PEDIATRIC INFECTIOUS DISEASES (Part 2)

In this Lecture: • Scabies • Chlamydia

• Fever • UTI’s • Gonorrhea
• Impetigo • Sepsis • Chancroid
• Molluscum contagiosum • Meningitis • HPV
• Pediculosis (Lice) • Syphilis • Herpes

FEVER CAUSES OF FEVER IN CHILDREN DX EVALUATION: NON-TOXIC DX EVALUATION: TOXIC TREATMENT

Temp ≥ 100.4◦F (38◦C).
Fever is a symptom of an
underlying condition (usually
infection)
FUO: Fever of unknown origin
3 most common causes of FUO
1. Infectious disease
2. Connective tissue diseases
3. Neoplasms
20% of childhood fevers have no
apparent cause
Risk for serious bacterial infection
greatest among febrile infants &
kids under 3 years old
TOP 3 Etiologies of Meningitis
in kids
Group B Strep
BACTERIAL Infections CBC w/ diff NON-TOXIC
• Strep pneumo (leading cause of bacterial -Schedule f/u within 24-48 hours or
upper resp. infection) Blood cultures (at least 2 from 2 diff sites) sooner if condition worsens
CBC w/ diff
• N.meningitidis -Treat the underlying cause of fever
CXR if elevated WBCs, tachypnea,
• H. influenzae UA by bladder catheterization &
• E. coli (most common cause of UTI’s) retractions, abnormal lung sounds, or O2
urine culture based on the TOXIC
• Salmonella • Sinusitis saturation <95%
following criteria: -Admit for further workup/treatment
• Abscesses • AOM
• Boys < 6 months & all uncircumcised -Administer IV antibiotics if indicated
UA by bladder catheterization & urine
VIRAL infections males
culture based on the following criteria:
• Adenovirus • CMV <12 months
• Girls < 2 years or older is symptoms
• Boys < 6 months & all uncircumcised males Empiric Antibiotics
• Hepatitis • Enterovirus <12 months
• Epstein-Barr (EBV) • Influenza suggest Ceftriaxone (Rocephin®): broad
• Girls < 2 years or older is symptoms suggest
UTI spectrum gran-negative activity
Misc. Infections UTI
• Q Fever • Rocky Mtn Sp. Fever Rapid testing for viruses (Flu, Cefotaxime for septicemia & tx. Useful as
Rapid testing for viruses (Flu, RSV)
• Malaria •Toxoplasmosis RSV) an alternative to ceftriaxone in babies age 1-2
Collagen Vascular Disease Consider stool studies/culture for WBC months (Ceftriaxone causes decreased
• Juvenile idiopathic arthritis Consider stool studies/culture for counts & guaiac if diarrhea present protein binding sites for bilirubin→
• Polyarteritis nodosa WBC counts & guaiac if diarrhea hyperbilirubinemia)
• SLE present Lumbar puncture or suprapubic aspiration
(CSF analysis) Ampicillin-Sulbactam (Unasyn®)
Malignancies Covers gram negative & gram positive,
• Leukemia, lymphoma, neuroblastoma Abdominal ultrasound for GI complaints covers skin, enteric flora, & anaerobes

IMPETIGO ETIOLOGY CLINICAL PRESENTATION DIAGNOSIS TREATMENT

AKA Pyoderma Stay home until healed! Super contagious!
• Starts as red
Usually diagnosed clinically based TOPICAL ANTIBIOTICS
Highly contagious NON-BULLOUS IMPETIGO: sore which
ruptures & on classic appearance Mupirocin (Bactroban®) ointment
Non-bullous impetigo is the most • Strep pyogenes (GABHS)
• Rarely Strep groups B, C, G oozes honey Fusidic Acid Cream
common skin infection in children Can Culture & Gram-stain
• Staph aureus may be colored crust
Occurs most often in children, especially Retapamulin (Altabax®) ointment
in hot, humid climates secondary
• Infection is tender / burning COMPLICATIONS
colonizer ORAL ANTIBIOTICS
RISK FACTORS • Strep infection (conjunctivitis,
• Bullous impetigo: fluid-filled blisters pharyngitis, FIRST LINE: Cephalexin (Keflex) or Dicloxacillin
• Daycare/school BULLOUS IMPETIGO: Nikolsy sign positive-apply lateral meningitis, endocarditis) 2nd line: Clarithromycin or Erythromycin
• Poor hygiene • Staph aureus strains that pressure to blister, positive sign • Scarlet Fever
• Compromised skin barrier (eczema, produce means the upper epidermis from the 3rd line: SMX-TMP (Bactrim), Clindamycin, or
• Urticaria
scratching, trauma, bug bites) exfoliative toxin A lower epidermis (blister moves) Doxycycline
• Erythema Multiforme
• Crowded living conditions Soak with warm water & use wet compresses to help
• Recent antibiotic treatment remove scabs

