infectious disorders

MC in < 2yrs, RSV is MC 

b.      SXS: tachypnea, hypoxemia, fever, nasal flaring

c.      Dx: nasal washing for RSV culture

d.      Hospitalization if O2 < 95%/age < 3 months/RR > 70 or atelectasis on CXY/toxic appearance

e.      Tx: nasal suctioning, humidified O2, and antipyretics

MC by virus, but also bacterial (M Cata is MC bacterial)

b.      SXS:

                 i.     COUGH for more than 5 DAYS

                ii.     FEVER IS UNUSUAL

c.      Tx: Supportive

If desire medication for cough: OTC dextromethorphan or guaifenesin

Influenza A associated with more severe outbreaks compared to B

b.      highest rates of infection are seen among children but individuals 65 or older are at the highest risk for complications

c.      SXS:

                 i.     Abrupt onset

                ii.     HA, fever, chills, myalgia (MC in legs and lumbosacral)

d.      Dx: Rapid nasal swab. GS is culture/PCR

e.      Tx:

                 i.     Mild: Supportive

                ii.     Antivirals recommended in patients that are hospitalized or at high risk of complications - eg, 65 years of age or older, w/comorbidities

1.      Zanamivir and Oseltamivir both treat influenza A and B (think Dr. “OZ” treats the flu). Needs to be within 48 HOURS OF ONSET OF SXS

                 i.     During Influenza outbreaks in long-term facilities, all residents should receive chemoprophylaxis (oseltamivir), regardless of immunization status

b.      Inactivated vaccine: annual influenza vaccination for all individuals 6mo or older (including pregnancy). Timing: End October-April

c.      Intranasal is live attenuated: only for 2 yrs-49yrs

d.      Contraindications to both: anaphylaxis to the influenza vaccine, Guillain-Barre syndrome within 6 weeks after a previous influenza vaccination, high fever, infants < 6 months of age.

                 i.     Contraindications to live attenuated vaccine only: immunocompromised patients (including HIV), pregnancy, adults age 50 or older

a.      Etiology: Parainfluenza type 1 then RSV

b.      RF: 6 mo-3 yrs, fall/winter

c.      SXS

                 Inspiratory stridor

                Seal-like Barking cough

               iii.     Hoarseness

CXY: tracheal narrowing (steeple sign)

d.      Tx: Supportive +/- corticosteroids (dexamethasone)  

a.      Etiology: MC is H. influenza type B (Hib). If Immunized suspect Streptococcus A. MC MALE/CHILDREN 3 mo-6yrs 

                 i.     SXS:

1.      3 D’s: Dysphagia, Drooling and Distress

2.      Stridor

3.      Fever

4.      muffled "hot potato" voice/tripoding

5.      CXY: thumbprint sign edema of epiglottis

                ii.  Dx: Laryngoscopy (GS)

Tx:

1.      Airway mgmt.

2.      ABX ceftriaxone +/- steroids

               iv.     Prevention: Hib vaccine and Rifampin to close contacts