Clinical Handbook of Pediatric Infectious Disease, 3rd Edition

Visit the link below to download the full version of this book:

https://medipdf.com/product/clinical-handbook-of-pediatric-infectious-disease-3r
d-edition/

Click Download Now

 INFECTIOUS DISEASE AND THERAPY

Series Editor

Burke A. Cunha
Winthrop-University Hospital
Mineola and
State University of New York School of Medicine
Stony Brook, New York

1. Parasitic Infections in the Compromised Host, edited by Peter D, Walter and

Robert M, Genta
2. Nucleic Acid and Monoclonal Antibody Probes; Applications in
Diagnostic Methodology, edited by Bala Sivaminathan and Cyan Prakash
3. Opportunistic Infections in Patients with the Acquired Immunodeficiency
Syndrome, edited by Gifford Leoung and John Mills
4. Acyclovir Therapy for Herpesvirus Infections, edited by David A. Baker
5. The New Generation of Quinolones, edited by Clifford Siporin,
Carl L. Heifetz, and John M. Domagala
6. Methicillin-Resistant Staphylococcus aureus: Clinical Management and
Laboratory Aspects, edited by Mary T. Cafferkey
7. Hepatitis B Vaccines in Clinical Practice, edited by Ronald W. Ellis
8. The New Macrolides, Azalides, and Streptogramins: Pharmacology and
Clinical Applications, edited by Harold C. Neu, Lowell S. Young, and
Stephen H. Zinner
9. Antimicrobial Therapy in the Elderly Patient, edited by Thomas T. Yoshikawa
and Dean C. Norman
10. Viral Infections of the Gastrointestinal Tract; Second Edition, Revised and
Expanded, edited by Albert Z. Kapikian
11. Development and Clinical Uses of Haemophilus b Conjugate Vaccines,
edited by Ronald W. Ellis and Dan M. Cranoff
12. Pseudomonas aeruginosa Infections and Treatment, edited by Aldona L,
Battch and Raymond P. Smith
13. Herpesvirus Infections, edited by Ronald Glaser and James F. Jones
14. Chronic Fatigue Syndrome, edited by Stephen E. Straus
15. Immunotherapy of Infections, edited by K. Noel Masihi
16. Diagnosis and Management of Bone Infections, edited by Luis E. Jauregui
17. Drug Transport in Antimicrobial and Anticancer Chemotherapy,
edited by Nafsika H. Georgopapadakou
18. New Macrolides, Azalides, and Streptogramins in Clinical Practice, edited by
Harold C. New, Lowell S. Young, Stephen H. Zinner, and Jacques F. Acar
19. Novel Therapeutic Strategies in the Treatment of Sepsis, edited by
David C. Morrison and John L. Ryan
20. Catheter-Related Infections, edited by Harald Seifert, Bernd Jansen, and
Barry M. Farr
21. Expanding Indications for the New Macrolides, Azalides, and
Streptogramins, edited try Stephen H. Zinner, Lowell S. Young, Jacques F. Acar,
and Harold C. Neu
22. Infectious Diseases in Critical Care Medicine, edited by Burke A. Cunha
23. New Considerations for Macrolides, Azalides, Streptogramins, and
Ketolides, edited by Stephen H. Zinner, Lowell S. Young, Jacques F. Acar, and
Carmen Ortiz-Neu
24. Tickborne Infectious Diseases: Diagnosis and Management, edited by
Burke A. Cunha
25. Protease Inhibitors in AIDS Therapy, edited by Richard C. Ogden and
Charles W. Flexner
26. Laboratory Diagnosis of Bacterial Infections, edited by Nevio Cimolai
27. Chemokine Receptors and AIDS, edited by Thomas R. O'Brien
28. Antimicrobial Pharmacodynamics in Theory and Clinical Practice, edited by
Charles H. Nightingale, Takeo Murakawa, and Paul G. Ambrose
29. Pediatric Anaerobic Infections: Diagnosis and Management, Third Edition,
Revised and Expanded, Itzhak Brook
30. Viral Infections and Treatment, edited by Helga Ruebsamen-Waigmann,
Karl Deres, Guy Hewlett, and Reinhotd Welker
31. Community-Aquired Respiratory Infections, edited by Charles H. Nightingale,
Paul G. Ambrose, and Thomas M. File
32. Catheter-Related Infections: Second Edition, Harald Seifert, Bernd Jansen,
and Barry Fair
33. Antibiotic Optimization: Concepts and Strategies in Clinical Practice (PBK),
edited by Robert C. Owens, Jr., Charles H. Nightingale, and Paul G. Ambrose
34. Fungal Infections in the Immunocompromised Patient, edited by
John R. Wingard and Elias J. Anaissie
35. Sinusitis: From Microbiology To Management, edited by Itzhak Brook
36. Herpes Simplex Viruses, edited by Marie Studahl, Paola Cinque and
Toms Bergström
37. Antiviral Agents, Vaccines, and Immunotherapies, Stephen K. Tyring
38. Epstein-Barr Virus, Alex Tselis and Hal B. Jenson
39. Infection Management for Geriatrics in Long-Term Care Facilities,
Second Edition, edited by Thomas T. Yoshikawa and Joseph G. Ouslander
40. Infectious Diseases in Critical Care Medicine, Second Edition, edited by
Burke A. Cunha
41. Infective Endocarditis: Management in the Era of Intravascular Devices,
edited by John L. Brusch
42. Fever of Unknown Origin, edited by Burke A. Cunha
43. Rickettsial Diseases, edited by Didier Raoult and Philippe Parola
44. Antimicrobial Pharmacodynamics in Theory and Clinical Practice,
Second Edition, edited by Charles H. Nightingale, Paul G. Ambrose,
George L. Drusano, and Takeo Murakawa
45. Clinical Handbook of Pediatric Infectious Disease, Third Edition,
Russell W. Steele
Clinical Handbook
of Pediatric
Infectious Disease
Third Edition

