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Inflammatory Enterocolitis

Acknowledgments The author acknowledges substantial use of the work of David A. Blanco and Harpreet Pall from the previous edition of this chapter. Inflammatory enterocolitis is a pathologic diagnosis characterized by ileal, colonic, and/or rectal inflammation that can range from superficial patches of leukocyte infiltration to extensive exudative ulcerations of the entire intestinal wall. Inflammatory enterocolitis should be considered in the differential diagnosis of a child…

Viral Gastroenteritis

Viral agents are the most common cause of acute gastroenteritis—a syndrome of acute vomiting and diarrhea associated with inflammation of the stomach and small and large intestines. Among children, viral gastroenteritis remains a leading cause of pediatric morbidity and mortality worldwide. Globally, an estimated 534,000 children <5 years of age died of diarrheal illness in 2017. With the discovery of both norovirus and rotavirus in the…

Approach to the Diagnosis and Management of Gastrointestinal Tract Infections

Acknowledgments The authors acknowledge the contributions of L. K. Pickering to previous editions. Most infections of the gastrointestinal tract manifest as diarrhea , a clinical syndrome of diverse origin associated with frequent loose or watery stools often accompanied by emesis, fever, abdominal bloating or pain, and occasional extraintestinal manifestations. Infectious diarrhea can have a bacterial, viral, or parasitic origin ( Table 55.1 ), and most cases…

Infectious Diseases Associated With Child Abuse

Sexual abuse is the persuasion or coercion of a child to engage in sexually explicit conduct. In 2018, sexual abuse accounted for 7% of the 677,529 children in the US found to be either abused or neglected. It is estimated that the lifetime prevalence of sexual abuse and sexual assault may be as high as 26.6% and 5.1% for 17-year-old females and males, respectively. Most perpetrators…

Epididymitis, Orchitis, and Prostatitis

Epididymitis Epididymitis, an inflammatory reaction of the epididymis to infectious or noninfectious stimuli, occurs across a wide age range in pediatric patients and may present in combination with testicular inflammation (epididymo-orchitis). Predisposing factors, clinical presentation, and etiologies differ by age and exposure history, and careful physical examination, laboratory testing, and imaging studies may be required to differentiate epididymitis or epididymo-orchitis from testicular torsion. Epidemiology The reported…

Pelvic Inflammatory Disease

Pelvic inflammatory disease (PID) is a clinical syndrome characterized by the ascension of microorganisms through the female genitourinary tract system. Historically PID has been linked to sexually transmitted disease (STD) pathogens Chlamydia trachomatis or Neisseria gonorrhoeae , but other organisms also have been implicated. Presenting symptoms are diverse, often vary in severity, and include a wide range of clinical manifestations. PID is one of the most…

Urethritis, Vulvovaginitis, and Cervicitis

Clinicians will encounter urethritis in adolescent and young adult (AYA) men and women as well as other lower genital tract syndromes in females, including vulvovaginitis and cervicitis. Although there are multiple etiologies, these syndromes are commonly caused by sexually transmitted pathogens and occur in AYA because one-half of all newly acquired sexually transmitted infections (STIs) occur in the 15–24 age group. This chapter is focused on…

Genitourinary Skin and Mucous Membrane Infections and Inguinal Lymphadenopathy

In children and adolescents, inguinal lymphadenopathy often occurs as part of generalized lymphadenopathy caused by systemic disease. In contrast, isolated inguinal lymphadenopathy commonly results from localized infections of the groin, buttocks, lower abdominal wall, or lower extremities. Firm or fixed nodes should always raise suspicion for malignancy. Inguinal Lymphadenopathy with Genital Ulcers Genital ulcer disease (GUD) frequently manifests as unilateral or bilateral inguinal lymphadenopathy, even when…

Sexually Transmitted Infection Syndromes

According to the Centers for Disease Control and Prevention (CDC), while youth age 15–24 account for only one-quarter of the sexually active population in the US, they are responsible for nearly half of the 20 million new sexually transmitted infections (STIs) that occur each year. In 2018, 61.8% of all reported chlamydia cases in the US were in persons age 15–24, and 21% of all new…

Urinary Tract Infections, Renal Abscess, and Other Complex Renal Infections

Infections of the genitourinary tract in children remain a significant health concern, accounting for 52–56 hospitalizations per 100,000 children with the majority of these children <2 years old, and more than 1.1 million US physician visits annually. Of all infectious agents, bacteria are the most common cause of urinary tract infection (UTI). In infants, UTI is a common cause of fever and may result in renal…

