CHILD WITH INFECTIOUS DISORDER
Illness - specific symptoms occur and site-specific
- Infections remain to be the leading cause of
morbidity in children.
- They may be prevented through vaccination,
household infection control, and proper triage for
hospital cases.
Assessment
- onset may be insidious (behavioral and pattern
changes) or acute.
- child may be contagious, but only before the onset
of the infection.
- not all infections (usually systemic) are not
contagious such as sepsis.
Planning
- centers on prevention such as vaccination and
prevention of further spreading by manipulating the
environment.
- education of families for reduction of infectious
diseases and how critical agents are spread in the
household.
Implementation
- includes patient education regarding infections,
modes of transmission and methods of prevention.
- use of technology to be updated about progress,
evaluation and management.
- telephone triage with standardized protocols to
avoid missing key points.
- assess history, vital signs, and do physical
assessment.
- relieve symptoms with antipyretics
anti-infectious agents.
- provide child with activities in cases of restrictions.
Evaluation
- relief from pruritus and pain
- free from ssx of disorder
- parent gives diversional activities to child
- there is a clear understanding of how the infection
works and understands importance of hand washing
(for parents)
- decreased immune response
THE INFECTIOUS PROCESS
Involves the host, environment, and pathogens:
bacteria, viruses, fungi, helminths, and rickettsia.
Stages of Infectious Disease
1. Incubation Period - time between invasion of
organism and onset of symptoms. It varies on
VIRULENCE, TRANSMISSION, and HOST.
2. Prodromal Period - time between beginning of
non-specific symptoms and arthralgia to the onset of
disease. Child may be infectious at this point.
Infections spread rapidly in this stage.
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3.
reactions as well.
4. Specific Rash - Exanthem for the skin, Enanthem
for the mucous membrane (in childhood infections).
and 5. Convalescent Period - interval between the
earliest sign of fading of symptoms and return to
healthy baseline.
CHAIN OF INFECTION
- spread of pathogens and entry to new host for
infection and disease.
- nosocomial infections are those that are acquired
in the healthcare setting.
1. Reservoir - container or place where the organism
originates, grows, and reproduces. It can be another
person, animal, or object. Fomites are inanimate
objects that can transmit infections without human
intervention.
2. Portal of Exit - the route by which the organism
exits to spread and infect others in the form of
bodily fluids, excretions, vomitus, lesion secretions,
and the like. Appropriate PPE must be donned.
3. Mode of Transmission - whether it is direct or
indirect contact. It may be spread by fomites,
vectors, droplet (mouth and nose secretions), and
airborne (small organisms suspended in the air and
move with it).
4. Portal of Entry - opening where the organism
enters the host.
5. Susceptible Host - the receiver of the infectious
agents. Some characteristics may affect the
susceptibility of the host such as age (very young
and very old), gender (for UTI due to physiologic
structure), virulence, and body defenses.
THE BODY’S IMMUNE RESPONSE
Two Lines of Defense:
- innate, nonspecific immunity
- adaptive, specific immunity
For innate:
Neutrophils >> activate monocyte >> become a
macrophage (cleans debris and kill infectious
organism) >> complement and cytokines signal
specific cellular and humoral immunity >> innate
immunity amplified via enhancing phagocytosis c/o
opsonin and chemotaxis of WBC, clotting factors,
and platelets to the area.
Two-Fold Rule of T-Cells:
T cells differentiate into TH1 Cells = promote cellular
immunity by activating macrophages, enhance
cytotoxic T cell function, produce cytokines, and
recognize the infecting agent.
TH2 Cells = release cytokines, enhance antibody
formation through B cells and mediating eosinophil
recruitment and activation.
Phagocytes action on organisms present in the form
of pus or purulent drainage. It signifies that
phagocytosis have been occurring and the infection
is resolving.
Systemic Inflammatory Response Syndrome may
present in three ways:
1. Sepsis Syndrome - infection with alteration in
body temperature, RR, HR, or WBC.
2. Septic Shock - organ dysfunction, hypotension,
and hypoperfusion.
3. Severe Sepsis - hypotension even with minimal
movement despite vigorous treatment regimen.
All systemic inflammatory responses are very
serious as it can ultimately lead to organ failure and
death.
HEALTH PROMOTION AND RISK MANAGEMENT
This is done in order to avoid:
- death (mortality)
- complications (morbidity)
The following must be known by parents and be met
by their children:
- basic needs for normal functioning and health
- immunization and vaccinations
PREVENTING SPREAD OF INFECTIONS
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Nosocomial/Health care-associated infections (HAIs)
are infections that are gained during the course of
medical intervention while in the health care facility.
Three-pronged approach for HAI prevention:
1. Prevention of infection in surgery or catheter
placement.
2. Prevent cross contamination between patients.
3. Proper use of antibiotics.
HAI-related Antibiotic-Resistant Bacteria:
1. Carbapanem-resistant Enterobacteriaceae (CRE)
2. Methicillin-resistant Staphylococcus aureus
(MRSA)
3. Extended-spectrum
beta-lactamases(ESBL)-producing
Enterobacteriaceae
4. Vancomycin-resistant enterococci (VRE)
5. Multidrug-resistant pseudomonas
6. Multidrug-resistant Acitenobacter
Risk for contracting HAI in children:
- younger than 2 years of age
- nutritional deficit
- indwelling vascular lines/catheters
- immunosuppressed
 - receiving multiple antibiotic therapy Vaccine Preventable:

- remain in the hospital for more than 72 hrs. - rubeola (regular measles)

- rubella (German measles)

Handwashing protocol for healthcare practitioners - mumps

is the best, easiest, and cost-effective way to
- varicella
prevent infections.
- rotavirus

- Hepatitis A & B
Further Ways to Avoid Infections:
- polio
- appropriate isolation for patient’s infection
- influenza
- device and cleaning practices follow protocols
- human papillomavirus (HPV)
- infection prevention protocols such as PPE use

Primary and Secondary Skin Lesions and Their

VIRAL INFECTIONS
Characteristics
- infection by viral agents are the most common
recognized infections in children.

- viruses are the smallest known infectious agents.