Russell W. Steele
Ochsner Children’s Health Center
and
Tulane University School of Medicine
New Orleans, Louisiana, USA
Informa Healthcare USA, Inc.
270 Madison Avenue
New York, NY 10016
© 2007 by Informa Healthcare USA, Inc.
Informa Healthcare is an Informa business
No claim to original U.S. Government works
Printed in the United States of America on acid-free paper
10 9 8 7 6 5 4 3 2 1
International Standard Book Number-10: 1-4200-5150-4 (Hardcover)
International Standard Book Number-13: 978-1-4200-5150-6 (Hardcover)
This book contains information obtained from authentic and highly regarded sources. Reprinted
material is quoted with permission, and sources are indicated. A wide variety of references are
listed. Reasonable efforts have been made to publish reliable data and information, but the author
and the publisher cannot assume responsibility for the validity of all materials or for the
consequence of their use.
No part of this book may be reprinted, reproduced, transmitted, or utilized in any form by any
electronic, mechanical, or other means, now known or hereafter invented, including photocopying,
microfilming, and recording, or in any information storage or retrieval system, without written
permission from the publishers.
For permission to photocopy or use material electronically from this work, please access www.
copyright.com (http://www.copyright.com/) or contact the Copyright Clearance Center, Inc.
(CCC) 222 Rosewood Drive, Danvers, MA 01923, 978-750-8400. CCC is a not-for-profit organiza-
tion that provides licenses and registration for a variety of users. For organizations that have been
granted a photocopy license by the CCC, a separate system of payment has been arranged.
Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and
are used only for identification and explanation without intent to infringe.

Library of Congress Cataloging-in-Publication Data

Steele, Russell W., 1942-
Clinical handbook of pediatric infectious disease / Russell W. Steele. – 3rd ed.
p. ; cm. – (Infectious disease and therapy ; v. 45)
Rev. ed. of: The clinical handbook of pediatric infectious disease / edited by
Russell W. Steele. 2nd ed. 2000.
Includes bibliographical references and index.
ISBN-13: 978-1-4200-5150-6 (hardcover : alk. paper)
ISBN-10: 1-4200-5150-4 (hardcover : alk. paper) 1. Communicable diseases in
children–Handbooks, manuals, etc. 2. Infection in children–Handbooks, manuals, etc.
I. Clinical handbook of pediatric infectious disease. II. Title. III. Title: Pediatric infectious
disease. IV. Series.
[DNLM: 1. Communicable Diseases–Handbooks. 2. Child. 3. Infant. W1 IN406HMN
v.45 2007 / WC 39 S814c 2007]
RJ401.C545 2007
618.92'9–dc22 2007009439

