Physical Address

304 North Cardinal St.
Dorchester Center, MA 02124

Sinusitis

Upper respiratory tract infections (URIs) are one of the most common medical conditions evaluated by primary practitioners who care for children. An estimated 5%–10% of URIs in early childhood are complicated by acute bacterial sinusitis (ABS). Sinusitis is a common problem in clinical practice and one of the most frequent indications for prescribing antibiotics in primary care. Pathogenesis Infections of the paranasal sinuses are a result…

Mastoiditis

Acute Mastoiditis Acute mastoiditis is exclusively a complication of acute otitis media (AOM). Previously, only one-third of cases occurred in the context of a first episode of otitis media ; over time, acute mastoiditis has been recognized more frequently as the first evidence of otitis media in at least 50% of affected children. , The incidence of mastoiditis declined remarkably after the introduction of antibiotics. Where…

Otitis Externa and Necrotizing Otitis Externa

Otitis Externa Epidemiology and Clinical Manifestations Otitis externa is an infection of the skin of the hairy and glabrous parts of the ear canal. Acute otitis externa (i.e., swimmer’s ear) is usually unilateral and is often associated with head immersion in water. Any source of prolonged ear canal moisture can cause otitis externa, including hearing aid use and drainage from otitis media with a perforated tympanic…

Otitis Media

Acute Otitis Media Acute otitis media (AOM) remains one of the most frequently diagnosed infectious diseases in early childhood. By 3 years of age, 60% of children will have experienced at least one episode of AOM, and 24% will have experienced at least 3 episodes. Although the incidence of AOM has been declining, more than 5 million cases are annually diagnosed in the US. AOM diagnoses…

Infections Related to the Upper and Middle Airways

Infections related to the upper airways comprise peritonsillar, retropharyngeal, and parapharyngeal abscesses, as well as Lemierre syndrome and epiglottitis. Infections of the middle airways include croup (laryngotracheitis), laryngitis, bacterial tracheitis, and bronchitis. These conditions share the potential for respiratory compromise and airway obstruction. Table 28.1 summarizes the typically affected age groups, common clinical features, frequently implicated organisms, and recommended treatment options. Differentiation from other airway infections…

Pharyngitis

Acute pharyngitis is one of the most common illnesses for which children and adults in the US seek medical care. There were approximately 10.4 million visits to physician offices for pharyngitis in 2016. It is estimated that a rapid antigen detection test (RADT) for group A Streptococcus was performed at 19 million office visits, and throat culture was performed at 8 million visits. There were 2.2…

The Common Cold

Acknowledgments The author wishes to highlight the dominant contribution of J. Owen Hendley to our understanding of respiratory viruses and to this chapter. The pediatric infectious diseases community recognizes our great loss with his death. The common cold, also known as the upper respiratory tract infection (URI), is an acute, self-limited viral infection of the upper airway that may also involve the lower respiratory tract. The…

Infections of the Oral Cavity

Immediately following birth, the mouth has a substantial microflora living in symbiosis with a healthy host. , Molecular methods of 16S DNA amplification reveal a tremendously diverse bacterial environment, largely uncharacterized. Odontogenic Infections Tooth Infections Caries is the most prevalent and consequential oral disease globally. In health, Streptococcus , Peptostreptococcus , and Veillonella species and diphtheroids account for more than 80% of the total recoverable flora…

Musculoskeletal Symptom Complexes

Musculoskeletal pain is a common presenting complaint in young children and adolescents. The usual cause of musculoskeletal pain is trauma or strain to joint, bone, or muscle. Often, the etiology is never determined, and symptoms resolve with symptomatic treatment. The challenge for the clinician is to rule out serious disease, including infection, as a cause of symptoms. This chapter focuses on the illnesses responsible for three…

Neurologic Syndromes

The child manifesting symptoms referable to the nervous system is challenging for the clinician and requires a thoughtful approach and evaluation. Often the presence of an infectious disease is not readily apparent. This chapter focuses on the most common presenting neurologic symptoms and features of the history and physical examination that are characteristic of infections, as well as those that distinguish infectious from noninfectious causes. Management,…