- symptoms are not apparent until a number of cells

have been invaded, therefore causing a longer
incubation period. Exanthem Subitum (Roseola Infantum)

- some viruses are target specific such as Causative Agent: human herpesvirus 6 (HHV6)
Epstein-Barr Virus = B-cells, HIV = CD4 T-cells,
Incubation: 9-10 days
Influenza Viruses = specific receptor sites of
tracheal cells. Communicability Period: during febrile period

Mode of Transmission: unknown

VIRAL EXANTHEMS - causes childhood skin rashes Immunity: No vaccine available, but contracting
with specific symptoms, characteristic lesions, and disease gives lasting natural immunity
specific pattern of distribution of the said lesions.

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- It is a disease with febrility followed by
defervescence (lowering of body temp). 77% of
children have this disease by age of 2.
SSX:
- It starts with a fever ranging from 38.3-40.6oC
- irritability during febrile phase, fever fades in 3-5
days
- cervical adenopathy (enlargement of nodes in the
neck)
- rashes discreet, rose-pink, macules that 2-3mm in
diameter that fades in pressure (1-2 days)
- no upper respi symptoms (also known as coryza),
conjunctivitis, or cough.
- can cause febrile seizure, bulging fontanels,
encelopathy, and encephalitis.
Therapeutic Management:
- acetaminophen or ibuprofen for fever in children
over 6 mnths.
- manage seizure accordingly, depending on age of
child.
Rubella (German Measles)
Causative Agent: rubella virus
Incubation: 12-23 days, but generally 14 days - further complications are: arthralgia, arthritis,
encephalitis, orchitis, neuritis, and hemorrhagic
Communicability: 7 days before and 7 days after
manifestations due to thrombocytopenia
rash appears
Mode of Transmission: direct and indirect contact
with droplets Therapeutic Management:
Immunity: contracting disease offers natural - antipyretics for comfort during febrility and joint
immunity, attenuated live virus vaccine (MMR), or pain (acetaminophen and ibuprofen)
immune serum globulin for pregnant women exposed
- droplet precaution for 7 days after onset of
to Rubella.
disease
- immunization with MMR especially prior
- It is called German measles or the 3-day measles, childbearing years
which appears first as rashes with no prodomal
Measles
period (except for older children and adolescent
children). Common during spring time in school-age Causative Agent: Measles Virus
children, though is in low prevalence as of today.
Incubation: 8-12 days after exposure to onset of any
symptoms, with general range of 7-21 days.
SSX: Communicability: 4 days before rash appears to 4
days after first appearance of rash
- discrete, pink-red maculopapular rash that starts
on the face and spreads downwards to the Transmission: direct droplet contract or airborne
extremities that disappears after three days from
the prodromal period. Immunity: contracting disease, attenuated live virus
vaccine (MMR), or immune serum globulin.
- 1-5 days prodromal period in older children
- in the prodromal period, there is low grade fever,
headache, malaise, anorexia, conjunctivitis, coryza, - Also known as Rubeola
and lympo-adenopathy in the head to neck areas.
- It is an acute febrile viral illness with 3 C’s: cough,
- joint pain may occur in children on the third day coryza (clear nasal discharge), conjunctivitis.
since the febrile period has started and may run for
5-10 days.
SSX:
- congenital rubella syndrome (malformations) might
occur if mother contracted rubella during - 3 C’s: cough, coryza, conjunctivitis
pregnancy.
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- confluent, erythematous rash starting from behind
the ear towards the feet for 3-6 days
- Koplik spots (white spots with bluish center on
erythematous background or a red surrounding
area) in the oral and buccal mucosa before any
other appearance of symptoms. These enanthems
look like raised papules and are only unique to
Rubeola.
- lymph nodes in the head and neck enlarge during
prodromal period and there is development of fever,
malaise, photophobia, and mild gastrointestinal
symptoms.
- The enanthem fades and is followed by a viral
exanthem on the skin, characterized as
maculopapular, coalescing rash that starts as red
(fades with pressure) and desquamizes (flatten) and
turn brown (like scars).
- Pneumonia is the most common complication. Other
complications include croup, diarrhea, secondary
bacterial infection, and subacute sclerosing
panencephalitis which can occur 7-11 years after
infection (rare).
- Fever lasting for more than 3-4 days during rash
and coughing indicates presence of pneumonia
What is the difference between scarlet fever and
Rubeola?
- The rash starts to fade, on pressure, after 5-6 days
and leaves a fine desquamation afterwards.
Therapeutic Management:
- antipyretics for fever
- comfort measures for rash such as emollients and
petroleum jelly to avoid excoriation.
- buckwheat honey for cough in children over one
year of age.
- providing dimness for photophobia
- have child examined after office hours as it may
infect other children due to its airborne
characteristic
- follow standard and airborne precautions
Chickenpox (Varicella)
Causative agent: varicella-zoster virus (VZV)
Incubation: 10-21 days (common incidence), 14-16
days following exposure
Communicability: 1 day prior rash to 5-6 days after
appearance, most especially in crusting of vesicles.
Transmission: highly contagious, direct/indirect
contact with saliva and vesicles.
Immunity: contracting disease provides immunity for
chickenpox, but it can be latent and may appear as
shingles (herpes zoster) when reactivated in later
time, attenuated live virus vaccine, children with
HIV/AIDS, leukemia, and those under corticosteroid
treatment.
- A common, highly contagious childhood infection
with a household attack rate of 90% due to ZVZ.
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SSX:
- rash accompanied with low-grade fever and
malaise
- lesions start from the trunk then outwards to the
face, extremities, mucosal surfaces, and even the
genitalia.
- hallmark characteristic of lesions is its 2-3mm
diameter vesicle on an erythematous base.
- lesions come in crops or groups and occur in four
stages at the same time in different areas from
macule, to papule, vesicle, and crust.
- Secondary soft tissue infections may occur due to
pruritic, open lesions a well as pneumonia and
encephalitis.
Therapeutic Management:
- oatmeal-based creams along with antihistamine to
decrease scratching and avoid tissue infection
- antipyretics such as acetaminophen
- avoid aspirin (may cause Reye syndrome)
- antivirals like acyclovir for immunodeficient
patients ages 13 and up to shorten course of illness
- standard, contact, and airborne precaution must
be observed.
- isolate up until crusted lesions are no longer
infectious
Herpes Zoster
- VZV stays latent in the posterior dorsal root
ganglia and when activated in the later years (such
as in adulthood) may cause paresthesia, pain with
subsequent vesicular groups on the skin.
- can be prevented with a varicella-zoster vaccine
formulated for patients older than 50 years
- acyclovir and analgesics are used to alleviate
lesions and pain, respectively especially for
immunocompromised and elderly px.
- smallpox has a pustular stage for lesions unlike the
original 4 stages for lesions in chickenpox.
- lesions in the crusting phase are contagious unlike
chickenpox
SSX:
- severe prodrome phase ranging from 38.9-40.0oC
- headache
Causative Agent: B19 parvovirus
Incubation: 4-14 days w/max of 21 days
Communicability: uncertain stage
Transmission: respiratory tract secretion, blood
trans, and vertical transmission from mother to child
(in pregnancy)
Immunity: none

