Pediatrics Subject Collection: Infectious Disease & Immunity

Visual Diagnosis: Sepsis, Respiratory Distress, and a Persistent Right Lung Opacification in a Newborn [ARTICLES]

Sabnis, H. — 2009-11-01

Presentation Presentation Diagnosis: Right Diaphragmatic... Summary Suggested Reading A 20-year-old primigravida woman delivers a term female infant weighing 3,112 g via caesarean section under spinal anesthesia. The mother's antenatal test results are unremarkable, including a negative group B beta-hemolytic Streptococcus (GBS) screen at 33 to 34 weeks' gestation. Apgar scores are 8 and 9 at 1 and 5 minutes, respectively. Physical examination results are normal. Four hours after delivery, the infant develops tachypnea, grunting, and "blue" lower extremities. Supplemental oxygen is provided, blood and urine cultures are performed, and empiric treatment with intravenous ampicillin and cefotaxime is initiated. A chest radiograph reveals a normal cardia ...

Adoption of Rotavirus Vaccination by Pediatricians and Family Medicine Physicians in the United States [ARTICLES]

Kempe, A. — 2009-11-01

OBJECTIVES: The goals were to assess, among pediatricians and family medicine physicians, (1) rates of offering the vaccine in their office; (2) knowledge of Advisory Committee on Immunization Practices recommendations; (3) barriers to use; and (4) factors associated with offering the vaccine. METHODS: Surveys of pediatricians and family medicine physicians were conducted in August to October 2007. RESULTS: Response rates were 84% for pediatricians and 79% for family medicine physicians (N = 623). Proportions routinely offering the vaccine were 85% of pediatricians and 45% of family medicine physicians (P < .0001); 70% of pediatricians and 22% of family medicine strongly recommended the vaccine (P < .0001). Sixty-two percent of pediatricians and 32% of family medicine physicians (P < .0001) knew the age by which all 3 doses should be completed. Definite barriers to vaccine use included reported lack of coverage by insurance companies (family medicine physicians: 22%; pediatricians: 19%; not significant), costs of purchasing vaccine (family medicine physicians: 22%; pediatricians: 17%; not significant), lack of adequate reimbursement (family medicine physicians: 18%; pediatricians: 15%; not significant), concerns about safety (family medicine physicians: 25%; pediatricians: 9%; P < .0001), and concerns about adding another vaccine to the schedule (family medicine physicians: 22%; pediatricians: 5%; P < .0001). CONCLUSIONS: Rates of offering the new rotavirus vaccine are high among pediatricians but <50% among family medicine physicians. Both specialties identified financial barriers to use of the vaccine, but family medicine physicians had significantly more concerns about safety and about adding another vaccine to the vaccination schedule.

Multistate Outbreak of Salmonella Infections Associated With Small Turtle Exposure, 2007-2008 [ARTICLES]

Harris, J. R. — 2009-11-01

OBJECTIVE: Turtle-associated salmonellosis was increasingly recognized in the United States during the 1960s, leading to a federal ban in 1975 on the sale of turtles <4 inches in carapace length (small turtles). Although sporadic reports of turtle-associated Salmonella are frequent, outbreaks are rare. In September 2007, several patients with Salmonella enterica serotype Paratyphi B var Java infections reported recent turtle exposure. We conducted an investigation to determine the source and extent of the infections. PATIENTS AND METHODS: Patients with Salmonella Paratyphi B var Java infections with a specific pulsed-field gel electrophoresis pattern (outbreak strain) and illness onset between May 2007 and January 2008, were compared with healthy controls. Reptile exposure and awareness of a Salmonella-reptile link were assessed. Turtle size and purchase information were collected. RESULTS: We identified 107 patients with outbreak-strain infections. The median patient age was 7 years; 33% were hospitalized. Forty-seven (60%) of 78 patients interviewed reported exposure to turtles during the week before illness; 41 (87%) were small turtles, and 16 (34%) were purchased in a retail pet store. In the case-control study, 72% of 25 patients reported turtle exposure during the week before illness compared with 4% of 45 controls (matched odds ratio [mOR]: 40.9 [95% confidence interval (CI): 6.9-unbounded]). Seven (32%) of 22 patients versus 11 (28%) of 39 controls reported knowledge of a link between reptile exposure and Salmonella infection (mOR: 1.3 [95% CI: 0.4-4.6]). CONCLUSIONS: We observed a strong association between turtle exposure and Salmonella infections in this outbreak. Small turtles continue to be sold and pose a health risk, especially to children; many people remain unaware of the link between Salmonella infection and reptile contact.

Bronchiolitis [ARTICLES]

Wagner, T. — 2009-10-01

Objectives Objectives Introduction Epidemiology Diagnosis Management Prevention Prognosis References Suggested Reading After completing this article, readers should be able to: Recognize the clinical presentation of bronchiolitis. Be aware of the recommendations made in the current American Academy of Pediatrics clinical practice guideline for diagnosis and management of bronchiolitis. Describe the role of laboratory testing in the diagnosis of bronchiolitis. Delineate the efficacy of current therapeutic interventions in the treatment of bronchiolitis. Discuss the evaluation fo ...

Index of Suspicion [ARTICLES]

George, R. P. — 2009-10-01

Case 1 Presentation Case 1 Presentation Case 2 Presentation Case 3 Presentation Case 1 Discussion Case 2 Discussion Footnotes Case 3 Discussion A 3[1/2]-year-old boy, who lives in the southeastern United States, is referred for evaluation of eosinophilia that was detected on laboratory tests performed during a routine health supervision visit. A few days ago, he had loose stools, without blood or mucus, associated with low-grade fever. He has no history of significant illness, allergies, respiratory symptoms, weight loss, sick contacts, or travel. He is not taking any medications. He lives with his mother, aunt, three siblings, four cousins, and two dogs in a rural area that has city water ...