Eosinophilic Meningitis

The finding of even some eosinophils in human cerebrospinal fluid (CSF) raises the suspicion of certain pathologic states. Helminthic infestation of the central nervous system (CNS), particularly with the rat lungworm Angiostrongylus cantonensis, is the most common cause of eosinophilic meningitis worldwide. However, the differential diagnosis of CSF eosinophilia is broad and includes infestation by other parasites ; reaction to placement, malfunction or infection of a…

Focal Suppurative Infections of the Nervous System

Despite diverse causes of focal suppurative nervous system infections, a few mostly gram-positive bacterial species predominate, usually related to the infectious portal. Risk factors include cyanotic congenital heart disease (CCHD), hematogenous spread from distant infected sites, penetrating trauma/instrumentation, or contiguous site infection (sinus, middle ear, or mastoid). Oto-rhinosinusitis-related intracranial site frequencies include subdural empyema (49%), epidural abscess (36%), cerebral abscess (21%), and meningitis (10%). Invasive fungal…

Parainfectious and Postinfectious Neurologic Syndromes

Inflammation of the central or peripheral nervous system can produce a myriad of symptoms depending on the site of injury. The inflammation often arises during, or in response to, an infection. However, the same syndrome can be seen when there have been no signs of a preceding infection or, occasionally, can develop after vaccination. The presentation can be localized to one structure (e.g., facial nerve palsy…

Encephalitis

Encephalitis is inflammation of the brain parenchyma. Typical signs and symptoms include fever, headache, and altered mental status. Patients often will have associated meningeal inflammation (i.e., meningoencephalitis ) . For the purposes of this chapter, the terms encephalitis and meningoencephalitis are used interchangeably. Encephalopathy is a general term implying any disorder of the brain, including central nervous system (CNS) dysfunction triggered by an infection but not…

Aseptic and Viral Meningitis

The term acute aseptic meningitis (AM) was introduced in 1925 to describe a self-limited central nervous system (CNS) syndrome characterized by acute onset of fever and meningeal irritation in which the cerebrospinal fluid (CSF) exhibited a mononuclear pleocytosis and was bacteriologically sterile. With advances in diagnostic methodologies it is now recognized that multiple infectious agents, drugs, and localized and systemic inflammatory conditions can cause AM syndrome…

Recurrent Meningitis

Recurrent meningitis typically is defined as two or more separate episodes of meningitis and associated cerebrospinal fluid (CSF) pleocytosis that occur weeks to months apart with full recovery between events. In contrast, recrudescence or relapsed meningitis represents the persistence of the original infection due to treatment failure. Recurrent meningitis is uncommon. Bacterial infection is the most common cause of recurrent meningitis, although recurrent episodes can be…

Chronic Meningitis

Chronic meningitis is defined arbitrarily as persistent or progressive signs and symptoms of meningeal irritation plus cerebrospinal fluid (CSF) pleocytosis lasting for at least 4 weeks without improvement. The symptoms of chronic meningitis vary, but most patients have a gradual onset of fever, headache, and vomiting. The 4-week timeframe is intended to avoid extensive evaluation for individuals with self-limited processes (e.g., acute or subacute meningoencephalitis, resolving…

Acute Bacterial Meningitis Beyond the Neonatal Period

Etiologic Agents and Epidemiology Haemophilus influenzae type b and Streptococcus pneumoniae In otherwise healthy children, the three most common organisms causing hematogenously acquired acute bacterial meningitis worldwide are Streptococcus pneumoniae, Neisseria meningitidis, and Haemophilus influenzae type b (Hib). Previously, Hib accounted for up to 48% of all bacterial meningitis cases in the US ; however, the introduction of the Hib conjugate vaccination program led to a…

Pericarditis

Pericarditis is inflammation of the pericardium and proximal great vessels. The etiologies of pericarditis are diverse and include infectious and noninfectious causes. Pericarditis may be acute, subacute, chronic, or recurrent in presentation. It may be the sole manifestation of a disease or part of a multisystem disorder. Pericarditis can manifest as cardiac tamponade with a fulminant, life-threatening process, as constrictive pericarditis from chronic disease, or as…

Endocarditis and Other Intravascular Infections

Acknowledgements The authors acknowledge substantial use of material from this chapter in the last edition. The American Heart Association (AHA) and the European Society of Cardiology, as well as other national societies, provide updated scientific statements on many of the topics discussed in this chapter. Readers are encouraged to review these consensus statements and seek updated documents. Infective Endocarditis Infective endocarditis is an uncommon infection of…