Welcome to Big Sky Country. Pediatrics Infectious disease update. Todd TwogoodMD

Transcription

1 Welcome to Big Sky Country Pediatrics Infectious disease update Todd TwogoodMD

2 My kid is always sick!!

3 We have to deal with parents

4 Snotty nose kids Average number of colds in children from Oct to March is 7 Average duration is 10 days That s 70 days of infection More days sick than days healthy

5 Who ever came up with this idea

6 Not a good idea

7 How to treat a cold Humidified air Nasal saline Upright position while awake Let fever go unless uncomfortable Ibuprofen safe at 3 months old Give it time

8 Sinusitis vs a cold Persistent type sinusitis Depends on duration 3-4 days of a cold gives green goop (that is not a sinus infection) Greater then 7-10 days, longer in infants (that is a sinus infection) Only symptom needs to be a snotty, congested nose Antibiotic treatment is valid Treat 3-4 days past symptom resolution

9 Common pediatric organisms Streptococcus pneumoniae 25% 50% Haemophilus influenzae 15% 30% Moraxella catarrhalis 3% 20% Group A streptococcus 1% 5%

10 Tonsillitis Not always strep Only 9-10 % is strep Need a strep test MD accuracy in diagnosis is only 37% Cephalexin is first choice Not PCN or Amoxicillin (co-pathagenicity)

11 Otitis media (listen up) Must have a middle ear effusion Insufflation, Tympanogram Amoxis still first choice, then Augmentin, Cephalosporin, Bactrim Criteria for tubes / ENT referral 4 OM in 6 months 6 OM in 12 months persistent MEE bilaterally for 3 months

12 Otitis media

13 Bronchitis and Pneumonia Bronchitis has to be cough of 2 weeks or greater Both 85-87% viral Prednisone should not be used routinely Do need Antibiotics (Zithromax, Augmentin or Cephalosporin)- What? Cough suppressant??

14 RSV 96.7 % of all children get it at least once before age 2yo RSV rapid test is poor, DFA is good Bronchiolitis, cough for 2-3 weeks Contagious for average 45 days Does not cause Asthma, or damage the lungs Albuterol does not work (unless they have Asthma)

15 Enterovirus Family of viruses Respiratory or Flu like symptoms Enterovirus D68- respiratory effects Adenovirus Most common cause of meningitis Common Fall and Spring May be hospitalized

16 Adenovirus Fever degrees off and on for 5-6 days Sore Throat Headache Muscle ache Fatigue Red glassy eyes Stomach Stuff (may have N/V/D)

17 Infectious Mononucleosis EBV is cause 89% of the time Syndrome of fatigue, tonsillitis, posterior lymphadenopathy, splenomegaly Average age is 5-9 years old Not a teenagers disease The younger you are the shorter duration and less severe symptoms Mono spot test has a lot of false negatives EBV titers is accurate, may not need

18 Hand foot and mouth disease Always caused by Coxsackie A-16 Has transformed in the past few years more of a diffuse rash less mouth sores may be older kids or adult Still supportive care

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20 Influenza A and B Usually hits Midwest region Feb or March Kills on average 2,600 people in the US yearly Vaccine (flu mist) etc

21 Vaccines Best health advancement in the 2000 year millennium What about parental refusal No link to Autism Don t split vaccines Myths vs Facts Andrew Wakefield, Jenny McCarthy, Bob Sears

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23 Vaccines and parental refusal Their responsible Sign a waiver How can you guide them Pneumococcal, Pertussis (DTaP) Smart Vaccine concepts and titers.

24 That s a bunch of Crap

25 Speaking of Crap Gastroenteritis Most common virus = Norovirus Younger you are: longer and worst of symptoms Signs of dehyration Pediatric gastroenteritis disaccharide reduced diet Anti-nausea meds (zofran, promethazine) Stool sample after 7 days Remember Shigella is a toxic appearing child E. coli O157: H7 causes HUS

26 UTI Only 3% of girls Circumcised boys < 0.05% E. Coli is 83% of cases Must get a urine culture to confirm Cath specimen vs Bagged, clean catch Leukocyte esterase and WBC is predictive Nitrates is not Future work up recommendations have changed

27 Recurrent Infections Immune deficiency work up CBC, Quantitative Immune Globulins (IgG, IgM, IgA) with IgG subclasses IgA is the most common Complement factor total CH50 More aggressive treatment

28 Contamination Control Hand washing vs sanitizing gel No sharing cups, spoons or straws Separate towels No close kissing Sneeze into your elbow

29 Thank you