The American Academy of Pediatrics is not responsible for the content of the resources mentioned in this publication. The American Academy of Pediatrics (AAP) Red Book® Atlas of Pediatric Infectious Diseases, 3rd Edition, is a summary of key disease information from the AAP Red Book®: 2015 Report of the Committee on Infectious Diseases.
Adenovirus Infections
The lung histopathology of an immunocompromised child in Figure 2.4 shows multiple adenovirus intranuclear inclusion cells. Histopathology of a lung with bronchiolar occlusion in an immunocompromised child who died of adenovirus pneumonia.
Amebiasis
Amebic liver abscesses are usually single and large in the right lobe of the liver. This patient had a case of invasive extraintestinal amoebiasis affecting the skin area of the right flank.
Amebic Meningoenceph
In infection with Acanthamoeba species and B mandrillaris, trophozoites and cysts can be visualized in parts of the brain, lungs and skin. Acanthamoeba species and Balamuthia mandrillaris are opportunistic free-living amoebae capable of causing granulomatous amebic encephalitis in individuals with compromised immune systems.
Anthrax
For anthrax with evidence of systemic disease, including fever, shock, and spread to other organs, anthrax immune globulin or Raxibacumab (GlaxoSmithKline, Research Triangle Park, NC), a humanized monoclonal antibody, should be considered in consultation with the Centers for Disease Control and - prevention. Courtesy Centers for Disease Control and Prevention/Larry Stauffer, Oregon State Public Health Laboratory.
Arboviruses
The disease is most often characterized by an acute onset of fever (usually >39°C [102°F]) and polyarthralgia. Persons at risk for severe disease include neonates exposed in utero, older adults (eg, > 65 years), and people with underlying medical conditions (eg, hypertension, diabetes, cardiovascular disease).
Clinical Manifestations for Select Domestic and International Arboviral Diseases
In general, the risk of severe clinical disease for most arbovirus infections in the United States is greater in adults than in children. Genus, geographic location, vectors, and average number of annual cases reported in the United States for selected domestic and international arbovirus diseases.
Genus, Geographic Location, Vectors, and Average Number of Annual Cases Reported in the United States for Selected Domestic and International Arboviral Diseases
For other arboviruses, the results of these tests are often negative early in the clinical course due to the relatively short duration of viraemia. Adult worms can be detected by computed tomography scan of the abdomen or by ultrasound examination of the bile ducts.
Aspergillosis
Monitoring of serum antigen concentrations twice weekly in periods of highest risk (e.g., neutropenia, active graft versus host disease) may be useful for early detection of invasive aspergillosis in at-risk patients. Allergic sinus aspergillosis is also treated with corticosteroids, and surgery has been reported to be beneficial in many cases.
Astrovirus Infections
Although astroviruses are often associated with gastroenteritis, they have not been associated with central nervous system disease.
Babesiosis
The most well-known association of emetic syndrome is with the ingestion of fried rice made from parboiled rice stored at room temperature overnight, but the illness has been associated with a wide variety of foods. For foodborne outbreaks, isolation of B cereus from the feces or vomitus of 2 or more sick people and not from control patients, or isolation of 105 colony-forming units/g or more from epidemiologically implicated food, suggests that B cereus is the cause of the outbreak.
Bacterial Vaginosis
Members of the Bacteroides fragilis group predominate in the flora of the gastrointestinal tract; members of Pre. Coronal T2-weighted magnetic resonance imaging of the brain in a 4-year-old with Baylisascaris procyonis eosinophilic meningitis.
Infections With
Knowledge of life cycle and transmission is still under investigation; therefore, this is the proposed life cycle for Blastocystis hominis. The amoeboid form gives rise to a precyst (6b), which develops into a thick-walled cyst (7b) through schizogony.
Blastomycosis
This micrograph shows the histopathological changes that reveal the presence of the fungal agent Blastomyces dermatitidis.
Bocavirus
Mortality rates are 10% to 70% in untreated relapsing louse fever (possibly associated with comorbidities in refugee-type environments where the disease is commonly found) and 4% to 10%. In the United States, tick-borne relapsing fever can only be acquired in western states, but has been diagnosed in other states in travelers returning from these areas. Treatment of recurrent tick-borne fever with a 5- to 10-day course of a tetracycline, usually doxycycline, produces rapid clearance of the spirochetes and relief of symptoms.
Brucellosis
In patients with chronic granulomatous disease, pneumonia is the most common manifestation of B cepacia complex infection; lymphadenitis also occurs. The source of acquisition of B-cepacia complex in patients with chronic granulomatous disease has not been identified. With vancomycin, gentamicin and polymyxin B, this agar is used to isolate B-cepacia complex from respiratory secretions of patients with cystic fibrosis.
Candidiasis
Evaluation should occur once candidemia is controlled and in patients with neutropenia, evaluation should be delayed until neutrophil counts recover. Candida albicans (thrush) infection of the tonsils and uvula of an otherwise healthy 6 month old. Photograph of a very low birth weight newborn who developed invasive fungal dermatitis of the back caused by Candida albicans.
Catscratch Disease
Cat-scratch disease granuloma of the finger in a 12-year-old white boy with epitrochlear node involvement (see image 25.10). Stellate microabscess in the lymph node of a patient with cat-scratch disease (Warthin-Starry silver stain; original magnification x158). A granulomatous lesion of cat scratch disease at the base of the right thumb in a 4-year-old white boy.