- abdominal pain - It is a disease common during late winter to spring

Smallpox
Causative Agent: smallpox virus
Incubation: 7-17 days, generally 12 days
Communicability: 24hrs before onset of rash until
crusting of lesions which can last about 4 weeks
Transmission: airborne
and occur at any life stage, with hematologic
- malaise and severe fatigue
manifestations.
- lesions after 24 hrs of symptom appearance,
- Can cause relative aplasia of the RBC line for 7-10
starting from the face to the trunk and extremities.
days, hemolytic anemia, and symptomatic anemia (in
Face and distal extremities are most affected in this
HIV px)
illness.
- Can cause restricted intrauterine fetal growth or
- lesions start as macules >> papules >> vesicles >>
fetal death
pustules on 7th day >> umbilicated & confluent
- Appearance of rashes does not make it contagious.

- It is a serious illness having greater than 30%

mortality rate. It manifests almost similarly to
Chickenpox, and is readily spread via direct contact
with infected px or fomites.
What is the difference between smallpox and
chickenpox?
- there is febrile prodromal period in smallpox
- lesions progress at the same time in the course of
infection unlike chickenpox which has scattered
stages of growth per grp.
Therapeutic Management:
SSX:
- antibiotics to avoid secondary lesion infection
- in well children, it may be asymptomatic
- vaccinia immune globulin (VIG) to modify symptoms
- classic presentation includes fever, headache, and
- oxygen to support respiratory and cardiac
malaise
functions as these can fail due to the course of
illness - “slapped cheek” appearance after 7-10 days of
mild, classic presentation of ssx. It includes erythema
- observe airborne, contact, and standard
of the cheeks with circumoral pallor.
precautions
- It is followed by maculopapular, lacy-appearing
rash on arms, thigh, and buttocks which intensity
Erythema Infectiosum (5th Disease) depends on activity level and environment of child.