MOLLUSCUM CONTAGIOSUM
Benign viral infection
from poxvirus
Common in children &
immunosuppressed
Contagious lesions
RISK FACOTRS
• Kids sharing bath
• School/public recreation
• Sexual activity
LICE
AKA Pediculosis
Ectoparasites that live on
the body & feed on
human blood
Pediculosis capitus: head lice
Pediculosis corporis: body lise
Very common, gross
SCABIES
Parasitic infection by mite
Sarcoptes scabiei
PEDIATRIC INFECTIOUS DISEASES (Part 2)
CLINICAL PRESENTATION DIAGNOSIS TREATMENT
Usually resolves within months on its own
Contagious- avoid sports, physical contact between
• Usually asymptomatic but may infected areas, sexual abstinence
Usually diagnosed clinically
be mildly itchy Benign Destruction
based on classic appearance
• Single or multiple umbilicated Cryotherapy (LN2), Curettage, or Cantharidin
pink, rounded, dome-shaped Skin biopsy if unsure
waxy papules (2-5 mm) The following may or may not be beneficial
• Lesions can show up anywhere- usually face, trunk In adolescent or adult • Cidofovir or amantadine (antiviral) if
& extremities in children consider STI panel immunocompromised
• Gyms
• In adults, predilection for groin & genitalia • Imiquimod (Zyclara®)
• Pools
• Retinoids (Adapalene, Tretinoin, Tazarotene)
• Cimetidine (Zantac®) -H2 antihistamine
CLINICAL PRESENTATION DIAGNOSIS TREATMENT
Not all meds are ovicidal so may need to retreat
to kill newly hatched eggs (7-10 days)
• Itchy scalp (difficulty
sleeping, always scratching) Physical Exam • Permethrin (Nix) cream
Eggs (nits) • Malathion
• Adults- usually associated with Nymphs • Benzyl alcohol
sex & groin involvement Mature lice • Spinosad
• Ivermectin
Examine under microscope
• Risk secondary infection from Careful combing to remove nits
excoriation Woods Lamp: lice will fluoresce Wash clothes, hair accessories, towels,
bedding
TREAT ALL PEOPLE WHO ARE IN CLOSE
CONTACT (especially sexual partners)
CLINICAL PRESENTATION DIAGNOSIS TREATMENT
• Permethrin cream- single application at night
• VERY ITCHY Skin scraping & microscopic (wash off in 8-14 hours) from neck to soles of feet
• LINEAR burrows on wrist, ankles, finger webs, axillary examination (put on glass slide *kids may have scalp involved so may need treat
folds, genitalia or face with mineral oil. Add KOH to scalp & face (sparing eyes and mouth)
dissolve keratotic debris).
• May have excoriations • Ivermectin oral tablets. (NOT for use in
-Will show scabies mites, eggs,
or fecal pellets (scybala)
pregnancy or in children weighing <15 kg)
• Other people in
school/home may also be Dermatoscope will help magnify Wash clothes, avoid skin to skin contact until at
infected with same least 8 hours after treatment, clean room/bedding
view of skin lesions/scabies to
symptoms
help diagnosis CLOSE PERSONAL CONTACTS SHOULD ALSO BE
TREATED
 PEDIATRIC INFECTIOUS DISEASES (Part 2)