Visit the Informa Web site at

www.informa.com

and the Informa Healthcare Web site at

www.informahealthcare.com
0 Preface

Physicians are expected to maintain, at their command, an extensive fund of knowledge. It is,
of course, not realistic to commit all important information to memory or even to retain what
will be considered essential aspects of diagnosis and treatment. We all, therefore, rely on
reference sources for optimal patient care. Our personal libraries not only assure against
omissions in medical management but also allow the most efficient method for keeping
abreast of new developments in each subspecialty.
A major addition to the literature over the last ten years has been the publication of
numerous guidelines for managing both the specific infections and clinical situations that
predispose to infectious diseases. These guidelines have been written by experts under the
direction of the American Academy of Pediatrics (Red Book: Report of the Committee on
Infectious Diseases), the Infectious Diseases Society of America, and the Centers for Disease
Control and Prevention. A major change to the third edition of this handbook is inclusion of all
current guidelines that pertain to the management of infectious diseases in children. These
guidelines, based on evidence-based medicine, are not meant to define standards of care;
rather, they offer a framework from which physicians can make final decisions.
In the care of pediatric patients, infectious diseases make up over half of all diagnostic
considerations. For this reason, the pediatrician or primary care physician must particularly
prepare him or herself with a basic understanding of infectious processes. In many cases,
knowledge of the disease must be applied in the clinical setting with minimal delay. These
situations may be best handled if the physician has at hand a reliable, concise manual that
condenses essential information related to diagnosis and treatment, and that is the primary
intent of this handbook. In most cases, it simply offers a rapid check of already planned
management. In other cases, it may give guidance in an area less familiar to the clinician.
Most of the information in this book is presented in tabular or protocol form, which is
essential for providing a quick reference in the broad area of pediatric infectious diseases.
Where there is some difference of opinion, particularly for modalities of treatment, I have often
elected to present just one approach. However, every effort has been made to use published
guidelines and consensus recommendations.
Changes from the second edition, published in 2000, include not only updates on all
infectious diseases but the addition of a number of published guidelines. All new
antimicrobial agents approved since the last edition are included, and all new recommen-
dations for therapies of choice have been updated.
Russell W. Steele
0 Contents

Preface iii
List of Tables vii

1. Congenital and Perinatal Infections 1

2. Infectious Disease Emergencies with Multiorgan Involvement 15
3. Common Outpatient Infections 49

4. Immunizations 69
5. Travel Medicine 79
6. Procedures 89
7. Laboratory Diagnosis 95
8. Respiratory Infections 109
9. Gastrointestinal Infections 125
10. Bone and Joint Infections 147
11. Urinary Tract Infections 159
12. Skin and Soft-Tissue Infections 171
13. Central Nervous System Infections 179
14. Surgical Infections 191
15. Sexually Transmitted Diseases and Genital Tract Infections 205
16. AIDS 219
17. The Immunocompromised Host 233
18. Systemic Fungal Infections 243
19. Infection Control 253
20. Antimicrobial Therapy 257

Index 283
0 List of Tables

CHAPTER 1
TABLE 1 Common Features of Early Onset vs. Late Onset Neonatal Sepsis 1
TABLE 2 Perinatal Risk Factors for Infection 2
TABLE 3 Infections Associated with Fetal Scalp Electrodes 2
TABLE 4 Clinical Manifestations of Sepsis 2
TABLE 5 Bacterial Etiology of Neonatal Infection 3
TABLE 6 Two Prevention Strategies for Early Onset Group B Streptococcal Infection 3
TABLE 7 Management of an Infant Born to a Mother Who Received Intrapartum
Antimicrobial Prophylaxis (IAP) 3
TABLE 8 Management of Suspected Neonatal Sepsis 4
TABLE 9 Clinical Manifestations of Congenital Infections 6
TABLE 10 Laboratory Evaluation of Suspected Congenital Infection 7
TABLE 11 Treatment of Congenital Toxoplasmosis 7
TABLE 12 Management of Hepatitis B in Neonates 8
TABLE 13 Infants to be Evaluated for Congenital Syphilis 9
TABLE 14 Treatment for Congenital Syphilis 9
TABLE 15 Management of Postnatal Varicella Exposure 10
TABLE 16 Common Neonatal Eye Infections 11