Development of a Patient-Reported Outcome Measure for Children With Streptococcal Pharyngitis [ARTICLES]

Shaikh, N. — 2009-10-01

OBJECTIVE: The objective of this study was to develop a patient-reported outcome measure (Strep-PRO) for assessing symptoms of group A Streptococcus (GAS) pharyngitis from the child's point of view and to present preliminary data on its internal reliability, construct validity, and responsiveness. METHODS: We selected 8 symptoms for inclusion in the Strep-PRO. We used the Strep-PRO to assess improvement in children who were aged 5 to 15 years and had confirmed GAS pharyngitis. Children completed the scale at study visits and as a diary at home. To evaluate internal reliability, we examined correlations between the items on the scale. To evaluate construct validity, we examined the correlation at entry between Strep-PRO scores and scores on other, previously validated measures of pain and functional status. To evaluate responsiveness, we examined the change in score from enrollment to follow-up. The correlation between the Strep-PRO score and parental assessment of symptoms was also evaluated. RESULTS: A total of 131 children were enrolled; 113 returned completed diaries. The internal reliability of the scale was high. The magnitude of correlations between Strep-PRO scores and other measures of pain and functional status ranged from 0.39 to 0.63. The responsiveness of the Strep-PRO was very good. The overall level of agreement between child Strep-PRO scores and parental assessment of symptoms was 0.57. CONCLUSIONS: The scale seems to measure effectively both pain and overall functional status in children with GAS pharyngitis. These data support the use of Strep-PRO as a measure of outcome in future clinical trials.

Mastering Diagnostic Skills: Enhancing Proficiency in Otitis Media, a Model for Diagnostic Skills Training [ARTICLES]

Kaleida, P. H. — 2009-10-01

OBJECTIVE: We developed a program for training in the diagnosis of otitis media that included images illustrating various otoscopic findings, mnemonic guides to recollection, and discrimination sessions that included feedback and assessments of diagnostic skills. METHODS: We prepared a computerized, interactive curriculum, Enhancing Proficiency in Otitis Media (ePROM), that was centered around assemblages of clinically diverse, still and video images of tympanic membranes (TMs). To assess curriculum effectiveness, we constructed a test, the Diagnostic Ear Assessment Resource, that consisted of 50 video TM images. We administered the test to 84 residents in pediatrics or family practice who had not been exposed to ePROM and, varying the order in which the images were presented, to another group of 102 residents in the same programs both before and after exposure to ePROM. RESULTS:o Mean proportions of correct diagnoses in the Diagnostic Ear Assessment Resource were larger among residents who had been exposed to ePROM than among residents at comparable levels of training who had not been exposed (67% vs 62%; P = .007). Among residents exposed to ePROM, mean proportions of correct diagnoses were larger after exposure than before (67% vs 55%; P < .001). CONCLUSION: A structured, computerized curriculum to supplement standard clinical training can enhance residents' abilities to interpret still and video images of TMs and may improve their skills in diagnosing otitis media.

Implementation of and Barriers to Routine HIV Screening for Adolescents [ARTICLES]

Minniear, T. D. — 2009-10-01

OBJECTIVES: We developed and implemented a process for routine HIV screening, and we report screening practices and acceptance among adolescents at a large, urban, pediatric emergency department (ED). METHODS: We surveyed health care providers regarding their knowledge and beliefs about HIV and generated a protocol for routine HIV screening. Free, routine, opt-out, HIV screening was offered for all adolescents (13-18 years of age) presenting for care in the ED. We studied ED HIV screening rates, rates of test acceptance among patients/guardians, patients' reasons for opting out, and HIV prevalence. A computerized prompt in the electronic chart was introduced 5 months after initiation, to address low screening rates. RESULTS: Of the 118 health care providers who responded to the preimplementation survey, 78% were unaware of the revised HIV testing guidelines and 58% predicted that routine screening would fail because of patient or guardian refusal. Of the 5399 patients who qualified for routine screening, 37% (2002) were offered opt-out screening. Of those, 13% opted out. Patients offered screening were more likely than patients not offered screening to be older ([≥]15 years; P = .002), female (P = .003), and nonwhite (P = .006). Older patients ([≥]15 years of age) who were approached for screening were less likely to opt out (P = .002). Computerized prompting improved screening rates. One of the 1735 tests (0.57 per 1000 tests) performed yielded positive results for HIV. CONCLUSION: Adolescents and their guardians accept routine, opt-out, HIV screening, regardless of gender or race, and a computerized reminder enhances screening.

Policy Statement--Recommendations for the Prevention and Treatment of Influenza in Children, 2009-2010 [FROM THE AMERICAN ACADEMY OF PEDIATRICS]

Committee on Infectious Diseases, — 2009-10-01

The purpose of this statement is to update current recommendations for routine use of trivalent seasonal influenza vaccine and antiviral medications for the prevention and treatment of influenza in children.

Thinking About HIV Infection [ARTICLES]

Simpkins, E. P. — 2009-09-01

Objectives Objectives Case Studies Introduction Epidemiology Pathogenesis Preventing HIV Transmission to... Testing for HIV Infection:... HIV-specific Treatment Counseling and Support Managing Potential HIV Exposure Having a High Degree... Conclusion Suggested Reading and Useful... After completing this article, readers should be able to: Recognize the important role that the general pediatrician plays in the prevention, detection, and care of human immunodeficiency virus (HIV)-infected and -affected patients. Select the proper HIV testing plan for pediatric and adolescent patients based on ...