URINARY TRACT INFECTIONS RISK FACTORS CLINICAL PRESENTATION DIAGNOSIS TREATMENT

One of the most common
pediatric infections
Escherichia coli is most common
bacterial culprit of UTI’s (80%)
Difficult to distinguish between
cystitis & pyelonephritis clinically,
especially in children under 2 y.o
Cystitis (Bladder infection)
Pyelonephritis (Kidney infection)
-Can lead to renal scarring, HTN,
and end-stage renal disease
• Girls < 4 years old
• Boys < 1 year old
• Uncircumcised
• Caucasians affected
more often
• Anatomic abnormalities
of urinary tract or kidneys
• Vesicoureteral reflux
(VUR): retrograde
passage of urine from
bladder into the upper
urinary tract
Urinalysis & culture
Symptoms vary with age- some nonspecific INDICATIONS FOR HOSPITALIZATION
CBC & CMP if risk • Toxemic or septic
• Poor feeding • Failure to thrive pyelonephritis • Signs of urinary obstruction or significant
• Fever • Vomiting, abdominal pain
Blood cultures if suspect underlying disease
• Flank pain • Frequency, urgency, dysuria • Unable to tolerate oral fluids or meds
bacteremia or urosepsis
• Suprapubic tenderness • Infants under 2 months with febrile
• Foul-smelling urine, hematuria Renal function studies (BUN, • UTI (presumed pyelonephritis)
Creatinine, etc. ) • All infants under 1 month with suspected
WAYS TO OBTAIN URINE SAMPLE FROM KIDS UTI (even if not febrile)
Electrolytes
Midstream clean catch
kid must be toilet-trained, proper technique IMAGING TREATMENT
Clean voided bag -Not indicated for infants & Obtain urine culture prior to tx with abx
Noninvasive, ok for UA but should NOT be used for culture (high children with first episode
rates of false positives)-Do NOT give abx based on this alone FIRST LINE: SMX/TMP or Amoxicillin
-UTI should be confirmed before
Bladder catheterization-more invasive imaging IV Antibiotics: Ceftriaxone, Cefotaxime,
Ampicillin
Suprapubic bladder aspiration Voiding cystourethrography
Typically reserved when catheterizing is difficult, tight foreskin, (VCUG) Alternatives: 1st or 3rd generation
tight labial adhesions, significant periurethral irritation cephalosporin or Amox/Clav (Augmentin)
Renal ultrasound

SEPSIS ETIOLOGY CLINICAL PRESENTATION DIAGNOSIS TREATMENT

SIRS (Systemic Inflammatory Response • Fever (most common symptom) *Blood culture for ALL patients Aggressive FLUIDS & maintain volume
Syndrome) in the presence of suspected or • Tachycardia (ideally before antibiotics given) with VASOPRESSORS
proven infection BACTERIAL • Rapid or labored breathing Normotensive
• Staph aureus including MRSA Blood glucose Dopamine
• Cool extremities, diminished -hypoglycemia can occur due to
• Strep pneumoniae
SIRS criteria pulses (“cold shock”) metabolic demands of sepsis, Hypotensive vasodilated “warm” shock:
• Strep pyogenes (GABS) Norepinephrine
≥ 2 of the following, one must be abnormal temp • Toxic or ill appearance especially in neonates & infant
• Group B Strep in neonates
or leukocyte count • Altered mental status Hypotensive vasoconstricted “cold” shock
• Pseudomonas aeruginosa ABG’s: often inadequate perfusion
1. Temperature >38.5◦ C (101.3◦F) or < 36◦ C • Change in tone in neonates & Epinephrine
(96.8F) VIRAL infants with lactic acidosis
2. Tachycardia • Herpes-Simplex • Seizures CBC with diff
Ventilatory support: SUPPLEMENTAL O2
3. Tachypnea • Enterovirus • Anuria Leukocytosis or leukopenia Goal is O2 saturation >70%
4. Leukocyte count elevated or depressed for age • Adenovirus • Hypothermia (more ominous
or >10% neutrophils sign than fever) Elevated blood lactate (>3.5 • Maintain adequate hemoglobin
FUNGAL
5. Systolic BP < 90 (in neonates < 59 mmHg) mmol/L) from arterial puncture • Correct any physiologic or metabolic
• Candida sp.
Fungal etiology more likely w/: *Lumbar puncture- must r/o derangements
SIRS can occur without infection, which -Immunocompromised meningitis • Monitor urine output
would NOT be considered sepsis -Indwelling catheters
-Prolonged neutropenia Urinalysis ANTIBIOTICS
RISK FACTORS -Recent broad spectrum abx Newborns & infants in first 6-8 weeks of life
ESR, CRP
• Age < 1 month Ampicillin PLUS one of the following:
• Serious injury (burns, penetrating wounds) OTHERS Gentamycin / Cefotaxime / Ceftriaxone
CMP & electrolytes- eval renal &
• Parasitic (Malaria)
• Chronic medical condition (Cerebral palsy, liver function
• Rickettsia (Rocky Mtn Spotted Older infants & children with unclear etiology
congenital heart disease) Fever) CXR if respiratory symptoms present [Vancomycin + 3rd generation cephalosporin]
• In-dwelling catheters or other invasive (Cefotaxime, Ceftazidime. Ceftriaxone / Cefdinir )
devices US, CT, Echo Add Clindamycin if staph or GABHS are possible
 PEDIATRIC INFECTIOUS DISEASES (Part 2)