CHAPTER 2
TABLE 1 Etiology of Bacteremia in Otherwise Normal Febrile Infants and Children 15
TABLE 2 Treatment of Patients with a Positive Blood Culture and No Focus of Infection 16
TABLE 3 Etiology of Bacteremia Associated with Intravascular Catheters 16
TABLE 4 Clinical Diagnosis of Infant Botulism 18
TABLE 5 Laboratory Diagnosis of Infant Botulism 18
TABLE 6 Differential Diagnosis of Infant Botulism 18
TABLE 7 Treatment of Infant Botulism 18
TABLE 8 Prevention of Infant Botulism 19
TABLE 9 Pediatric Endocarditis: Clinical and Laboratory Findings 19
TABLE 10 Infective Endocarditis—Duke Criteria 20
TABLE 11 Definition of Endocarditis: Modified Duke Criteria 20
TABLE 12 Therapy of Endocarditis Caused by Viridans Group Streptococci and Streptococcus
bovis 21
TABLE 13 Therapy for Endocarditis Caused by Staphylococcus aureus 23
TABLE 14 Therapy for Native Valve or Prosthetic Valve Enterococcal Endocarditis 24
TABLE 15 Therapy for Culture-Negative Endocarditis Including Bartonella Endocarditis 27
TABLE 16 Care During and After Completion of Antimicrobial Treatment 28
TABLE 17 Pediatric Myocarditis 28
TABLE 18 Pediatric Pericarditis 30
TABLE 19 Treatment of Diphtheria 31
TABLE 20 Management of Contacts of Index Cases 31
TABLE 21 Factors Associated with Onset of Guillain-Barré Syndrome 31
TABLE 22 Diagnostic Criteria for Guillain-Barré Syndrome 32
TABLE 23 The Course of Guillain-Barré Syndrome 32
TABLE 24 Management of Guillain-Barré Syndrome 33
TABLE 25 Common Clinical Characteristics of Hantavirus 33
viii List of Tables

TABLE 26 Diagnosis of Hantavirus 33

TABLE 27 Management of Hantavirus-Related Acute Respiratory Distress Syndrome
(ARDS) 33
TABLE 28 Laboratory Diagnosis for Meningococcemia 34
TABLE 29 Treatment of Meningococcemia 34
TABLE 30 High-Risk Contacts of Meningococcal Disease 34
TABLE 31 Antibiotics for Meningococcal Prophylaxis 34
TABLE 32 Staging and Management of Orbital Cellulitis 35
TABLE 33 Characteristic Forms of Peritonitis 35
TABLE 34 Bacteriology of Peritonitis 35
TABLE 35 Signs and Symptoms of Generalized Peritonitis 36
TABLE 36 Laboratory Diagnosis of Peritonitis 36
TABLE 37 Treatment of Peritonitis 36
TABLE 38 Factors Affecting Time-to-Onset of Symptoms in Rabies 37
TABLE 39 Symptoms of the Classic Form of Rabies 37
TABLE 40 Diagnosis of Rabies 37
TABLE 41 Treatment of Rabies 37
TABLE 42 Prophylaxis for Rheumatic Fever 38
TABLE 43 Clinical Findings in Rocky Mountain Spotted Fever 38
TABLE 44 Laboratory Studies in Rocky Mountain Spotted Fever 39
TABLE 45 Differential Diagnosis of Rocky Mountain Spotted Fever 40
TABLE 46 Treatment of Rocky Mountain Spotted Fever 40
TABLE 47 Diagnosis and Treatment of Human Ehrlichiosis 40
TABLE 48 Clinical Findings in Presumed Septicemia 40
TABLE 49 Clinical Syndromes Commonly Associated with Sepsis in Children 40
TABLE 50 Effects of Sepsis on Organ Systems 41
TABLE 51 Incidence of Shock with Bacteremia 41
TABLE 52 Progression of Septic Shock 41
TABLE 53 Management of Septicemia in Children 41
TABLE 54 Initial Antibiotic Therapy for Presumed Septicemia of Unknown Source 42
TABLE 55 Treatment of Septic Shock 42
TABLE 56 Clinical Manifestations of Tetanus 43
TABLE 57 Treatment of Tetanus 43
TABLE 58 Incubation Period for Staphylococcal Toxic Shock Syndrome 44
TABLE 59 Clinical Manifestations of Toxic Shock Syndrome 44
TABLE 60 Criteria for Diagnosis of Toxic Shock Syndrome 44
TABLE 61 Laboratory Abnormalities in Toxic Shock Syndrome 45
TABLE 62 Factors Associated with Increased Risk for Toxic Shock Syndrome 45
TABLE 63 Treatment for Toxic Shock Syndrome 45
TABLE 64 Recommended Treatment Regimens for Tuberculosis in Infants, Children, and
Adolescents 46
TABLE 65 Infants, Children, and Adolescents at High Risk for Tuberculosis Infection:
Immediate and Annual Skin Testing Recommended 47
TABLE 66 Definition of a Positive Mamtoux Skin Test (5TU-PPD) in Children 47
TABLE 67 Clinical Syndromes of Tularemia 48

