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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,…

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…