MENINGITIS BACTERIAL MENINGITIS NON-BACTERIAL ETIOLOGIES CLINICAL PRESENTATION

CLASSIC TRIAD OF BACTERIAL MENINGITIS
BACTERIAL = Life-threatening!! 1. Fever
Clinical syndrome due to inflammation _____________________________ 2. Headache
Neonates (< 4 weeks) 3. Neck stiffness (60-80%)
of the meninges surrounding the brain VIRAL serious but rarely fatal
& spinal cord 1. Group B streptococcus 1. Enteroviruses (85%) Other symptoms:
2. E. coli 2. Human parechoviruses
3. Herpesviruses (HSV especially) • Nausea, vomiting • Sleepiness, lethargy
Bacterial meningitis is the most severe, 3. Other gram-neg bacilli
however, it is less common than viral _______________________________________________ 4. Others (Arboviruses, Rabies, • Irritability • Delirium
meningitis ≥ 1 month and < 3 months Influenza) • Headaches • Photophobia
_______________________________________________
1. Group B streptococcus (39 %)
RISK FACTORS Indications of nuchal rigidity (neck stiffness)
2. Gram-negative bacilli (32 %) FUNGAL
• Recent exposure to someone with 3. Strep pneumoniae (14 %) 1. Candida albicans Kernig Sign: pt supine with
meningococcal or Hib meningitis 4. N. meningitidis (12 %) 2. Coccidioidomycosis hip & knee flexed at 90◦,
_______________________________________________ _______________________________________________
• Recent infection (especially cannot extend knee more
respiratory or ear infection) ≥ 3 months and < 3 years than 135◦ and/or if there is
PARASITIC
1. Strep. pneumoniae (45 %) flexion of opposite knee
• Recent travel to areas with 1. Angiostrongylus cantonensis
2. N. meningitidis (34 %) 2. Baylisascaris procyonis
endemic meningococcal Brudzinski sign: pt supine,
3. Group B Streptococcus (11%) 3. Gnathostoma spinigerum
disease (sub-Saharan Africa) flexes lower extremities during
4. Gram-negative bacilli (9%) _______________________________________________
• Penetrating head trauma _______________________________________________ attempted passive flexion of
≥ 3 years and < 10 years NON-INFECTIOUS neck
• CSF otorrhea (congenital
defects) or CSF rhinorrhea 1. Cancers
1. Strep pneumoniae (47 %) Infants < 1 year old
2. Systemic lupus erythematosus
• Cochlear implant devices 2. N. meningitidis (32 %t)
_______________________________________________ 3. Head injury • Lethargy
• Anatomic defects • Respiratory distress
≥ 10 years and < 19 years
• Jaundice • Seizures
1. N. meningitidis (55 %)
• Poor feeding • Bulging fontanelle
DIAGNOSIS TREATMENT
OBTAIN STAT
1. Blood cultures (2 sets)- sepsis may be present • Ensure adequate oxygenation, ventilation, and circulation.
2. CBC with diff & platelets • Obtain venous access & start cardiorespiratory monitoring while obtaining labs
3. PT / PTT (especially if petechiae or purpura present) • Keep the head of bed elevated at 15 to 20 degrees.
4. CMP (electrolytes, BUN, creatinine, glucose) • Treat hypoglycemia, acidosis, and coagulopathy, if present
5. Lumbar puncture with CSF analysis (*unless contraindicated)
DON’T DELAY THE ANTIBIOTICS!! Start empiric tx immediately after LP / blood cultures
Lumbar Puncture CONTRAINDICATIONS: (Do NOT delay abx if LP is contraindicated) IV Ceftriaxone or Cefotaxime PLUS Vancomycin
• Increased intracranial pressure (hydrocephalus) • Papilledema
• Focal neurologic signs (CN palsies) • Immune deficiency IV Dexamethasone if the following risk factors present:
• CSF shunt • CNS trauma
• Hx of neurosurgery • Space-occupying lesion ( brain tumor) - Unimmunized patient - Young children[age ≥6 weeks to ≤5 years]
• Skin infection over site of LP • Uncorrected coagulopathy - Sickle Cell Disease - Asplenia
• Significant cardiorespiratory compromise - Known H. influenzae infection (based on culture/gram stain)
CONSIDER: **If dexamethasone is given, it should be administered before, or immediately after, the first dose of
• Nasopharynx or resp. secretions • Urine / skin lesion cultures antimicrobial therapy.
• Syphilis testing • Head CT or MRI

