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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)…

Superficial Bacterial Skin Infections and Cellulitis

The skin has a primary protective function, providing a permeability barrier that prevents the loss of water and electrolytes and protects against the invasion of pathogens. Intact skin is resistant to colonization and invasion of bacteria by several mechanisms. The outermost layer of the epidermis, the stratum corneum, constitutes the principal barrier against infection. The stratum corneum consists of corneocytes (i.e., anucleated keratinocytes or skin cells)…

Intra-abdominal, Visceral, and Retroperitoneal Abscesses

Acknowledgments The authors acknowledge substantial use of material from this chapter in the previous edition. Abdominal abscesses in children can be difficult to diagnose and treat. Even when managed appropriately, morbidity still can be high. Abdominal abscesses are categorized as intra-abdominal (i.e., intraperitoneal), visceral, and retroperitoneal. Intra-abdominal abscesses are the most common type. Abscesses form when bacteria from an original site of colonization or infection are…

Appendicitis

Acknowledgments The authors acknowledge Marion C. W. Henry and R. Lawrence Moss, who contributed this topic to the previous edition. Appendicitis is the most common reason for emergent abdominal surgery in children. Although this disease is no longer responsible for significant mortality, the morbidity surrounding appendicitis, in particular perforated appendicitis, can be substantial. Efforts to decrease morbidity have focused on improving diagnostic strategies, optimizing management, and…

Peritonitis

Acknowledgments We would like to acknowledge Drs. Shawn J. Rangel, Samuel E. Rice-Townsend, Mahima Karki, and R. Lawrence Moss, authors of this chapter in the previous edition. Peritonitis is an inflammatory process involving the peritoneum, a specialized lining of the abdominal cavity that lubricates the abdominal organs and clears the cavity of infectious particles and other debris. Infectious peritonitis classically has been described as primary or…

Cholecystitis and Cholangitis

Acknowledgements Substantial material for this chapter is taken with permission from the chapter of the same name and topic by Dr. Beverly Connelly in the previous edition. Cholecystitis and cholangitis refer to inflammation of the gallbladder and extrahepatic bile ducts, respectively. Both occur more commonly in adults than in children, but the incidence in children appears to have increased in recent years, possibly due to increased…

Acute Pancreatitis

Acknowledgements Substantial material for this chapter is taken from the chapter of the same name and topic by Dr. Beverly Connelly in the previous edition. The incidence of acute pancreatitis (AP) in children has been rising over recent decades. Admissions for AP have increased as have costs associated with it management. The cause of this increase is not clear and may be due to increased awareness…

Granulomatous Hepatitis

Acknowledgements Substantial material for this chapter is taken from the chapter of the same name and topic by Dr. Beverly Connelly in the previous edition. Histologically, evident granulomas in the liver are referred to as granulomatous hepatitis . Granulomas are reported in 2%–15% of liver biopsy specimens from adults and 4%–7% of specimens from children. , Granulomas are most often a manifestation of an underlying systemic…

Chronic Hepatitis

Chronic hepatitis is a clinical and pathologic syndrome associated with a wide variety of diseases and conditions ( Table 60.1 ). , Chronic hepatitis typically is defined as ongoing injury with inflammation lasting ≥6 months. However, the impact of inflammation can vary greatly, so a combination of clinical, laboratory, and histologic findings is sought that can establish the diagnosis sooner and enable earlier treatment. TABLE 60.1…

Acute Hepatitis

Acute hepatic inflammation in children can have many infectious and noninfectious causes ( Table 59.1 ). Acute liver injury of various causes results in a limited number of clinical manifestations and findings. This chapter covers the evaluation and diagnosis of acute liver injury in immunocompetent children. The pathogenesis of many infectious causes is covered more fully in pathogen-specific chapters. TABLE 59.1 Age at Onset of Infectious…

Enteric Diseases Transmitted Through Food, Water, and Zoonotic Exposures

More than 200 known pathogens and noninfectious agents can be transmitted through ingestion of food or water contaminated with viruses, bacteria, parasites, toxins, metals, chemicals, or prions, or through contact with animals or their environments. Enteric disease is one of the most common illness types resulting from foodborne, waterborne, or zoonotic transmission. Symptoms of enteric illness range from mild gastroenteritis to life-threatening sepsis and neurologic, hepatic,…