Infectious Diseases

This season, pediatric offices and clinics will work to meet the challenges posed by the new influenza vaccination.

A 13-year-old Hispanic boy presented to emergency department with a 1-day history of red eyes. The eye changes were not associated with vision changes, increased tearing, discharge, pain, fever, or trauma.

A 17-year-old Haitian girl who was visiting Florida presented to the emergency department after she experienced pain and a change in vision in her left eye. Her right eye was asymptomatic. For the past 3 to 4 days, she had been wearing a pair of colored contact lenses she bought for fun at a discount store.

Julie Gerberding, MD, Director of the Centers for Disease Control and Prevention (CDC), reported on progress in the availability of influenza vaccine during a plenary session presentation this morning at the American Academy of Pediatrics 2006 National Convention and Exhibition.

A report issued late this past summer by the National Foundation for Infectious Diseases (NFID) provides practical strategies and tools to help pediatricians and other health care professionals increase what NFID considers an alarmingly low rate of influenza immunization among children who have asthma—part of an initiative to address immunization barriers and improve parental education about the importance of influenza vaccination for all children with asthma. Influenza vaccination has been shown to reduce morbidity and mortality in this high-risk pediatric population.

The child has orbital cellulitis, an infection with sometimes serious sequelae that involves the soft tissue of the orbit posterior to the orbital septum. Children are more likely than adults to contract orbital cellulitis; the median age of those affected is 7 years. Preseptal cellulitis--the other major infection of the ocular and adnexal orbital tissue--involves the soft tissue of the eyelids and periocular region anterior to the orbital septum and is considered less severe.

A 4-year-old African American boy presented with his second episode of orbital cellulitis in 9 months. William Demshok, PA-C, of Bascom Palmer Eye Institute, University of Miami, reports that a CT scan showed an abscess in the ethmoidal sinus with extension into the left orbit that impinges on the medial rectus muscle.

Tuberculosis (TB) remains one the most important infectious diseases in the world. More than 8 million people are infected every year. The vast majority of infections--95%--occur in developing countries, where the disease accounts for 25% of avoidable adult deaths.

Emerging and spreading zoonoses are major concerns among the public and public health professionals. Recognition, surveillance, and reporting are our first line of defense.

Photo Essay: A Collage of Infectious Diseases in Children Perichondritis Periorbital Cellulitis Bacterial Conjunctivitis Roseola Infantum (Exanthem Subitum) Tinea Corporis ("Ringworm")

The July 2006 issue, which featured an update on STDs, included a case on primary syphilis in a teenager (page 427). Therapy with intramuscular penicillin G (weekly for 3 weeks) or ceftriaxone (daily for 2 weeks) was recommended. However, the CDC's newly published guidelines on STD treatment recommend therapy with a single intramuscular dose of 2.4 million units of penicillin G.1 If the patient is allergic to penicillin, the alternative is therapy with doxycycline (100 mg orally bid for 14 days) or tetracycline (500 mg qid for 14 days). Ceftriaxone is not a recommended treatment for syphilis.

Musculoskeletal infections in children include osteomyelitis, septic arthritis, and pyomyositis. Most of these infections are bacterial. Staphylococcus aureus is the most common organism in children in all age cat-egories. Others include group A Streptococcus, Neisseria meningitidis in purpura fulminans, Streptococcus pneumoniae, Neisseria gonorrhoeae, Mycobacterium tuberculosis, and Borrelia burgdorferi.

A 3-year-old boy with high fever, malaise, anorexia, and drooling of 3 days' duration was brought to the emergency department (ED). A bacterial throat infection was diagnosed, and oral antibiotic therapy was started.

With children two to three times more likely than adults to become ill with the flu and spread the virus to others, the National Association of School Nurses (NASN) has launched a program to educate parents and students about influenza. "Don't Get Sidelined by the Flu," includes educational materials-in English and Spanish-for school nurses to share with parents and students to raise awareness about flu prevention, recognition of symptoms, and treatment options.

Nationally, immunization levels are higher than ever, but new challenges mean no rest for the pediatric community. Consider these tips on maintaining immunization coverage-to help you preserve and extend essential protection for children in your care.

Musculoskeletal infections in children encompass a broad spectrum of entities that vary greatly in severity and complexity. Their presentation ranges from obvious and acute to insidious and chronic.

A 12-year-old boy from Pakistan presented with weakness, night sweats, anorexia, and chronic cough of 2 months' duration. He had undergone spinal surgery about 5 months before immigrating to the United States when acute paralysis, kyphosis, and a prominent midline hump (gibbus deformity) developed in his thoracic spine. The child appeared pale and weak but in no acute respiratory distress. His weight was 20.5 kg (45 lb). He had difficulty in walking without assistance. Muscle wasting was noted in the arms and legs, and he had a healing lesion on the left elbow that drained pus. Other physical examination findings were unremarkable except for a fever (temperature of 37.2°C [99°F]) and the gibbus deformity.

The Centers for Disease Control and Prevention (CDC) Advisory Committee on Immunization Practices (ACIP) unanimously voted on June 29 that children 4 to 6 years old receive a second dose of varicella vaccine for the prevention of chickenpox.

Child Protective Services (CPS) has asked you to evaluate a 6-month-old girl with a genital mass. The goal is to determine whether the "weird lump in the baby's private area"--noted while the child's diapers were being changed in day care--was the result of sexual abuse.

Fourteen-year-old JT is worried. During health class last week, he learned about the different sexually transmitted infections as well as about testicular self-examination. While practicing his monthly testicular examination in the shower, he noticed that he had a number of small growths on his penis. On further questioning, JT insists that he has never been sexually active with another person.