Infectious Arthritis Bacterial (Pyogenic) Arthritis Epidemiology The incidence of…

Osteomyelitis

Osteomyelitis is inflammation of bone. It is usually caused by bacteria but occasionally by fungi. Osteomyelitis in children has a mainly hematogenous origin; less commonly, it occurs as a result of trauma, surgery, or spread from infected contiguous soft tissue. Osteomyelitis due to vascular insufficiency is rare in children. Acute Hematogenous Osteomyelitis Pathogenesis Acute hematogenous osteomyelitis (AHO) is primarily a disease of young children, presumably because…

Myositis, Pyomyositis, and Necrotizing Fasciitis

Skin and soft tissue infections (SSTIs) are common in children. They usually are recognized easily and treated with few residual long-term problems. However, myositis, pyomyositis, and necrotizing fasciitis are soft tissue infections that can be difficult to diagnose in their early stages, and despite appropriate antibiotic therapy, they can be associated with substantial morbidity and mortality. The epidemiology of SSTIs is evolving, and the incidence among…

Subcutaneous Tissue Infections and Abscesses

Acknowledgment The author acknowledges the use of substantial material from this chapter in the previous edition. Infection of soft tissues can involve the skin, subcutaneous tissues, fascia, and skeletal muscle or a combination of these structures. The subcutaneous compartment is continuous over the entire body and consists of fat and loose connective tissue containing blood and lymphatic vessels underlying the dermis. The fascia is subdivided into…

Urticaria and Erythema Multiforme

Urticaria and erythema multiforme (EM) are common cutaneous hypersensitivity reactions seen in children. They can be triggered by infection, although noninfectious causes also are prevalent. Although distinctly different entities, acute urticaria often is misdiagnosed as EM. Although urticaria usually is an isolated finding, urticaria and urticarial dermatoses can be seen in several syndromes and disorders such as papular urticaria, urticarial vasculitis, and the cryopyrin-associated periodic syndromes…

Purpura

Purpura is a significant finding, especially because it has been associated with multiple infectious causes, some of which are life-threatening. Purpura results from trauma to blood vessels in the skin, causing hemorrhage into the surrounding tissue. Purpuric lesions do not blanch with pressure. Vessel damage can be the result of direct trauma, endothelial infection (e.g., rickettsial infection, meningococcemia), vessel occlusion, immune complex deposition, platelet depletion or…

Vesicles and Bullae

Vesicles and bullae (i.e., blisters) result from a disturbance of epidermal or basement membrane connections, creating spaces that allow fluid collection. Blisters can be caused directly by bacterial, viral, and fungal infections or a reactive phenomenon to an infection. Diagnosis of vesiculobullous eruptions must be made promptly because, although some conditions are benign, others are rapidly progressive and rarely life threatening. The skin consists of epidermis,…

Erythematous Macules and Papules

Approach Differentiating rashes due to infection from other common cutaneous eruptions, particularly adverse drug eruptions, can be difficult. Recognizing the differences in presentation and using proper terminology for erythematous exanthems are the initial steps. The commonly used (and often overused) term maculopapular describes a rash that has components of both macules (discolored spots or patches of various shapes and sizes that are neither raised nor depressed)…