Advanced Pediatric Bacterial Infections

Advanced Pediatric Bacterial Infections www.phwiki.com

Advanced Pediatric Bacterial Infections

Barber, Robert, Operations Manager has reference to this Academic Journal, PHwiki organized this Journal Content as long as this module was developedby the Society as long as Pediatric Dermatology.Advanced Pediatric Bacterial Infections Basic Dermatology Curriculum 1Last updated January 2016Module InstructionsThe following module contains a number of blue, underlined terms which are hyperlinked to the dermatology glossary, an illustrated interactive guide to clinical dermatology in addition to dermatopathology.We encourage the learner to read all the hyperlinked in as long as mation.Learner should complete this module after completion of “Bacterial skin infections” “Atopic dermatitis” in addition to “Blisters” modules2Goals in addition to ObjectivesDevelop a clinical approach to the evaluation in addition to initial management of select pediatric bacterial infectionsBy completing this module, the learner will be able to:Summarize the clinical manifestations of pediatric streptococcal in addition to staphylococcal skin infections Identify in addition to treat infectious complications in pediatric patients with eczema3

Universitas HKBP Nommensen ID www.phwiki.com

This Particular University is Related to this Particular Journal

Case 1: HistoryHPI: John is a 10 week old baby with fragile blisters as long as 2 days. Lesions are present in the folds of the neck, arms, legs in addition to groin. He also has some perioral crusting. He is more irritable than baseline.ROS: +rhinorrheaPMH: Healthy, full term male born via uncomplicated vaginal delivery with unremarkable prenatal in addition to postnatal course. Immunizations are up to date.Medications: noneSH: in daycare, no contacts with rashVital signs: Tm 38.5, HR/RR/BP within normal range. 4Case 1: Skin Exam5Case 1: Question 1Based on John’s findings, what is the most likely infectious diagnosisBullous impetigoErythrasmaIntertrigoMeningococcemiaStaph Scalded Skin Syndrome6

Case 1: Question 1Answer eBased on John’s findings, what is the most likely infectious diagnosisBullous impetigo (more localized blisters in addition to erosions)Erythrasma (scaling in addition to redness but no erosions or blisters, not acute, no fever) Intertrigo (redness, occasionally erosions but no blisters, no fever) Meningococcemia (purpura in a critically ill child)Staph Scalded Skin Syndrome7Case 1, Question 2The most likely causative organism isGroup A streptococcus Group B streptococcus Neisseria meningitidis Staphylococcus epidermidis Staphylococcus aureus8Case 1, Question 2Answer: eThe most likely causative organism isGroup A streptococcus (impetigo, cellulitis, necrotising fasciitis, scarlet fever, toxic shock syndrome)Group B streptococcus (less common cause of cutaneous infections) Neisseria meningitidis (meningococcemia, purpura fulminans)Staphylococcus epidermidis (skin colonizer, opportunistic infections) Staphylococcus aureus9

Case 1: Questions 1 in addition to 2Staphylococcal Scalded Skin Syndrome (SSSS) Blistering skin infection caused by toxins produced by some strains of S. aureusUsually presents in infants in addition to children under 5 years of ageStarts with tender, sunburn-like erythema followed by blisters filled with clear fluid that rupture leaving erosions in addition to superficial desquamationFever, malaise in addition to /or pain may be associated10Case 1: Questions 1 in addition to 2Staphylococcal Scalded Skin Syndrome (SSSS) Typical sites of involvement: Skin around the eyes UmbilicusNose PerineumMouth Flexural creasesAlthough areas around mucous membranes are usually involved, the actual mucous membranes are sparedNikolsky sign is positive (when you press the edge of an intact blister, the blister gets larger) 11Case 1, Question 3How would you make the diagnosis of SSSSClinically Culture the fluid from a blister Direct immunofluorescence testObtain a CBC12

Case 1, Question 3Answer: aHow would you make the diagnosis of SSSSClinicallyCulture the fluid from a blister (toxin mediated process, blisters are sterile) Direct immunofluorescence test (not antibody mediated, DIF is negative)Obtain a CBC (WBC may be elevated, not diagnostic)13Case 1, Question 4You treat the patient with appropriate antibiotics in addition to he is starting to get better. The pain is resolving in addition to he is not getting new blisters. The parents ask if he will have scars. You answer:YesNo14Case 1, Question 4Answer: bYou treat the patient with appropriate antibiotics in addition to he is starting to get better. The pain is resolving in addition to he is not getting new blisters. The parents ask if he will have scars. You answer:YesNo15

Case 1, Questions 3 in addition to 4Staphylococcal Scalded Skin Syndrome (SSSS) Caused by an exfoliative toxin produced by Staphylococcus aureusThe toxin spreads via the blood stream so blisters themselves are usually sterileThe exfoliative toxin attacks desmoglein 1 (Dsg-1)There is no scarring because this is a very superficial process Diagnosis is usually clinical based on history in addition to examS. aureus can sometimes be isolated from a pus-filled area on the skin, conjunctiva, nose or nasopharynx A biopsy can also confirm the diagnosis (shows a superficial blister with acantholysis)16Case 1: TreatmentStaphylococcal Scalded Skin Syndrome (SSSS) Treatment includes antibiotics in addition to supportive careAntibiotics Anti-staphylococcal Penicillinase-resistant penicillin 1st in addition to 2nd generation cephalosporinsClindamycinConsider coverage as long as MRSASupportive CarePain management Wound careFluid/electrolyte management 17Case 2: HistoryHPI: Angelo is a 5-year-old male who presents with fever, anorexia in addition to rash x 2 daysPMH: Otherwise healthyImmunizations are up to dateSH: 2 older siblings18

Case 2: Skin Exam19Case 2: Skin Exam20Case 2: ExamIn addition to this appearance of the tongue, you also appreciate a tonsilar exudate when you examine the oropharynx.21In addition to this appearance of the tongue, you also appreciate a tonsilar exudate when you examine the oropharynx.

