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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…

Hemophagocytic Lymphohistiocytosis and Macrophage Activation Syndrome

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…

The Systemic Inflammatory Response Syndrome, Sepsis, and Septic Shock

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 and the Inflammatory Response

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…

Immunologic Development and Susceptibility to Infection

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.…

Protection of Travelers

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…

Antimicrobial Chemoprophylaxis

Chemoprophylaxis is prevention of disease by administration of an anti-infective drug product. An antimicrobial product is given to an individual who is at risk of developing an infection following exposure to bacteria, viruses, fungi, mycobacteria, or parasites. The term “prophylaxis” as used in this chapter does not apply to those situations in which infection is already established; however, for some children who already are infected but…

Active Immunization

Immunization and Vaccines: Overview Immunization is the process of artificially inducing immunity or providing protection from disease. Active immunization is the process of stimulating the body to produce antibody and other immune responses (e.g., cell-mediated immunity) through administration of a vaccine or toxoid. Passive immunization is provision of temporary immunity via administration of preformed antibodies derived from humans or animals (see Chapter 5 ). Vaccines are…

Passive Immunization

Immunoglobulin therapy plays an increasingly important role in the treatment of a variety of medical conditions, not only to prevent or ameliorate infection but also because of antiinflammatory and immunomodulating effects. Passive immunization provides exogenous, preformed antibodies that can prevent or treat certain infectious diseases. In the early 20th century, hyperimmune animal sera were produced to treat specific infections. After human plasma fractionation was developed (during…

Infectious Diseases in Refugee and Internationally Adopted Children

In this chapter, the infectious disease issues of 2 groups of immigrants are discussed: refugees and internationally adopted children. Refugees are noncitizen immigrants who are unable or unwilling to return to their country of origin because of persecution or a fear of persecution. Internationally adopted children are immigrants who are classified as orphans; most however are not truly orphaned but have been abandoned by or separated…

Infections Associated With Group Childcare

On average, 12.5 million (61%) of the 20.4 million children in the United States who are younger than 5 years of age were enrolled in a regular childcare arrangement during the spring of 2011. Children in group childcare experience increased frequency of certain infectious diseases and amplify outbreaks of illness ( Table 3.1 ). Aggregation of young children potentiates transmission of organisms that can produce disease…

Pediatric Healthcare: Infection Epidemiology, Prevention and Control, and Antimicrobial Stewardship

Pediatric healthcare epidemiology is the study and analysis of the distribution (who, when, where) of patterns and determinants of health and disease conditions in healthcare settings where children receive healthcare or gather in locations where disease conditions could be present. Prevention of healthcare-associated infections (HAIs) is the major goal and is an important component of quality and patient safety programs. Healthcare epidemiologists must be ready to…

Principles of Epidemiology and Public Health

Epidemiology is the study of the distribution and determinants of disease or other health-related states or events in specified populations and the application of this study to the control of health problems. A key component of this definition is that epidemiology focuses on populations, an emphasis that distinguishes epidemiology from clinical case studies, which focus on individual subjects. Health events can be characterized by their distribution…

Websites and Applications for Mobile Devices With Information About Immunization

CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC) WEBSITES National Center for Immunization and Respiratory Diseases (NCIRD) www.cdc.gov/vaccines NCIRD is an interdisciplinary immunization program that brings together vaccine-preventable disease science and research with immunization program activities. Its website provides information about vaccine-preventable diseases, the benefits and risks of immunization, vaccine licensures, Advisory Committee on Immunization Practices (ACIP) recommendations, Vaccine Information Statements (VISs), and vaccine supply issues, as…

Vaccines to Prevent Mpox

INTRODUCTION Mpox (formerly monkeypox) is a disease caused by infection with the Monkeypox virus (MPXV), a zoonotic orthopoxvirus (OPXV) in the same genus as Variola virus (which causes smallpox). There are two distinct genetic clades, Clade I (formerly Congo Basin Clade) and Clade II (formerly West African Clade); historically, Clade I was believed to cause more severe disease and be more transmissible. The virus was first…

Ethics

The global effort to develop and deliver vaccines against COVID-19 has brought unprecedented attention and scrutiny to all aspects of vaccines and vaccination efforts, including the many ethical issues they raise. During public health emergencies and ongoing disease prevention efforts alike, vaccines present a spectrum of novel ethical considerations compared with those associated with other medical interventions. Central to these differences are the role of vaccines…

Legal Issues

This chapter reviews liability for vaccine injuries historically; the rationale, development, and implementation of the National Vaccine Injury Compensation Program (VICP); the VICP’s current status; and the CDC COVID-19 Vaccination Program; international vaccine compensation programs; and the power to compel vaccination in the United States. The first part of the chapter discusses the development of the law in the United States until 1986, the year of…