CHAPTER 3
TABLE 1 Organisms Recovered from Cutaneous Abscesses in Children 49
TABLE 2 Management of Recurrent Subcutaneous Abscesses 50
TABLE 3 Organisms Recovered from Perirectal Abscesses in Children 50
TABLE 4 Treatment of Perirectal Abscesses 50
TABLE 5 Bacterial Etiology of Adenitis 52
TABLE 6 Treatment of Adenitis 52
TABLE 7 Organisms Recovered from Infected Animal Bites 52
TABLE 8 Treatment of Animal and Human Bites 53
List of Tables ix

TABLE 9 Bacteremia in Infants 53

TABLE 10 Cellulitis: Clinical Features Associated with Specific Bacteria 54
TABLE 11 Treatment of Cellulitis 55
TABLE 12 Etiology and Treatment of Conjunctivitis 55
TABLE 13 Treatment of Dermatophytoses 56
TABLE 14 Laboratory Criteria for Infants 28–60 Days of Age for Being at Low Risk for Severe
Bacterial Infection 57
TABLE 15 Laboratory Studies for Children Two Months to Three Years of Age with Fever and
No Apparent Source 57
TABLE 16 Antipyretic Therapy 57
TABLE 17 Initial Evaluation of Children with FUO and Rationale for Screen 57
TABLE 18 Protocol for Continued Evaluation of Children with FUO 58
TABLE 19 Upper Respiratory Infections—Common Etiologic Agents and Treatment 59
TABLE 20 Organisms Causing Otitis Externa 59
TABLE 21 Treatment of Otitis Externa 59
TABLE 22 Etiology of Otitis Media in Infants and Children 60
TABLE 23 Etiology of Otitis Media in Neonates 65
TABLE 24 Presenting Manifestations of Common Parasitic Infections 65
TABLE 25 Treatment of More Common Parasitic Infections 66
TABLE 26 Postexposure Rabies Management 66
TABLE 27 Emergency Treatment of Snakebites 67
TABLE 28 In-Hospital Treatment of Snakebites 67

CHAPTER 4
TABLE 1 Routine Immunization Schedule 71
TABLE 2 Vaccines Available in the United States 72
TABLE 3 Contraindications to Immunizations 73
TABLE 4 Consider Discontinuation of Acellular Pertussis Vaccine 74
TABLE 5 Hepatitis B Prevention for Premature and Full-Term Infants of HBsAg-Positive
Mothers 74
TABLE 6 Hepatitis B Virus Vaccine and HBIG in Neonates 75
TABLE 7 Vaccines for Immunodeficient and Immunosuppressed Children 75
TABLE 8 Influenza Vaccine 76
TABLE 9 Hyperimmune Immunoglobulin 77
TABLE 10 Guidelines for the Use of VariZIG 77