SYPHILIS
Treponema pallidum spirochete
Congenital syphilis: transplacental
transmission
• usually occurs in 2nd half of pregnancy
• Women w. untreated primary or secondary
syphilis more likely to transmit it than women
with latent disease
•T. pallidum is NOT transferred in breast milk
Acquired syphilis: infected through
sexual contact
TERTIARY SYPHILIS
Early latent syphilis (<1 year from initial infection)
• Meningitis meningovascular disease
Late latent (> 1 year from initial infection):
• Paresis, tabes dorsalis
• Gummas (granulomas of subcutaneous
tissues)
Destructive lesions, usually affect skin &
bones. Progressive, painless, dull nodule or
plaque that can ulcer. Non-infectious
• Cardiovascular involvement: ascending
thoracic aorta may become dilated or develop
aortic valve regurgitation
• Can progress to neurosyphilis
PEDIATRIC INFECTIOUS DISEASES (Part 2)
CONGENITAL SYPHILIS ACQUIRED SYPHILIS (PRIMARY & SECONDARY)
• Late abortion or stillbirth
• Hydrops fetalis
• Premature delivery PRIMARY SYPHILIS
60-90% are ASYMPTOMATIC at birth •Incubation period: 2-3 weeks
• Painless chancre: heals spontaneously in 3-6 weeks (usually on
EARLY SYMPTOMS: (young infants) genitalia)
• Hepatomegaly • Bilateral lymphadenopathy
_________________________________________________________________________________________
• “Snuffles” (syphilitic rhinitis): initially clear, then ______________
purulent or bloody SECONDARY SYPHILIS
• Rash: usually appears 1-2 weeks after the rhinitis • Weeks to months after chancre develops
(lesions on trunk, thighs, palms & soles of feet) • Rash: diffuse macular or popular involving entire trunk,
extremities, including palms & soles
• Thrombocytopenia, anemia
• Lesions are discrete copper, red, or reddish-brown (0.5-2
• Pseudoparalysis of arms or legs
cm)
• Metaphyseal dystrophy, osteochondritis • Lesions are often scaly but may be smooth
• Condyloma lata: when rash presents on mucosal surfaces, large
LATE CHILDHOOD gray/white lesions develop in mouth & perineum
• Interstitial keratitis • “Moth-eaten” patchy alopecia
• Hutchinson teeth • Hepatitis, GI, renal, or musculoskeletal abnormalities
• Deafness (CN VIII affected)
• Periosteum thickening of tibias
DIAGNOSIS TREATMENT
T. pallidum CANNOT BE CULTURED- can only be seen with
darkfield microscopy
NONTREPONEMAL (reported as titers)
Use if just screening
• RPR • VDRL • TRUST
IM Penicillin G
TREPONEMAL (reactive or nonreactive)
Use if +NTT or high suspicion of syphilis
• Fluorescent aby absorption (FTA-ABS) If PCN allergy- desensitization therapy to make them not
• Microhemagglutination (MHA-TP) allergic to PCN
• Particle agglutination assay (TP-PA)
• Enzyme immunoassay (TPEIA) If desensitization is not possible: Doxycycline
***Not always positive initially, recheck in 3-4 weeks
NERUOSYPHILIS
• Lumbar puncture with CSF examination is the only way to
definitively diagnose
• Presence of gummas or cardiovascular involvement must have
LP to r/o neurosyphilis
 PEDIATRIC INFECTIOUS DISEASES (Part 2)

