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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…

Myocarditis

Myocarditis is an inflammatory disease of the heart muscle that may progress to dilated cardiomyopathy. The condition can manifest with a range of clinical presentations from nonspecific systemic symptoms to fulminant heart failure or sudden death. There is continued debate regarding the appropriate diagnosis, classification, and management of myocarditis. , Etiology Myocarditis can have a variety of infectious and noninfectious etiologies. For most cases in routine…

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…

Pneumonia in the Immunocompromised Host

Pneumonia is a common disease in children with both primary immunodeficiencies and secondary immunodeficiencies, such as cancer chemotherapy, transplantation, treatment of autoinflammatory diseases, human immunodeficiency virus, and malnutrition. Pneumonia and other infections of the respiratory tract have been identified by the Jeffrey Modell Foundation as one of the 10 warning signs of primary immunodeficiency. The broad array of pathogens and clinical presentations make pneumonia in this…

Persistent and Recurrent Pneumonia

Persistent pneumonia has been defined as continuation of symptoms and radiographic findings beyond 4 weeks given that most acute pneumonia improves clinically and radiographically within that time. Persistent or residual abnormalities occur in 10%–30% of children with radiographically confirmed community-acquired pneumonia (CAP) 3–7 weeks after initial imaging. , In adults with CAP, clinical resolution occurs in more than 85% of cases and radiographic resolution in 67%…

Acute Pneumonia and Its Complications

Acknowledgment The authors acknowledge previous contributions of Dennis Murray and Chitra Mani to this chapter. Pneumonia , a Greek word meaning “inflammation of the lungs,” is the most common cause of morbidity and mortality in infants and children due to infection worldwide. Acute Pneumonia Pneumonia is a lower respiratory tract disease usually caused by an infectious agent resulting in inflammation of the tissues of one or…

Bronchiolitis

Bronchiolitis is a syndrome of inflammation and obstruction of the lower respiratory tract that usually is caused by a viral infection. A young child with bronchiolitis typically comes to medical attention during the winter months after 2–4 days of low-grade fever, nasal congestion, and rhinorrhea with symptoms of lower respiratory tract illness that may include cough, tachypnea, and increased respiratory effort as manifested by grunting, nasal…

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…