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- there can be a petechial, papular, pruritic stocking
and glove distribution or mild respi illness with no
rashes.
- arthralgia and arthritis may develop due to the
causative agent.
Therapeutic Management:
- supportive treatment
- antipyretics and analgesics
- comfort for rashes
- avoid getting them in contact with pregnant women
- observe droplet and contact precautions
NONPOLIO ENTEROVIRUSES
Causative Agent: member of enteroviral family
Incubation: 3-6 days, w/ hemorrhagic conjunctivitis
which has incu. period of 1-3 days
Communicability: uncertain
Transmission: respi tract secretion, fecal-oral,
vertical transmission from mother to child (during
birth), breastfeeding
Immunity: none
- there are 90 serotypes of the causative agent with
3 main members of the enterovirus family:
enteroviruses, echoviruses, and coxsackievirus. It
was then classified at enterovirus A, B, C, and D
based on genetics and phenotypes.
in the pharynx. High fever and anorexia can lead to
dehydration.
SSX:
2. Herpangina - discrete, pinpoint, grayish vesicles
- nonspecific viral illness
or ulcers in the tonsillar fauces, soft palate, and
- respi illness (coryza, pneumonia, uvula that disappears in a few days. Also associated
bronchi/pharyn/stomatitis) with fever, difficulty swallowing, sore throat, abdo
pain, vomiting,and headache.
- skin infections (hand, foot, and mouth disease)
- GI & GU illness
Therapeutic Management:
- eye infections (hemorrhagic conjunctivitis, uveitis)
- soft, bland diet to avoid lesion irritation
- neurologic disease (encephalitis, aseptic meningitis,
acute flaccid paralysis) - non-irritating liquids
- Heart disease (myocarditis) - analgesia w/ acetaminophen (10-15mg/kg/dose
q4-6hrs) no more than 5 doses a day, before feeding
- muscular manifestations (myositis)
- follow contact and standard precautions
Numbered Enterovirus and Echovirus Infections
Poliovirus Infections: Poliomyelitis (Infantile
- potentially serious, usually benign and self-limiting Paralysis)
- responsible for childhood diseases like: aseptic Causative Agents: poliovirus
meningitis, diarrhea, acute respi illness, and
maculopapular rashes Incubation: 3-6 days (for nonparalytic) 7-21 days
with a range of 3-35 days (for paralytic)
- needs supportive treatment like antipyretics and
comfort measures for rashes Communicability:
- follow contact precautions - greatest shortly before or after onset of clincal
symptoms
- 1-2 weeks after onset of illness when virus is in the
Coxsackievirus Infections throat
- this group is responsible for the ff diseases: - 3-6 weeks when virus is in feces (and will stay
contagious)
1. Hand-foot-mouth disease (via A6 & A16
parvovirus) - causes erythematous papules on hands Transmission: respi secretions and feces
and feet sometimes on the buttocks, and oral ulcers
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Immunity: contracting disease, inactivated polio
vaccine, and no passive artificial immunity
- 72% of polio cases do not result to pralysis and are
often asymptomatic, only a small percentage
progress to paralysis.
- 25-40% of px get a postpolio syndrome after 15-40
years since last polio infection and cause weakness
and pain affecting muscles and joints.
SSX:
(non-paralytic; occurs in 24% of polio px)
- nonspecific fever
- sore throat
(paralytic; 4% of the 24% polio cases)
- fever, malaise, headache, nausea
- vomiting, abdominal pain, constipation
- a period of being asymptomatic (further progress
only in less than 1% of the paralytic cases)
- paralysis with areflexia
- bulbar symptoms (loss of voluntary and involuntary
movement like swallowing and respi muscle
involvement, respectively)
- sensations are kept, but motor capabilities are
impaired
Therapeutic Management:
- bed rest and antipyretics (non paralytic)
- supportive care for specific symptoms (long-term
ventilation if respi muscles are affected)
- physical therapy to avoid contracture and promote
strength
VIRAL INFECTIONS OF THE INTEGUMENTARY
SYSTEM
Herpesvirus Infections
Causative Agent: HSV-1 or HSV-2
Incubation: 2 days - 2 weeks, mean of 6 days
Communicability: potent at early course of infection
Transmission: direct contact of person with
herpes-related lesions, and those who are shedding
the virus asymptomatically.
Immunity: HSV has latency, but will
reinfections
- common but potentially life-threatening, primary
mucocutaneous infection, an cute infection of the
ganglia, or reactivated form for recurrent infection.
Lesions may occur anywhere on the skin.
A. Acute Herpesvirus Gingivostomatitis
SSX & Manifestation:
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- runs for 5-14 days
- common in children ages 5mos. - 6 years and in
older children
- onset of pain, drooling, anorexia, and high fever
(40.6oC)
- swollen gumline and easily bleeds
- white, shallow, red-bordered ulcers on external and
internal surfaces of the mouth, tongue, peioral skin,
and less commonly in tonsillar pillars.
- cervical adenopathy
Therapeutic Management:
- acid-free, soft, non-irritating food (for oral lesions)
- popsicles, Jell-O, and ice milk to soothe oral lesions
- increased fluid intake to avoid dehydration
- oral acyclovir to shorten course of illness
cause
B. Herpes Simplex (Herpes Labialis)
SSX & Manifestations:
- aka cold sore or fever blisters
- recurrent form of HSV which remained dormant in
the ganglia of the trigeminal nerve (5th cranial nerve)
- cluster of painful, erythematous-based vesicles on
the vermillion border (of the lips) with initial tingling,
burning, and itching sensation 6-48hrs. before
vesicles erupt
- complete healing takes about 6-10 days with no
scarring
Therapeutic Management:
- topical (Zovirax cream/ointment) or oral acyclovir
- reassurance to children that lesions will go away in
a few days.
C. Acute Herpetic Vulvovaginitis (Genital Herpes)
SSX & Manifestations:
- primarily due to HSV-2 that are dormant in the
ganglia of sacral nerves.
- spread via sexual contact
- if it happens in children, sexual maltreatment may
have occurred and must be reported.
Warts (Verrucae)
Causative Agent: human papillomavirus (HPV) of the
Papillomaviridae family.
Incubation: 3 weeks - 8 months, mean of 3 months
Transmission: direct contact and probably fomites
Immunity: Gardasil 9 Vaccine (for strains 6, 11, 16,
18, 31, 33, 45, 52, and 58) children of 11-12 years,
males (13-21 y.o), and females (13-26 y.o)
- the virus commonly causes skin manifestations
which may progress to genital and oral
malignancies.
SSX:
- flesh-colored, dirty-looking, callus-looking, papules
which usually appear on the hands (dorsal area) and
feet soles (plantar warts).
- HPV can also infect the conjunctiva, oral cavity,
genital tract, respi tract,apart from the skin.
- can be painful as it grows and obliterates skin lines
and surface especially when pressure is exerted
such as on the soles and are candidates of removal
- anogenital warts (looks like HSV lesions) in children
suggests sexual maltreatment
- some HPV strains can cause vaginal, vulvar,
cervical, penile, oral, and oropharyngeal cancers.
Therapeutic Management:
- can be painful but not usually necessary, though
not all choices can be used to remove genital warts
- salicylic acid solution (OTC)
- carbon dioxide snow
- liquid nitrogen
- electrodessication/cauterization
- laser
- cryotherapy
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VIRUSES CAUSING CENTRAL NERVOUS SYSTEM
DISEASES
Rabies
Causative Agent: Rhabdovirus (RABV)
Incubation: Can take days to years, mean is 1-3
months
Communicability: 3-5 days prior onset of symptoms
through the course of disease
Transmission: rabid animal bites (rodents, bats, dog,
and other warm-blooded mammals), saliva secretions
to open lesion or wound on a child’s skin (rare but
highly possible)
Immunity: contracting disease (though very minimal
survivors can attest to this, there were only 4
recorded in history), human diploid cell rabies
vaccine, and rabies immunoglobulin (RIG)
SSX:
- prodromal signs: fever, malaise, anorexia, nausea,
sore throat, irritability, and restlessness
- clinical manifestations:
- anxiety
- radicular pain pruritus
- hydrophobia (fear of water)
- dysautonomia
- paralysis and progresses towards death
- drooling due to mouth muscles contraction esp.
when drinking
- comatose and peripheral vascular collapse,and
death follows in as fast as 5-6 days.
Therapeutic Management:
- prevention of the active process of infection by
taking thorough history of the bite and determining
the species of the infected animal, or when
presentation of skin and tissue damage is that of an
animal.
- immunize and use prophylaxis after contacting bite
center/facility/office
- immediately administer vaccine and RIG once
confirmed
- post-prophylaxis is two-fold:
- human rabies vacc + RIG (20 IU/kg), IM (both
on day 0)
- rabies vacc on day 3, 7, and 14.
OTHER INFECTIONS TRANSMITTED BY ANIMAL
VECTORS
Hantavirus
- caused by the arbovirus group
- can either be Hantavirus Pulmoary Syndrome (HPS)
or hemorrhagic fever with renal syndrome (HFRS)
- have 60% and 12% mortality rate, respectively.
- HPS has 1-6 weeks of incubation, 5 days or less for - repellants with 30% N, N-diethyl-meta-toulamide
prodrome period (DEET)
- HPS = fever, chills, cough, myalgia, GI symptoms - use of condoms
diarrhea and vomiting and headache.
- blood screening
- capillary leak develops into the lungs leading to
pulmonary edema and hypoxemia.
West Nile Virus Disease
- HFRS has 3 weeks incubation, with 5 ohases of the
disease: febrile, hypotension, oliguria, polyuria, and Causative Agent: virus from arthropods
convalescence.
- no antiviral treatment available, but supportive
measures can be taken. SSX:
- avoid rodent-infested areas - fever, arthralgia, and myalgia
- for neuroinvasive form: encephalitis, meningitis,
and accute flaccid paralysis.
Zika Virus Disease
- within the neural ssx, there is mental confusion,
Causative Agent: Aedes aegypti (main vector), lethargy, photophobia, headache, muscle weakness,
Aedes albopictus (transmittive vector) coma, until death.
Incubation: Less than 1 week
Therapeutic Management:
SSX: - ribavirin
- fever and arthralgia - intravenous immunoglobulin
- conjunctivitis and eye pain - West-Nile-specific IgM
- myalgia, rash, and headache
- may be transmitted w/o vector, but sexually. OTHER VIRAL INFECTIONS
- cause microcephaly and affect growth of the
child’s head if contracted during pregnancy.
Mumps (Epidemic Parotitis)
Causative Agent: mumps virus
Prevention:
Incubation: 16-18 days or 12-25 days (outside range)
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Communicability: 5 days from onset of parotid gland
swelling
Epstein-Barr Infectious Mononucleosis Therapeutic Management:
Mode of Transmission: direct contact w/ respi
Causative Agent: EBV - acetaminophen and NSAIDs for fever and pain
droplets
Incubation: 30-50 days (shorter in children) - avoidance of contact sports for a month after
Immunity: having the disease, MMR vaccine, and
onset
mumps immune globulin Communicability: direct contact to saliva for
sympto/asymptomatic people shedding the virus - hydration of patient

