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Diphtheria ( Corynebacterium diphtheriae)

Diphtheria is an acute toxic infection caused by Corynebacterium species, typically Corynebacterium diphtheriae and, less often, toxigenic strains of Corynebacterium ulcerans. Although diphtheria was reduced from a major cause of childhood death to a medical rarity in the Western hemisphere in the early 20th century, recurring reminders of the fragility of this success, particularly in conflict areas, emphasize the need to continue vigorous promotion of those…

Enterococcus

Enterococcus has long been recognized as a pathogen in select populations and has become a common and particularly troublesome cause of hospital-acquired infection over the past 2 decades. Formerly classified with Streptococcus bovis and Streptococcus equinus as Lancefield group D streptococci, enterococci are placed in a separate genus and are notorious for causing hospital-acquired infection and resisting antibiotics. Etiology Enterococci are gram-positive, catalase-negative facultative anaerobes that…

Group B Streptococcus

Group B streptococcus ( GBS ), or Streptococcus agalactiae, is a major cause of neonatal bacterial sepsis in the United States. Although advances in prevention strategies have led to a decline in the incidence of neonatal disease, GBS remains a major pathogen for neonates, pregnant women, and nonpregnant adults. Etiology Group B streptococci are facultative anaerobic gram-positive cocci that form chains or diplococci in broth and…

Group A Streptococcus

Group A streptococcus ( GAS ), also known as Streptococcus pyogenes, is a common cause of infections of the upper respiratory tract (pharyngitis) and the skin (impetigo, pyoderma) in children. Less frequently, GAS causes perianal cellulitis, vaginitis, septicemia, pneumonia, endocarditis, pericarditis, osteomyelitis, suppurative arthritis, myositis, cellulitis, omphalitis, and other infections. This organism also causes distinct clinical entities (scarlet fever and erysipelas), as well as streptococcal toxic…

Streptococcus pneumoniae (Pneumococcus)

Streptococcus pneumoniae (pneumococcus) is an important pathogen that kills more than 1 million children each year. Childhood pneumococcal disease is prevalent and typically severe, causes numerous clinical syndromes, and is a major cause of life-threatening pneumonia, bacteremia, and meningitis. Antimicrobial resistance in pneumococcus is a major public health problem, with 15–30% of isolates worldwide classified as multidrug resistant ( MDR ; resistant to ≥3 classes of…

Staphylococcus

Staphylococci are hardy, aerobic, gram-positive bacteria that grow in pairs and clusters and are ubiquitous as normal flora of humans and present on fomites and in dust. They are resistant to heat and drying and may be recovered from nonbiologic environments weeks to months after contamination. Strains are classified as Staphylococcus aureus if they are coagulase positive or as one of the many species of coagulase-negative…

Principles of Antibacterial Therapy

Antibacterial therapy in infants and children presents many challenges. A daunting problem is the paucity of pediatric data regarding pharmacokinetics and optimal dosages; as a consequence, pediatric recommendations are frequently extrapolated from adult studies. A 2nd challenge is the need for the clinician to consider important differences among pediatric age-groups with respect to the pathogenic species most often responsible for bacterial infections. Age-appropriate antibiotic dosing and…

Infection Associated With Medical Devices

Use of implanted synthetic and prosthetic devices has revolutionized pediatric practice by providing long-term venous access, limb-salvage surgery, and successful treatment of hydrocephalus, urinary retention, and renal failure. However, infectious complications of these devices remain a major concern. These infections are related to the development of biofilms , organized communities of microorganisms on the device surface protected from the immune system and from antimicrobial therapy. A…

Infections in Immunocompromised Persons

Infection and disease develop when the host immune system fails to protect adequately against potential pathogens. In individuals with an intact immune system, infection occurs in the setting of naïveté to the microbe and absence of or inadequate preexisting microbe-specific immunity, or when protective barriers of the body such as the skin have been breached. Healthy children are able to meet the challenge of most infectious…

Fever of Unknown Origin

Fever of unknown origin ( FUO ) is a diagnostic dilemma for pediatricians because it is often difficult to distinguish clinically between benign and potentially life-threatening causes. Pediatricians face the important challenge of not missing the diagnosis of a serious illness or an easily treatable condition that can result in increased morbidity. Fortunately, FUO is usually an uncommon presentation of a common disease, with most of…

Fever in the Older Child

Fever is the most common reason for a child to seek medical care. While most infants and children have benign viral causes of fever, a small percentage will have more serious infections. Unlike the situation in infants <2 mo of age, in older children with fever, pediatricians can rely more readily on symptoms and physical examination findings to establish a diagnosis. Diagnostic testing, including laboratory testing and…

Fever Without a Focus in the Neonate and Young Infant

Fever is a common reason for neonates and young infants to undergo medical evaluation in the hospital or ambulatory setting. For this age-group (0-3 mo), fever without a focus refers to a rectal temperature of 38°C (100.4°F) or greater, without other presenting signs or symptoms. The evaluation of these patients can be challenging because of the difficulty distinguishing between a serious infection (bacterial or viral) and a…

Fever

Fever is defined as a rectal temperature ≥38°C (100.4°F), and a value >40°C (104°F) is called hyperpyrexia . Traditionally, body temperature fluctuates in a defined normal range (36.6-37.9°C [97.9-100.2°F] rectally), so that the highest point is reached in early evening and the lowest point is reached in the morning. Any abnormal rise in body temperature should be considered a symptom of an underlying condition. The range…

Health Advice for Children Traveling Internationally

Children are traveling internationally with increasing frequency and to more exotic destinations that pose unique injury and disease risks. Compared to adults, children are less likely to receive pretravel advice and more likely to be seen by a medical provider or be hospitalized on return for a travel-related illness. Primary care providers are confronted with the challenge of trying to ensure safe, healthy travel for their…

Childcare and Communicable Diseases

More than 20 million children <5 yr old attend a childcare facility. These facilities can include part-day or full-day programs at nursery schools or preschools and full-day programs based in either a licensed childcare center or another person's home. Regardless of the age at entry, children entering daycare are more prone to infections, largely from the exposure to greater numbers of children. Childcare facilities can be classified…

Infection Prevention and Control

Infection prevention and control ( IPC ) programs have an important role in pediatric medicine. To be fully effective, IPC programs require a functional infrastructure that addresses collaboration with the public health system, widespread immunizations, and use of appropriate techniques to prevent transmission of infection within the general population and within healthcare institutions. The national focus on preventing healthcare-associated infection (HAI) is exemplified by The Joint…

Immunization Practices

Immunization is one of the most beneficial and cost-effective disease-prevention measures available. As a result of effective and safe vaccines, smallpox has been eradicated, polio is close to worldwide eradication, and measles and rubella are no longer endemic in the United States. However, cases of vaccine-preventable diseases, including measles, mumps, and pertussis, continue to occur in the United States. Incidence of most vaccine-preventable diseases of childhood…

The Microbiome and Pediatric Health

From the time of birth, the human infant is exposed to a myriad of microbes found on the mother and in the surrounding environment. Microbes rapidly form assemblages across exposed areas of the body, including the skin and enteral tract. The microbial communities are called the microbiota and make a substantial impact on short- and long-term physiology, including immunologic and metabolic development and function. Together the…

Diagnostic Microbiology

Laboratory evidence to support the diagnosis of an infectious disease may be based on one or more of the following: direct examination of specimens using microscopic or antigen detection techniques, isolation of microorganisms in culture, serologic testing, host gene expression patterns, or molecular detection of an organism, resistance determinant, or virulence factor. Some additional roles of the clinical microbiology laboratory include performing antimicrobial susceptibility testing and…