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Hepatitis B Infection

Abstract Hepatitis B infection is one of the most common global health problems. Persons with acute hepatitis B infection can be asymptomatic or present with hepatitis with or without jaundice. Most acute infections resolve without sequelae; however, progression to chronic infection may occur and the risk is inversely related to age at the time of acquisition of infection. This progression to chronic hepatitis B infection may…

Hepatitis A Infection and Prevention

Abstract Hepatitis A infection is the most common cause of viral hepatitis worldwide and a commonly reported vaccine-preventable disease in the United States. Clinical illness—characterized by fever, malaise, jaundice, and nausea—caused by hepatitis A virus (HAV) is similar to hepatitis caused by other viral pathogens. Although most cases of hepatitis A are self-limited, fulminant hepatitis resulting in death may occur. Widespread routine childhood vaccination against hepatitis…

Varicella-Zoster Virus Infections

Abstract Varicella-zoster virus (VZV) causes primary varicella, a common childhood illness called chickenpox. This virus establishes latency and may reactivate later in life, causing herpes zoster, which is commonly called shingles or simply zoster. Although both chickenpox and zoster usually resolve without event, significant complications may develop, even in healthy individuals. In the United States, widespread use of a VZV vaccine in children has diminished the…

Rubella

Acknowledgment The authors acknowledge Alison Margaret Kesson for her contributions as author of a prior version of this chapter. Abstract Rubella (German measles), a leading cause of vaccine-preventable birth defects, is an acute viral infection that can affect people of all ages. When acquired postnatally, rubella is most often characterized by a generalized maculopapular rash, fever, and lymphadenopathy resembling a mild case of measles (rubeola). Many…

Mumps

Acknowledgment The authors acknowledge the work of Alison Margaret Kesson on the previous edition chapter. Abstract Mumps is an acute, highly contagious systemic viral infection and the leading cause of parotitis worldwide. The most common clinical manifestation is nonsuppurative inflammation of the salivary glands, most notably the parotid glands. In most prepubertal children and adults, the illness is benign and self-limited, with one third of infections…

Measles

Abstract Measles (rubeola) is an extremely contagious, prolonged respiratory and systemic viral illness characterized by high fever, an erythematous maculopapular rash, cough, coryza, and conjunctivitis. Measles infects the immune system and leads to continued susceptibility to other pathogens long after recovery. A variety of complications lead to serious morbidity and mortality, particularly in under- and malnourished populations, where death rates can be up to 30%. Vitamin…

Rotavirus Infection

Acknowledgment The author acknowledges S. Michael Marcy and Susan Partridge for their contribution to the previous edition chapter. Abstract Rotavirus infections are the most common cause of severe dehydrating gastroenteritis worldwide. In developing countries, virtually all children have been infected by 2 to 3 years of age. Rotaviruses are segmented, nonenveloped, double-stranded ribonucleic acid (RNA) viruses that belong to the family Reoviridae. There are eight distinct…

Influenza

Abstract Influenza is a viral infection characterized by abrupt onset of fever, chills, myalgias, and respiratory symptoms such as cough, sore throat, and rhinitis. Influenza viruses, types A and B, cause annual epidemics worldwide leading to a substantial morbidity and mortality. Vaccination is the most cost-effective means of prevention. Antiviral therapy is available, but development of strain-specific resistance is becoming more common and requires continued global…

Poliomyelitis (Polio) and Polioviruses

Abstract In the early 20th century, poliomyelitis was one of the most feared illnesses of humans, in part because it affected previously healthy individuals with little or no warning and could result in devastating paralysis. Although the disease was once endemic worldwide, with vaccines eradication has been achieved in all but two countries. In current times, acute flaccid paralysis (AFP) is associated with vaccine-derived poliovirus strains…