Transmission: direct contact and blood transfusions - soft, non acidic, cool, and non irritating foods
SSX:
Immunity:one episode gives lasting immunity, but
- fever, headache, anorexia, and malaise.
can be latent. No vaccines exist for EBV.
BACTERIAL INFECTIONS
- 1/3 of cases are subclinical and have no swelling of
the parotid gland.
- also known as kissing disease (common in 15-24
- classic manifestation is enlargement of parotid - bacteria of the same family may act differently
gland, by the obscure jawline angle, without any Year-olds) because of the M protein surrounding their cell
erythema. Resolves in 5 - 7 days. walls.
- differentiate enlargement from submaxillary - exotoxins are toxins that at as super antigens. With
adenitis. SSX:
this, ssx arise from the bacteria and body response
- CNS manifestations: Alice in Wonderland to exotoxins.
- if more swelling is above the hands, it is mumps.
Syndrome, Guillian-Bare Syndrome, transverse
- there is trismus or difficulty in opening mouth. myelitis, cranial nerve palsies
STREPTOCOCCAL DISEASES
- may lead to orchitis after puberty esp in boys, and - Hematologic manifestations: thrombocytosis,
may lead to sterility. hemolytic anemia, hemophagocytotic - Streptococci are gram-positive, found in the respi,
lymphohistiocytosis, agranulocytosis GI, and GU tract.

- days of prodromal symptoms and enlargement of - 120 serotypes or genotypes of group A

Therapeutic Management:
cervical nodes & tonsils. beta-hemolytic strep responsible for mild infections
- Supportive care like impetigo, scarlet fever, and more serious like
- if splenomegaly, there is pharyngitis w/ palatal
TSS and necrotizing fasciitis.
- Acetaminophen and NSAIDs petechial and periorbital edema
- S. pyrogenes are responsible for strep throat,
- soft, bland diet - if mesenteric lymph nodes enlarge, there is sharp
scarlet fever.
pain like appendicitis.
- manage pain at swelling area
- group A is responsible for:
- can be detected through blood smear, Monospot
test, and heterophile antibody test - erysipelas
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 - cellulitis - release of exotoxin SpeA, SpeC, and SSA cause Incubation: 7-10 days
formation of rashes 12-48 hr after onset of pharyn.
- pneumonia Communicability: from outbreak to healing of lesions
- rash is red w/ pinpoint lesions that blanch on
- endocarditis Transmission: direct contact w/ lesions
pressure, rough as sandpaper in skin folds (Pastia’s
- pericarditis sign), lasts for a week and peels off in flakes Immunity: none

- ostemyelitis - inflammation of tonsils w/ white exudate

- sepsis
- bacteremia
- TSS
- group A and group B can be obtained from vaginal
secretions at birth.
Scarlet Fever
Causative Agent: beta-hemolytic strep., grp. A
Incubation: 2-5 days for strep pharyngitis
Communicability: greatest during acute phase of
illness, 1-7 days
Transmission: direct contact, large droplets
Immunity: one episode of disease, no vaccination
- occurs mostly in schoolage children (7-8 yr old age
group), in temperate climates
SSX:
- strep. Pharyngitis begins abruptly w/ sore throat,
fever, chills, malaise
- palate may also have the reddened punctiform
lesions and scattered petechiae
- Day 2: tongue is white and feels furry
- Day 3: tongue papillae enlarge and look like white
strawberry
- Day 4-5: tongue turns into red strawberry (a
hallmark symptom)
Therapeutic Management:
- Penicillin V for infection management, avoids
sequela, is the drug of choice
- Amoxicillin 50/mg/kg up to 1,200mg for 10 days is
recommended by AHA
- IM penicillin G benzathine is the alternative drug
- analgesics and antipyretics for fever
- soft or liquid diet for pharyngitis until it improves
- complication of this is reactive arthritis after the
illness occurs
Impetigo
Causative Agent: beta-hemolytic strep, grp. A or S.
Aureus including MRSA
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- it can affect children in a family due to contact
contamination
- mau cause scabies due to scratching impetigo
lesions
SSX:
- epidermal layer having honey-colored crusts with
local erythema.
- found in face and extremities
- may be seen secondary to bites and body piercings
- extensive impetigo = local enlarged nodes
Therapeutic Management:
- mupirocin (Bactroban) ointment for 7-10 days for
lesions
- retapamulin (Altabax) for kids over 9 mos., use for
5 days BID
- oral antibiotics reserved for more serious impetigo
- rheumatic fever or glomerulonephritis may be the
sequelae to the illness
Cat-Scratch Disease - may use azithromycin to decrease node size - treatment is systemic antibiotic for staph & strep.

