Infectious Diseases

Prophylactic antibiotics have long provided asplenic children with a measure of protection against bacteremia and sepsis. Recent progress in vaccines promises to strengthen the defense.

Wheeler D et al: Arch Dis Child 2003;88:688

I've been on service this month caring for hospitalized patients and, once again, I'm reminded that managing illness in children isn't as straightforward as it used to be.

A toddler was brought to the emergency department with a 3-day history of a rash on her neck and irritability and fever (temperature, 38.3°C [101°F]) of 1 day's duration. The child's mother noticed a red, purulent bump on the girl's hand 2 days before the rash developed.

Complaints of pain in an ear prompted the mother of a 4-year-old boy to seek medical consultation for her son. The external ear was red, swollen, and warm. This appearance is typical of erysipelas caused by group A β-hemolytic streptococci.

After several days of suffering fever, headache, and malaise, a 17-year-old boy noticed a rash developing over much of his body. He sought medical attention and was admitted to the hospital.

All cutaneous and mucosal surfaces can fall prey to fungi such as dermatophytes and yeasts. Here's how to recognize superficial fungal infections and initiate treatment.

This year, for the first time, the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics have issued a statement that yearly influenza immunization for infants 6 to 23 months of age "is encouraged when feasible."

October signals the beginning of flu immunization season, and expanded guidelines encourage the vaccination of even healthy young children.

Advances in rapid diagnostic tests and antiviral therapy for influenza have given pediatricians new options for identifying and fighting this old and resilient foe.

Keeping track of changes in immunization recommendations is the best way to be certain that our patients receive maximal benefit.

Developments have opened new vistas in diagnosing and treating the broad spectrum of illness caused by the versatile nonpolio enteroviruses.

The biggest change in this year's schedule is the addition of the seven-valent pneumococcal conjugate vaccine.

Many families feel that pediatricians just don't listen when they try to voice concerns about vaccines. Our recommendation: Identify each family's specific issues, target your response accordingly, and use a nonconfrontational approach. Time-consuming lectures on big subjects like immunology generally aren't needed.

Arthritis can be caused by a range of viruses or other infectious agents, or develop in the wake of an enteric, genitourinary, or respiratory tract infection. Knowing the possible causes and typical signs and symptoms of infection-related arthritides helps make the diagnosis.

Widespread vaccination of children isn't yet a reality, but rapid diagnostic tests and new drugs are putting early, effective treatment of both influenza A and B within reach.