CHLAMYDIA MANIFESTATIONS DIAGNOSIS TREATMENT

WOMEN
• Asymptomatic (majority)
• Pelvic Inflammatory. Disease
If untreated in pregnancy
Chlamydia trachomatis
• ↑ risk premature membrane rupture &
Gram-negative aerobe • Low birth weight
Obligate intracellular parasite
NEWBORNS
Most common bacterial STI in US • Mucopurulent conjunctivitis
• Pneumonia
• “Staccato cough”
More common in women
MEN
• Urethritis
• Epididymitis (Men < 35)
• Proctitis (more common in men who have sex w men)
Often coexists with gonorrhea so
• Cervicitis
treat for both
• Urethritis
Gold standard: Nucleic Acid
Amplification Tests Azithromycin
Conjunctival secretions, vaginal or Doxycycline (NOT in kid)
secretions, urine
Alternatives:
Gram-stain for epididymitis Levofloxacin or Ofloxacin
RETEST for cure with:
Viral culture
-Pregnancy
expensive & time consuming
-Persistent symptoms
-Use of agent with inferior cure rate
(erythromycin or amoxicillin)

GONORRHEA CLINICAL PRESENTATION DISSEMINATED GONOCOCCAL INFECTION DIAGNOSIS TREATMENT

Neisseria gonorrhoeae
Intracellular gram-negative
diplococci
2nd most common bacterial
STI in US
Increasing antibiotic
resistance
Sites of infection
Cervix, urethra, rectum,
pharynx, eyes
Virtually indistinguishable from
chlamydia (always test for both) Occurs in 1-3% of pts infected IM Ceftriaxone (Rocephin)
3x more common in women than men PLUS Azithromycin or Doxy (to
WOMEN • Asymptomatic infection predisposes Nucleic acid amplification cover chlamydia)
• Pelvic Inflammatory Disease (PID) • Immunocompromised more at risk (pregnancy, test (NAAT)
• Most common site is cervix *Emerging resistance to ceftriaxone
SLE, complement deficiencies)
• Urethritis Alternatives: cefotaxime, cefoxitin +
Culture can be difficult- probenecid
DGI TRIAD
MEN fastidious organism
1. Tenosynovitis
• Urethritis Requires Thayer-Martin Neonatal gonococcal
• Epididymitis 2. Dermatitis agar conjunctivitis-
• Proctitis 3. Polyarthralgias
all newborns get prophylactic
NEONATAL Gram stain usually for dx Erythromycin ophthalmic gel
• Multiple inflamed tendons near joints
CONJUNCTIVITIS • Painless skin lesions- few in number, transient
urethritis in men
• Gonococcal • Purulent arthritis without skin lesions Gonorrhea is a reportable infection
Ophthalmia Neonatorum (knees, wrists, ankles) All sexual contacts within past 60 days
• Corneal ulceration, perforation, & blindness should be evaluated & treated