Infections Caused by Neisseria meningitidis

Acknowledgment The author acknowledges Anjali N. Kunz for contributions to the previous edition. Abstract Neisseria meningitidis is both a commensal organism of the upper respiratory tract and a significant pathogen for humans. It causes devastating disease with significant morbidity and mortality worldwide. Infections caused by N. meningitidis can have various clinical presentations ranging from asymptomatic carriage or a mild upper respiratory illness to purulent meningitis and/or…

Pneumococcal Disease: Infections Caused by Streptococcus pneumoniae

Abstract Streptococcus pneumoniae (pneumococcus) is a gram-positive encapsulated bacterium that causes significant morbidity and mortality across all age groups. S. pneumoniae can be carried asymptomatically in the nasopharynx, and it can cause a wide range of diseases from upper respiratory infections including sinusitis and otitis media, lower respiratory infections (most commonly pneumonia), and invasive disease, including bacteremia and meningitis. Children younger than age 2 years, the…

Haemophilus influenzae Type b

Abstract Haemophilus influenzae type b (Hib) was a leading cause of bacterial sepsis and meningitis in children before the widespread availability of conjugate vaccines. Globally, the burden and incidence of Hib disease has dramatically declined with increases in vaccine uptake. Clinical Vignette A 3-year-old boy presents to the emergency department with high fever and difficulty breathing for 1 day. There is mild rhinorrhea but no rash.…

Bordetella pertussis and Pertussis (Whooping Cough)

Abstract Despite the availability of vaccines against pertussis in most developed and developing countries, pertussis remains a significant cause of morbidity and mortality worldwide due to immunity following vaccination and clinical disease waning with time. Routine use of pertussis vaccines has shifted the burden of disease from middle childhood to young infants and older children, adolescents, and adults. The changing epidemiology dictates the need for new…

Introduction to Vaccine-Preventable Diseases in Children and Adolescents

Acknowledgment The author acknowledges ChrisAnna M. Mink for her contribution on this chapter in the previous edition. The assertions expressed herein are those of the author and do not reflect the official policy or position of the Uniformed Services University or the Department of Defense. Abstract This section provides information about the vaccines currently recommended in the United States for routine immunization of children and adolescents,…

Neonatal resuscitation

Essentials 1 Occasionally deliveries occur in the ED when labour cannot be delayed to enable transfer of the patient to a labour ward setting. 2 The ED should have available appropriate equipment and guidelines for the resuscitation of the newborn. 3 The unique physiological events at birth affect the resuscitative interventions in the newborn. 4 Ventilation is the main priority in the resuscitation of the newborn.…

Acute neonatal emergencies

Essentials 1 Duct-dependent congenital heart disease is the most common cause for the collapsed neonate presenting to the emergency department (ED). Left-sided obstructive heart lesions can present with shock in the first few weeks after birth, often precipitated by delayed closure of the ductus arteriosus. Prostaglandin E1 maintains ductal patency. 2 In the collapsed neonate, bacterial sepsis must be considered. 3 Endocrine emergencies are rare but…

Neonatal dermatology

Skin in the neonatal period The skin has many important functions. It provides a physical, chemical and immunological barrier and has a major role in thermoregulation, electrolyte balance, metabolism, sensation and physical appearance. Defects or changes in the skin can impact on these functions. At birth, the barrier function of the skin is reduced, particularly in premature infants. This makes newborns vulnerable to increased transepidermal water…

The crying infant

Essentials 1 Define if this presentation is part of a recurrent stereotypical pattern in an otherwise well infant or a single acute episode. 2 A careful history and examination will often lead to an appropriate diagnosis. 3 Screening tests, except for urine culture, have little utility. 4 Carefully review carer’s coping and supports. 5 Organise appropriate follow-up. Introduction Crying is normal physiological behaviour in young infants…

The normal neonate

Definition and introduction A neonate is an infant aged from birth to 28 days of life. This is a period of rapid change and vulnerability for both the infant and their parents. Neonates are at higher risk than older infants of serious bacterial infections and may also present with previously unsuspected congenital abnormalities. Many parents have limited family support and little experience to guide them through…