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…
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…
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 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…
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,…
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…
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…
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…
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…
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…
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…
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…
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…
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…
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…
Hemophagocytic lymphohistiocytosis (HLH) is a hyperinflammatory syndrome characterized by the accumulation of activated T lymphocytes and well-differentiated macrophages (histiocytes) in the bone marrow, lymph nodes, liver, spleen, and, often, the central nervous system (CNS). , HLH is a rare disease with estimates of prevalence of approximately 1 in 100,000. The prevalence may be substantially higher in populations in which there is an increased consanguinity resulting in…
Epidemiology Sepsis remains a major cause of morbidity and mortality among children across the globe. In the US, the estimated incidence annually is 1 case per 1000 persons, an increase compared with prior years. , , Sepsis now accounts for 4.4% of children’s hospital admissions and 7% of patients treated in US PICUs. , Global estimates for sepsis are limited; however, the Sepsis Prevalence, Outcomes, and…
Fever Fever is defined as a centrally mediated rise of body temperature above normal daily variation in response to various stimuli. , The classic definition for fever includes a rectal temperature ≥38°C (100.4°F). An excess of the body temperature above ≥41°C (106°F) is called hyperpyrexia , while hyperthermia refers to the uncontrolled increase in the body temperature that exceeds the body’s ability to lose heat. The…
The human immune system has evolved to protect an individual from infectious microbes. It does this by using a complex interactive network of cells, proteins, and organs. Rapidly expanding research of inborn errors of immunity has taught us that despite the apparent redundancy of the system, quantitative and qualitative defects of individual components or pathways, or both, result in abnormal function and susceptibility to particular infections.…
More than 1.4 billion people travel internationally each year, approximately 10% of whom are children. Although travel can expose children to some risks, the benefits are many. A careful pretravel evaluation to provide appropriate guidance and preparation is critical to protect pediatric travelers and their families and allow them to enjoy their time abroad. The COVID-19 pandemic has altered both domestic and international travel and, in…