CHANCROID CLINICAL PRESENTATION DIAGNOSIS TREATMENT

Caused by Haemophilus ducreyi
Gram negative anaerobe
Mainly found in developing & 3rd
world countries
• Symptoms develop in 1-14 days: small
papule in genitals which becomes an Gram stain of exudate from an
ulcer within a day of its appearance ulcer
• PAINFUL chancroid Azithromycin or Ceftriaxone
• More whitish-gray than syphilis
chancre Culture (requires special media
• Base bleeds easily that’s not widely available
• May have inguinal lymphadenopathy
 PEDIATRIC INFECTIOUS DISEASES (Part 2)

HUMAN PAPILLOMA VIRUS MANIFESTATIONS CLINICAL PRESENTATION DIAGNOSIS TREATMENT

TOPICAL MEDS
Genital warts-condyloma acuminata • Imiquimod (Zyclara®)
• Podofilox (Condylox®)
Bowenoid papules & Bowen’s disease Anogenital warts are THE MOST COMMON • Trichloroacetic acid- (preferred tx for
HPV (SCC-in situ) VIRAL STI in the US pregnancy)
Usually by visual
double stranded DNA virus Bowenoid papules- transitional state -mostly women • 5-fluorouracil (Efudex®)
inspection
between condyloma & SCC-in situ
AKA Condylomata acuminata • May be DESTRUCTIVE TREATMENTS
Biopsy of lesions
Giant condyloma (Buschke-Lowenstein asymptomatic • Intralesional inj with alpha interferon
Carcinogenic types: tumors) -carcinoma • Itching/burning • Cryotherapy (LN2)
-plays a role in SCC of head/neck & oral Pap smear
HPV 16 & 18 • Bleeding • Laser therapy- requires anesthesia,
cavity • Pain/tenderness risk of scarring
5% acetic acid causes • Ultrasonic aspiration
Genital wart types: • Discharge (women)
Recurrent respiratory papillomatosis- lesions to turn white • Excision- requires anesthesia, risk of
HPV 6 & 11 • Large condylomata can interfere with
benign laryngeal tumor in children defecation, intercourse, & vaginal delivery infection & hemorrhage, send
caused by HPV acquired during birth specimen to path

PREVENT WITH GARDASIL VACCINE

HERPES SIMPLEX
CLINICAL PRESENTATION CONGENITAL HSV DIAGNOSIS TREATMENT
VIRUS (HSV)
• Grouped vesicles on an erythematous base High mortality rate: most commonly acquired
• Fever & malaise during birth in transit through infected birth canal
• Tender regional adenopathy Transmission more likely if mom is having a
primary outbreak
PRIMARY INFECTION-no HSV
antibodies PCR can test for asymptomatic Valacyclovir (Valtrex)- BID
90% with HSV are
-Range from asymptomatic to severe shedding
undiagnosed
-Symptoms more severe in women Acyclovir (Zovirax) QID
Direct fluorescent antibody -rapid,
HSV-1 Systemic symptoms- local pain/itching, dysuria, sensitive test or Famciclovir
HSV-2 (more common) lymphadenopathy
Dysuria can be due to acute urinary retention or rarely Skin, Eye, Mouth Disease (45%) Viral culture if active lesions present
Can be subclinical Primary: best if treated within
to lumbosacral radiculomyelitis -Characteristic vesicular lesions (sensitivity 50%) 72 hrs
-Conjunctivitis, excessive tearing
Recurrent outbreaks may be NONPRIMARY INFECTION -Ulcerative lesions in mouth, palate, tongue Serology Recurrent:
triggered by -1st episode infection due to acquiring HSV type
CNS Disease (30%) -type specific antibody testing chronic therapy-expensive,
- Stress where person has preexisting antibodies to the other
-Seizures -Lethargy -see if at risk of acquiring from partner may not be covered
- Sun exposure type
-Irritability -Tremors with HSV Episodic tx- start at first sign
- Cold weather -Less symptomatic than the 1st episode
- Poor feeding -see if evidence of prior infection of prodrome, take for 3 days
RECURRENT Disseminated Disease (25%)
-Reactivation of HSV -Sepsis -DIC
-Less severe & shorter duration -Elevated LFT’s - Fever or hypothermia
-May be asymptomatic shedding -Respiratory distress -Thrombocytopenia