Causative Agent: Bartonella henselae, a - analgesic for body pain

slow-growing bacteria
- do not destroy the cat, it imparted immunity to the Methicillin-Resistant Staphylococcus aureus
Incubation: 1-2 weeks with a rage of 7-60 days kid
- MRSA is a strain of staph which cause skin
Communicability: unknown infections that are resistant to broad-spectrum
antibiotics.
Transmission: bite or scratch from kittens than cats STAPHYLOCOCCAL INFECTIONS
- HA (healthcare-associated) or CA
Immunity: one episode of disease - staph. normally on skin surface
(community-associated) MRSA
- S. Aureus is responsible for pyogenic skin
- vancomycin is used for hospital based lesions, it is
infections and infection of soft tissues
- most commonly occurs in pre-school children the drug of choice
because of their tendency to handle pets like cats - grow rapidly in creamy food products causing
- clindamycin or trimethoprim-sulfamethoxazole for
and kittens roughly. summer food poisoning.
community-associate MRSA (CA-MRSA)
- cat does not appear ill
- prevention must be focused on nasal, skin, and
Furunculosis/Carbunculosis (Abscess or boils) household decolonization as it can re-occur to
children within a year.
SSX: - furuncle a staph infection of a single hair follicle,
carbuncle is multiple hair follicles - handwashing and reporting skin wounds is key.
- single skin papule or pustule at site of inoculation
- a single or multiple yellow pustule forms at the site
- followed by swollen nodes by 1 - 2 weeks
- w/ localized redness, pain, and edema around Scalded Skin Disease
- enlarged nodes will resolve in 4-6 weeks w/o any
pustule
treatment, other will drain on its own - aka Ritter disease seen in infants
- may need incision to drain pus, if large
- Parinaud oculoglandular syndrome is a form of this - rough-textured skin and general erythema on
disease that presents with preauricular - do not press lesions friction areas
lymphadenitis and follicular conjunctivitis and 1-2
- treatment w/ anti-microbials after draining - large bullae (vesicles) filled with clear liquid
weeks of fever.
depends on size of lesions.
- epidermis separate in large sheets, desquamates,
- Indirect Immunofluorescent Antibody (IFA) is used
and leave Nikolsky sign
to diagnose this disease
Cellulitis - Nikolsky sign is a raw, red, glistening,
scalded-looking skin surface
- a staph inflammation of dermal and subQ layer of
Therapeutic Management:
the skin
- is symptomatic in approach
- includes warmth, erythema, and tenderness at area OTHER BACTERIAL INFECTIONS
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- despite vaccination, children can still acquire - with CNS involvement paralysis of diaphragm is
infections due to exposure to another serotype, possible
SSX:
waning immunity, or lack of vaccination compliance.
- illness may form skin lesions
- 3-stage process

- Stage 1: Catarrhal = upper respi symptoms (coryza,

Diphtheria
Therapeutic Management: snezzing, etc.)
Causative Agent: Corynebacterium diphtheriae
- single dose equine antitoxin based on clinical - Stage 2: Paroxysmal = 5-10 short, rapid coughs,
(Klebs-Loffler bacillus)
suspicion followed by rapid inspiration which gives a “whoop”
Incubation: 2-5 days with range of 1-10 days characteristic. Exhausting after effortful coughing.
- penicillin or erythromycin, IV
Communicability: very infectious at portals of - Stage 3: Convalescent = gradual cessation of
- CBR (complete bed rest) on acute phase of illness is
entrance/exit 2-6 weeks from infection, 48 hrs after coughing and vomiting
crucial
starting of antibiotics
- membrane obstruction may call for a need for
Immunity: episode of disease, DTaP vaccine, and
endotracheal intubation Therapeutic Management:
diphtheria antitoxin
- observe droplet precaution - younger than 3 mos are admitted for further stuff

