1. Infectious and Communicable Diseases Ball & Bindler Donna Hills APN EdD

2. Clinical Considerations Etiology: bacterial, fungal, viral, or protozoan Cluster of symptoms are disease specific fever secondary to the release of prostaglandins, triggered by the invading organism may be a beneficial physiologic response. Fevers < 101-101.5 may not be treated right away.

3. Clinical Management Fevers > 101.5 are only treated with Acetominophen or Ibuprophen;not Aspirin due to association with Reye’s syndrome Symptomatic relief with viruses Antibiotics with bacterial infection; (anti- fungal or protozoan as applicable) Prevention of transmission/Isolation of infected child. Good handwashing/ bacteriostatic hand gel

4. The Toxic Child exhibits more severe symptomatology of illness high fever, lethargy, poor ability to focus or give eye contact, decreased tone, poor perfusion (delayed cap refill), hypoventilation or hyperventilation, cyanosis, saturation less than 95% on room air, significantly low temperature in a premie or child with neurologic impairment.

5. Evaluating Child with Fever/illness Body’s natural defense against infection Low grade fever may be beneficial to fight off organisms or enhance the effect of antibiotics. Antipyretics are usually given for temps >100 or 101 Ax (per Dr.’s order). Fevers >102 should be treated Some children experience febrile seizures so may treat more rapidly in this case. Acetominophen or Ibuprophen are preferred in children: no ASA d/t assoc with Reyes Syndr.

6. Case Study: 1 month old with a fever Mrs. Carole calls the pediatric office to report that her 1 mo old has an axillary temp of 101. She is eating a little less than usual but otherwise seems fine. What is your response to Mrs. Carole and what is your rationale?

7. Otitis Media Used to be a common cause for fever Incidence is now decreased with the use of the HIB and PCV vaccines. Some children are still anatomically prone to OM due to poor eustachian tube dysfunction with or without a URI Treatment with antibiotics: Amoxicillin, Azithromycin, Augmentin, Cefuroxime. Persistent fluid (SOM) can lead to hearing loss over time.

8. Infectious Skin Infestations Lice (Pediculosis Capitis) Common among children of all socioeconomic levels; ages 3-10yr most common. Nits found on hair shaft Incub for eggs 8-10 days Presents with itching and “flaking” Rx with Permethrin (Nix) shampoo Lindane is last resort: neurotoxic No-nit policy can be diffic for parents; not recommended by AAP.

9. Scabies Mite infestation: Sarcoptes scabei Skin to skin contact; household transmission common Most common in kids <2yrs Presents with intense puritis and characteristic linear rash (on hands or fingers) or diffuse trunkal rash. Rx with scabicide lotion (Permethrin 5%).

10. Impetigo Bacterial infection caused by staph or streptococcus. Common sites: face, around mouth, hands, neck, and extremities, intertriginous areas. Irritation or break in the skin serves as an entry Presentation as pustule surrounded by erythema/edema, erupts with honey colored crust. Bullous impetigo: vesicles enlarge, stim by release of endotoxin: coalesce Spread to face or extr: self innoculation.

11. Infectious and Communicable Diseases Review and study table 12-5 pgs 620- 635. Complete the worksheet/handout for infectious diseases.