Abdominal Symptom Complexes

Acknowledgments The author acknowledges substantial use of the work of I. Kaur in the previous editions of this chapter. Approach To guide the clinical approach, abdominal pain is classified as either acute or chronic Acute abdominal pain demands rapid diagnosis and appropriate intervention so that catastrophic outcomes can be avoided. Chronic or recurrent abdominal pain is most often attributed to functional abdominal pain disorders (FAPDs) stemming…

Respiratory Tract Symptom Complexes

Mucopurulent Rhinorrhea Mucopurulent rhinorrhea (i.e., purulent nasal discharge) denotes nasal discharge that is thick, opaque, and colored. It occurs at any age and usually is a manifestation of a self-limited and uncomplicated viral upper respiratory tract infection (URI). Mucopurulent rhinorrhea is most problematic in children <3 years, due to a protracted course and frequent recurrences, especially in those in out-of-home childcare ; parental concern and misperception…

Localized Lymphadenitis, Lymphadenopathy, and Lymphangitis

Lymphadenopathy and Lymphadenitis Lymphadenopathy is defined as disease of the lymph nodes, but the term is more commonly used to denote lymph node enlargement. Enlarged lymph nodes can arise in association with a wide variety of infectious, inflammatory, or neoplastic disease processes. Lymphadenitis refers to a localized inflammatory process within a given lymph node or group of nodes, with accompanying clinical characteristics, and usually has a…

Abdominal and Retroperitoneal Lymphadenopathy

Lymphadenopathy, the abnormal enlargement of lymph nodes, can result from a wide variety of infectious and noninfectious causes. Acute enlargement of superficial lymph nodes caused by infection can occur over a period of days, accompanied by pain and tenderness to palpation, resulting in lymphadenitis. Alternatively, the enlargement of nodes can occur over weeks to months, with little tenderness, representing a more chronic inflammatory process. Abdominal and…

Mediastinal and Hilar Lymphadenopathy

Anatomy of the Mediastinum The mediastinum is the space between the pleural cavities that contains the heart and all chest viscera except the lungs. Consisting of loose areolar tissue and organs, the mediastinum is more a potential space than an actual body cavity. It is bounded laterally by the parietal pleurae, anteriorly by the sternum, posteriorly by the ribs and paravertebral gutters, superiorly by the thoracic…

Cervical Lymphadenitis and Neck Infections

Epidemiology Neck masses in children, unlike those in adults, seldom represent ominous disease. Most (95%) masses are acute, enlarged, or inflamed lymph nodes and are transient in nature. In one series, 44% of children younger than 5 years had palpable lymph nodes. Other masses are congenital cysts and sinuses, vascular malformations, salivary and thyroid anomalies, benign and malignant neoplasms, traumatic injuries, and nonlymphatic infections. Malignancy accounts…

Lymphatic System and Generalized Lymphadenopathy

Anatomy and Function of Lymphoid Tissue The lymphoid system is composed of an extensive capillary network that drains lymph into elaborate systems of collecting vessels. The collecting vessels merge and empty lymph into the bloodstream by way of the thoracic duct at its entry into the left subclavian vein or by the right lymphatic duct, which empties into the right subclavian vein. Specialized lymphatic structures interspersed…

Prolonged, Recurrent, and Periodic Fever Syndromes

Optimal evaluation of patients with prolonged, recurring, or periodic fever requires extensive review of signs and symptoms to establish the onset and cardinal features of illness, to define the exact fever pattern, and to understand the context of illness within the patient’s environment, exposures, and family history. Defining fever patterns ( Box 15.1 ) is the first essential step to prioritize the differential diagnosis and pace…

Fever Without Localizing Signs

Most young children with fever and no apparent focus of infection have self-limited viral infections that resolve without treatment and are not associated with significant sequelae. However, a small proportion of young children with fever who do not appear to be seriously ill can come to medical attention early in the course of a bacterial infection that could progress to bacteremia or meningitis. Despite numerous studies…

Mucocutaneous Symptom Complexes

Generally, in differentiating between bacterial and viral causes of febrile illnesses in children, the more mucous membranes involved in the patient’s illness (e.g., conjunctiva, throat, respiratory, gastrointestinal tract), the more likely the cause is viral. When multiple mucous membranes are involved and an exanthem (i.e., mucocutaneous complex) is present, a self-limited viral cause is likely, but other important diagnoses must be considered. These commonly include inflammatory…