CHAPTER 5
TABLE 1 Routine Immunizations and the Age When Protection is Provided 81
TABLE 2 Age Limitations for Vaccines and Chemoprophylaxis 81
TABLE 3 Recommended Preventive Measures for Travel to Countries Where Specific
Diseases Are Endemic 82
TABLE 4 Traveler’s Diarrhea 85
TABLE 5 Recommended Antibiotic Regimens and Dosage for Malaria Prevention 87
TABLE 6 Schedule for Immunization and Chemoprophylaxis 87
TABLE 7 Suggested Travel Supplies 88

CHAPTER 6
TABLE 1 Blood Culture Technique 90
TABLE 2 Procedure for Quantitative Blood Cultures 90
TABLE 3 Technique for Lumbar Puncture 91
TABLE 4 Needle Aspiration of the Lung 91
TABLE 5 Technique for Subperiosteal Aspiration 92
TABLE 6 Procedure for Peritoneal Tap 92
TABLE 7 Procedure for Thoracentesis 93
x List of Tables

TABLE 8 Aspiration of Middle Ear Fluid 94

CHAPTER 7
TABLE 1 Gram Stain 96
TABLE 2 Acid-Fast Stain 97
TABLE 3 Uses of Wright’s and Giemsa Stains 97
TABLE 4 Three Commonly Used Wet Mounts 98
TABLE 5 Processing CSF from Meningitis Patients 98
TABLE 6 Common Errors in CSF Staining Interpretation 99
TABLE 7 Routine Screening Urinalysis 99
TABLE 8 Bacteriologic Cultures for Urine 100
TABLE 9 Evaluation of Fecal Specimens 100
TABLE 10 Guaiac Method for Occult Blood 101
TABLE 11 Staining Procedure for Fecal Leukocytes 101
TABLE 12 Fecal Leukocytes Associated with GI Diseases 101
TABLE 13 Simple Methods for Detecting Parasites 102
TABLE 14 Evaluation of Synovial Fluid 102
TABLE 15 Examination of Synovial Fluid 103
TABLE 16 Differentiating Transudates and Exudates 103
TABLE 17 Evaluation of Fluid Exudates 104
TABLE 18 General Procedures for Viral Specimen Collection 104
TABLE 19 Collections from Suspected Viral Infections 105
TABLE 20 Specimens and Tests Used for Chlamydia Identification 106

CHAPTER 8
TABLE 1 Etiology of Common Upper Respiratory Infections 109
TABLE 2 Acute Sinusitis 111
TABLE 3 Signs and Symptoms of Epiglottitis at Time of Hospital Admission 112
TABLE 4 Differential Diagnosis of Epiglottitis 112
TABLE 5 Treatment of Epiglottitis 112
TABLE 6 Therapy for Infectious Croup 114
TABLE 7 Epidemiology and Presenting Symptoms of Bacterial Tracheitis 115
TABLE 8 Etiology of Bacterial Tracheitis 115
TABLE 9 Viruses Causing Lower Respiratory Tract Infection 115
TABLE 10 Bronchiolitis 116
TABLE 11 Afebrile Pneumonitis of Early Infancy: Etiology and Treatment 116
TABLE 12 Antiviral Agents for Influenza A and B 117
TABLE 13 Bacterial and Fungal Causes of Pneumonia Related to Age of the Pediatric
Patient 118
TABLE 14 Suggested Diagnostic Evaluation for Pneumonia in Children 118
TABLE 15 Empiric Antimicrobial Therapy for Presumed Bacterial Pneumonia 122
TABLE 16 Children with Pneumonia Warranting Consideration of Inpatient
Management 123
TABLE 17 Organisms Causing Aspiration Pneumonia 123
TABLE 18 Empyema in Children 123

CHAPTER 9
TABLE 1 Clinical Forms of Amebiasis 125
TABLE 2 Diagnosis of Amebiasis 127
TABLE 3 Treatment of Amebiasis 127
TABLE 4 Clinical Characteristics of Campylobacter 128
TABLE 5 Symptoms of Campylobacter Infection 128
TABLE 6 Gastrointestinal Manifestations of Campylobacter Infection 128
TABLE 7 Extraintestinal Manifestations of Campylobacter Infection 128