- monitor nutritional and oxygen intake, and

- rare illness due to available immunization
complications
Whooping Cough (Pertussis)
- the bacilli invades and grows in the nasopharynx
- WBC, esp lymphocyte, can reach
area of children Causative Agent: Bordetella pertussis
20,000-30,000/cubic millimeter
Incubation: 5-21 days
SSX: Communicability: greatest in catarrhal stage (respi
Therapeutic Management:
illness stage), may decrease when in treatment for
- the exotoxin is produced which causes necrosis and
5th to 7th day. - admitted px if 3 mos below
inflammation
Transmission: highy contagious viia direct or indirect - provide oxygenation if pertussis is severe
- endotoxin promotes growth of characteristic gray
contact
membrane at nasopharynx region, from infected - avoid environmental irritants and strenuous
cells. Immunity: one episode of disease, DTap vacine, activities
pertussis immune serum globulin
- if membrance reaches further, it causes purulent - 10-day course of erythromycin or azithromycin
nasal discharge and brassy cough
- observe droplet precaution even at day 5 of
- can spread systemically to infect other organs - primarily manifest as a mild rhinitis w/ mild to treatment
persistent cough illness.
- myocarditis w/ HF and conduction disturbances
may occur
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- immunize pregnant women 27-36 weeks of
gestation
Anthrax
Causative agent: Bacillus anthracis
Incubation: 1-7 days (inhalational or GI), 1-12 days
(cutaneous)
Transmission: contact w/ contaminated sheep and
cow feces, can never be person to person
Immunity: unstudied but may be prevented with a
vaccine for adults 18-65 Y.O.
- acute infectious disease contracted from bacteria
exposure or its spores.
- toxin will be produced causing three bulk symptoms:
cutaneous, inhalational, gastrointestinal
SSX:
- Inhalational = 90% mortality rate, w/ short
prodome, followed by dyspnea, SSS, mediastinal
widening, and pleural effusion on X-ray;
bio-terrorism
- Cutaneous = skin lesion that starts as a papule, to a
vesicle, to depressed black eschar. Fever may be a
symptom too. Can be treated with antibiotics. 1%
M.R.
- Gastrointestinal =eating undercooked meat, cause
abdo pain, fever, bloody diarrhea, and septicemia.
25% M.R.
Therapeutic Management:
- prophylaxis with ciprofolxacin (Ciprobay) after
exposure
- continued drug therapy for 60 days due to potence
and difficulty to kill spores.
Tetanus (Lockjaw)
Causative agent: C. tetani
Incubation: 3 days - 3 weeks
Communicability: none
Transmission: direct or indirect contamination of a
closed wound
Immunity: development of disease, DTaP vaccine,
TIG
- covers an accute, spastic paralytic illness caused
by neurotoxin produced by Clostridium. Highly fatal
due to an anaerobic, spore-forming bacillus found in
soil and animal excrement
- enters through open wound
- to the extent where the wound is shut off from any
oxygen source, the bacteria begins to reproduce
SSX:
- 1-7 days onset of disease, muscle spasm stimulated
by external stimuli and autonomic response
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- arrythmias, tachycardia, and diaphoresis
- site does not appear infected
- umbilical cord can be an entry point
- there is noticeable stiffness in neck and jaw
- 24-48 hrs, rigidity of trunk and extremities develop
- opisthotonos (arched back)
- abdo muscles are board-like and stiff
- sardonic grin sign, corners of mouth and forehead
distortion
- paroxysmal spasms in exposure to bright light
- sensorium is still clear
Therapeutic Management:
- decrease stimulation from environment
- total parenteral nutrition, sedation, and muscle
relaxation to avoid aspiration
- first line of treatment is human TIG with parenteral
penicillin G or PO/IV metronidazole to decrease
vegetative forms of causative agent.
- intubation and mechanical ventilation to support
respiration
- prevent w/ 3 doses vaccination, w/ booster shot at
10 years of age
- if wound is deep, and child had immunization more
than 5 years ago, Td is needed.
Lyme Disease
Causative agent: Borrelia burgdorferi (spirochete)
Incubation: 3-30 days
Communicability: not communicable
Transmission: deer tick
Immunity: no vaccine, but there is immune globulin
- erythematous papule appears after bite which
spreads the next 3-30 days into a large ring with
raised swollen border (erythema chronicum migrans)
- there can be systemic involvement of symptoms
- arthritis, stiff neck, nerve palsy, heart block can
occur
- treat with doxycycline if >8 y.o., amoxicillin if <8
y.o.
OTHER INFECTIOUS PATHOGENS
Rickettsial Diseases
- Rickettsiae are organisms that resemble viruses
both in size and their inability to function not unless
they get inside a host.
- reproduces by fission, containing DNA and RNA.
- multiply inside ticks, lice, mites, and fleas
(arthropods), but only cause disease to humans
through bites or contact to feces of the said vectors.
- exception is Q fever which is transmitted by
droplets.
- rickettsial multiplication in the endothelial cells of
small blood vessels cause fever, and rash.
Rocky Mountain Spotted Fever
Causative agent: Rickettsia rickettsii
Incubation: 3-12 days
Communicability: not possible
Transmission: wood, dog, or rabbit tick
Immunity: RMSF vaccine is not available
- a common tick infection in the US, which includes
fever and rashes. It is caused by bites.
SSX:
- has a presentation of a triad rash, fever, and tick
bite history.
- malaise, nausea, vomiting, and myalgia
- prominent reddened area at the site of bite
- blanching, pink, macular rash on ankles, wrists, and
forearms appear in the 2nd to 8th day.
- the rash will eventually spread to the palms, soles,
arms, legs, and trunk, the face usually spared.
- the classic petechial rash will develop in 5-6 days
which denotes a more serious rickettsial infection.
- sharp abdominal pain (like appendicitis)
-diarrhea, gastroenteritis, edema around the eyes
and extremities.
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- fever can reach up to 40oC, headache, and
confusion
Complication
- meningoencephalitis
- renal failure
- pneumonia
- cardiac and pulmonary failure
Therapeutic Management:
- first-line therapy is doxycycline for 7-10 days, but
must be started around the first 5 days of symptoms
- usually requires hospital admission
- caution parents to ensure drug compliance to avaid
risk of complication
Psittacosis
Causative agents: Chlamydophila psittaci
Transmission: inhalation of aerosolized excrement or
fluids from bird’s eyes and beak infected w/
bacteria
- it is a respiratory disease that can occur in children
due to the fluids inhaled from bird’s eyes or beak,
and aerosolized excrement. Bird does not appear ill,
however. Disease can last from 3-4 weeks.
SSX:
- cough, fever, pharyngitis, headache, malaise, or
diarrhea may be developed by children
- extensive interstitial pneumonia can also develop
- complications are myocarditis, endocarditis,
nephritis, hepatitis, or encephalitis.
Therapeutic Management:
- tetracycline or doxycyline for children >8 y.o.
- erythromycin or azithromycin for children <8 y.o.
And pregnant teens.
Parasitic Infections
- an infection where the agent lives in the hosts and
feeds on it.
- includes lice and scabies.
HELMINTHIC INFECTIONS