Case 2, Question 1What is your diagnosisFifth’s DiseaseH in addition to Foot in addition to Mouth DiseaseMeaslesMumpsScarlet Fever22Case 2, Question 1Answer: eWhat is your diagnosisFifth’s Disease (slapped cheek in first stage, then lacy in addition to reticulated exanthem on trunk in addition to extremities)H in addition to Foot in addition to Mouth Disease (vesicular lesions on palms, soles in addition to mouth)Measles (prodrome with fever, cough, coryza in addition to conjunctivitis; exanthem is maculopapular)Mumps (parotid gl in addition to swelling in addition to pain, rash is not a typical manifestation)Scarlet Fever 23Case 2, Question 2In addition to the tonsillar exudate, the oral examination may also reveal this finding:Koplik spotsForschheimer spotsStrawberry tongueUlceration on the buccal mucosaUlceration of the palate24

Barber, Robert WBHY-FM Operations Manager www.phwiki.com

Case 2, Question 2Answer: cIn addition to the tonsillar exudate, the oral examination may also reveal this finding:Koplik spots (associated with measles)Forschheimer spots (associated with rubella)Strawberry tongue (associated with scarlet fever, but also seen in other diseases such as Kawasaki’s disease in addition to toxic shock syndrome)Ulceration on the buccal mucosa (nonspecific)Ulceration of the palate (nonspecific)25Case 2Scarlet FeverExanthem caused by group A beta-hemolytic streptococcal infection, most commonly of the oropharynxPatients typically present with: FeverThroat painHeadache Cervical lymphadenopathyRash in addition to mucosal findings26Case 2Skin findings S in addition to paper-like exanthem Rough, fine, erythematous papules on the trunk in addition to extremitiesPastia’s linesAccentuation of the rash in the folds of the extremitiesMucosal findings Oropharynx:Tonsillar exudate Tongue has bright red, strawberry appearanceScarlet Fever

Case 2, Question 3Which of the following is your initial treatment recommendationSupportive care alonePenicillinLinezolidAdmission to burn unit 28Case 2, Question 3Answer: bWhich of the following is your initial treatment recommendationSupportive care alone (treatment is recommended to prevent acute rheumatic fever)PenicillinLinezolid (not first line, used as second line or complicated infections)Admission to burn unit (rash does not require burn unit care) 29Case 2: TreatmentTreatment with antibiotics is necessary to prevent complications, primarily acute rheumatic feverPenicillin, amoxicillin, ampicillin, macrolides in addition to 1st generation cephalosporins may be usedDesquamation of the distal extremities may occur in addition to last as long as weeks (independent of treatment)30

Take Home Points Patients with impaired skin barrier including atopic dermatitis are at risk of infectious complications including impetigo in addition to eczema herpeticum Antimicrobial therapy should be tailored to cover bacterial infections with consideration of regional variability in isolate resistance patterns70AcknowledgementsThis module was developed by the Society as long as Pediatric Dermatology in addition to the American Academy of Dermatology Basic Dermatology Curriculum Work Group.Primary authors: Marla Jahnke MD, Christine Lauren MD Peer reviewers: Esteban Fern in addition to ez Faith, MD, Sheilagh MaguinessLast revised: 1/31/1671ReferencesBangert S, Levy M, Hebert AA. Bacterial resistance in addition to impetigo treatment trends: a review. Pediatr Dermatol. 2012 May-Jun;29(3):243-8.Berk DR, Bayliss SJ. MRSA, staphylococcal scalded skin syndrome, in addition to other cutaneous bacterial emergencies. Pediatr Ann. 2010 Oct;39(10):627-33.Creech, C. Buddy, Duha N. Al-Zubeidi, in addition to Stephanie A. Fritz. “Prevention of Recurrent Staphylococcal Skin Infections.” Infectious disease clinics of North America 29.3 (2015): 429-464.Fritz SA, Camins BC, Eisenstein KA etal. Effectiveness of measures to eradicate Staphylococcus aureus carriage in patients with community-associated skin in addition to soft-tissue infections: a r in addition to omized trial. Infect. Control Hosp. Epidemiol. 2011; 32: 872–880.Herbst R. Perineal streptococcal dermatitis/disease: recognition in addition to management. Am J Clin Dermatol. 2003;4(8):555-60. Huang JT, Abrams M, Tlougan R, Paller AS. Treatment of Staphylococcal aureus colonization in atopic dermatitis decreases disease severity. Pediatric 2009;123:808–814.Jen M, Chang MW. Eczema herpeticum in addition to eczema vaccinatum in children. Pediatr Ann. 2010 Oct;39(10):658-64.M in addition to ers SM. Toxin-mediated streptococcal in addition to staphylococcal disease. J Am Acad Dermatol. 1998 Sep;39(3):383-98; quiz 399-400.72

Barber, Robert Operations Manager

Barber, Robert is from United States and they belong to WBHY-FM and they are from  Spanish Fort, United States got related to this Particular Journal. and Barber, Robert deal with the subjects like Entertainment; Music

Journal Ratings by Universitas HKBP Nommensen

This Particular Journal got reviewed and rated by Universitas HKBP Nommensen and short form of this particular Institution is ID and gave this Journal an Excellent Rating.