- these are pathogenic or parasitic worms
- roundworms (nematodes)
- flukes (trematodes)
- tapeworms (cestodes)
- helminths begin their life when their eggs and larvae
are expelled outside the human through excrements.
- children are prone due to their habit in using their
hands to eat or thumbsuck.
Hookworms
Roundworms (Ascaris) Causative agents: hookworm, hookworm eggs
Causative agents: Ascaris lumbricoides Transmission: contact w/ contaminated human feces
Incubation: 8 weeks
- enters the skin as larvae, migrate to the intestines,
and attach itself onto the intestinal villi and suck
- a parasitic helminthic infection
blood from the intestinal wall. It tends to be
- nurse must obtain px travel history asymptomatic.
- parasite lives in the intestinal tract - abdominal pain will be colicky in nature
- the larvae, when ingested, penetrates through the - nausea, vomiting, and diarrhea
intestinal wall and enter the blood stream. It can then
- eosinophilia can be a presenting sign 4-6 weeks
transfer to different body tissues.
after exposure to causative agent.
- can be prevented by sanitary fecal disposing to
- severe anemia is a complication
avoid soil contamination.
Therapeutic Management:
SSX:
- albendazole, mebendazole, pyrantel pamoate
- loss of appetite
- correct any signs of anemia through therapy
- nausea and vomiting
- intestinal obstruction due to worms
Enterobiasis (Pinworms)
Caustive agent: pinworms
Therapeutic Management:
Incubation: 2 months (in the cecum)
- there are three methods and course of treatments
Transmission: by ingestion or by breathing in the
- single dose albendzole with food
eggs
- nitazoxanide, BID, for 3 days
- single-dose ivermectin (not for children <15kg)
- mature female pinworms exits, after maturng in the
intestines, through the anus and deposit eggs on the
anal and perianal region
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- movement of the worms can cause itching and
scratching. Child may cry due to discomfort.
- a number of these eggs will be stuck in the child’s
fingernails and enter through the mouth again and
the cycle repeats.
SSX:
- pinworms in the anus can be large enough to be
seen by the naked eye. One can use a tape against
the anus and inspect it with a microscope for further
confirmation.
- itching and scratching of the anus
Therapeutic Management:
- single dose mebendazole or pyrantel pamoate
- washing before re-use of fabrics and linens
- all members of the family must be treated as well as
it can easily spread from person to person
- avoid nailbiting, practice hand hygiene
PROTOZOAN INFECTIONS
- infections caused by unicellular organisms which
reproduce through binary fission (for some)
- absorbs fluid through cell membrane and is motile
due to their flagella, pseudopod, or cilia
- most pathogenic in the GI, GU, and circulatory
systems
- can create cysts or membrane to surround them - metronidazole is the least expensive drug, making it
making it more difficult to destruct. a drug of choice in pediatric cases.
- nitazoxanide is for children >1 y.o.
Giardiasis - tinidazole is for children >3 y.o.
Causative agent: Giardia lamblia - treatment of asymptomatic carriers is not
recommended for well children living in a household
Transmission: fecal-oral route, may be from
with well people.
person-person or person-animal
FUNGAL INFECTIONS
- it can be a symptomatic or asymptomatic parasitic
infection - larger than bacteria, are unicellular (some), but
generally multicellular
- it can be sourced from contaminated water and
stool - deep mycoses invade internal organs
- cysts are ingested, develops, and matures in the - respiratory transmission = inhalation of spores
intestine. Infection is possible even if one has
- subcutaneous mycoses invade the skin, subQ tissue,
ingested as little as 10 cysts only.
and bone
- contagious as long as infected person still has cysts
- superficial mycoses invade the hair, skin, or nails.
- hand hygiene and proper sanitation are good
prevention measures.
Superficial Fungal Infections
- there are 4 fungal infections commonly seen in
SSX:
children:
- abdominal cramps
- tinea cruris
- weight loss
- tinea pedia
- diarrhea
- tinea capitis
- bloating
- tinea corporis
- diagnostic used is DFA assays and specific EIA
Tinea Cruris
Therapeutic Management:
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- also known as jock itch - yellow, crusting, perifollicular erythema of the - treat with topical antifungal for 1 week following
complete clearing of the lesion.
- brownish to erythematous, well-demarcated patch scalp with heavy hair loss; or
on the groin, inner thighs, and scrotum.
- a kerion or boggy circular area of hair loss
- it can have a central clearing and a papular or due Candidiasis
vesiculopapular border.
to due an inflammatory response to the fungus Causative agents: Candida albicans
- site is pruritic due to maoisture, tight fitting clothes,
and obesity.
Therapeutic Management: - this type of yeast reproduces by budding, cause
- incubation is from 1-3 weeks
skin monilial or candida infections
- treat child with oral antifungal treatment such as
- treat with antifungals for 4-6 weeks and do not use
griseofulvin (Gris-PEG) or terbinafine - it is the most common normal flora of the vagina
corticosteroids.
and infants get this upon birth.
- use of a topical shampoo such as selenium sulfide,
ketoconazole, and ciclopirox for 2x-3x a week.
Tinea Pedis
- advise px not to have any alcohol intake while SSX:
- also known as athlete’s foot under treatment to avoid nausea and vomiting as
- oral candidiasis, or thrush, which appear as white
these substances are metabolized by the liver.
- pruritic, pinpoint, vesicular with fissuring between plaques on an erythematous base on the buccal
the toes and on the plantar surface of the foot. - avoid sunlight when under griseofulvin treatment membrane. it looks like milk curd after feeding.
due to photosensitivity.
- treated with clotrimazole - on the skin it causes a severe, bright red, sharply
circumscribed, rash in the diaper area

Tinea Corporis - diaper rash has an intense erythema on the surface

Tinea Capitis
- a dermatophytic fungal infection of the scalp
- it presents in 4 ways:
- patchy alopecia w/ short (2-4mm) broken-off
with a well-demarcated border surrounded with
- superficial, well-demarcated, mildly erythematous,
satellite lesions and goes into the skin folds.
ring-like infection of the epidermal layer of the skin.
- rash worsens despite frequent changing of diapers,
- it has a slightly scaly central scaling and raised
application of ointment, and exposure to air.
papular borders.

hair shafts; - it also known as ringworm due to the shape, but it is

not caused by a worm. Therapeutic Management:
- well-demarcated scaling, erythematous patch
in - starts as a papular lesion which spreads over in - antifungals:
several days. Incubation is 1-3 weeks.
circular area; - nystatin
- may be confused with granuloma annulare and
- clotrimazole
nummular eczema.

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 - naftifine

- ketoconazole

- econazole

- cicloprox

- miconazole

- for oral candidiasis, nyastatin is administered at

lesion sites, QID after cleansing of mouth and
feeding.

--- fin. ---

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