Chancroid
C trachomatis is the most common sexually transmitted infection in the United States, with high rates among sexually active adolescent and young adult women. Although disease is rare in the United States, outbreaks of LGV have been reported in men who have sex with men. Chlamydia trachomatis is the most commonly reported sexually transmitted infection in the United States, with high infection rates among sexually active adolescents and young adults.
Clostridial Myonecrosis
Isolation of the organism or toxin detection from the stool of a patient who does not have liquid stools (unless toxic megacolon is suspected) should not be performed. Clostridium difficile is a gram-positive, spore-forming bacterium that may be part of the normal intestinal flora in as many as 50% of children under 2 years of age. Enteritis necroticans (also known as pigbel) results from hemorrhagic necrosis of the midgut and is a cause of severe illness and death attributable to C perfringens food poisoning caused by Clostridium β-toxin.
Coccidioidomycosis
An EIA test for urine, serum, plasma, or bronchoalveolar lavage fluid is available from a US laboratory for the detection of Coccidioides antigen. Pneumonia due to Coccidioides immitis in the upper lobe of the left lung of a 5½ month old. Erythema nodosum lesions on skin of the back due to hypersensitivity to antigens of Coccidioides immitis.
Coronaviruses, Including SARS and MERS
MERS-CoV is thought to have evolved from a natural reservoir of MERS-CoV-like viruses in bats. The yield from lower respiratory tract samples is higher for SARS-CoV and MERS-CoV. Stool and serum samples are also frequently positive using reverse transcriptase-polymerase chain reaction assays in patients with SARS-CoV and have been positive in some patients with MERS-CoV.
Cryptosporidiosis
Given the seriousness of this infection in immunocompromised individuals, use of nitazoxanide may be considered in immunocompromised HIV-infected children in conjunction with combination antiretroviral therapy for immune restoration. Cryptosporidium, a spore-forming coccidial protozoan, can be seen on the brush border of the intestinal mucosa. Histopathologic features of gallbladder epithelium include numerous Cryptosporidium organisms along luminal surfaces of epithelial cells.
Cutaneous Larva Migrans
Cyclosporiasis
Fresh produce and water can serve as vehicles for transmission (4), and the sporulated oocysts are ingested (in contaminated food or water) (5). The oocysts excyst in the gastrointestinal tract and release the sporozoites, which invade the epithelial cells of the small intestine (6).
Cytomegalovirus Infection
A presumptive diagnosis of CMV infection after the neonatal period has been associated with a 4-fold increase in antibody titer in paired serum specimens or by evidence of virus shedding. Intravenous ganciclovir is the drug of choice for induction and maintenance treatment of retinitis caused by acquired or recurrent CMV infection in immunocompromised adult patients, including HIV-infected patients, and for prophylaxis and treatment of CMV disease in adult transplant recipients. Cytomegalovirus establishes a lifelong persistent infection and as such is not eliminated from the body with antiviral treatment of CMV disease.
Dengue
Dengue virus is detectable by reverse transcriptase polymerase chain reaction or nonstructural protein 1 antigen OIs from the onset of the febrile phase until day 7 to 10 after the onset of illness, but anti-DENV IgM antibodies are not detectable until at least 5 days after the onset of the disease. . A 4-fold or greater increase in anti-DENV IgG antibodies between the acute (≤ 5 days after onset of . symptoms) and recovery (>15 days after onset of symptoms) samples confirms recent infection. A single anti-DENV IgG antibody titer of 1:1280 or more is highly suggestive of a dengue diagnosis.
Diphtheria
In order to neutralize toxins from the organism as quickly as possible, intravenous administration of the antitoxin is preferred. However, because of the non-specific symptoms, Rocky Mountain spotted fever should be considered. Sequence confirmation of the amplified product provides specific identification and is often necessary to identify infection with certain species (eg, E ewingii; . E muris-like agent in the United States).
Human Ehrlichiosis, Anaplasmosis, and Related Infections
The intracytoplasmic inclusion, or morula, of human monocytic ehrlichiosis in a cytocentrifuge preparation of cerebrospinal fluid from a patient with central nervous system involvement. Photomicrographs of human white blood cells infected with the agent of human granulocytic ehrlichiosis (Anaplasma phagocytophilum, formerly Ehrlichia phago . cytophila) and the agent of human monocytic ehrlichiosis (Ehrlichia chaffeensis). This tick is a vector for several zoonotic diseases, including human monocytic ehrlichiosis, southern tick-associated rash, tularemia, and rocky mountain spotted fever.
Enterovirus ( Nonpoliovirus)
A more recent classification system groups these nonpolio EVs into 4 types (EV-A, -B, -C, and -D) based on genetic similarity; polioviruses are members of EV-C. Characteristic papulovesicular lesions on the palm of a 2-year-old boy with foot-and-mouth disease, a coxsackievirus A infection, usually A16, or enterovirus 71. A 4-year-old Caucasian girl with pharyngeal inflammation and palatal lesions of hand-foot-and- mouth disease, a coxsackievirus A infection.
EpsteinBarr Virus Infections
Neonatal septicemia or meningitis caused by Escherichia coli and other gram-negative bacilli cannot be distinguished clinically from septicemia or meningitis caused by other organisms. Expert advice from an infectious disease specialist can assist in the management of ESBL-producing gram-negative infections in newborns. The treatment of infections caused by carbapenemase-producing gram-negative organisms is guided by expert advice from an infectious disease specialist.
Classification of Escherichia coli Associated With Diarrhea
Shiga toxin-producing E coli O157:H7 is the serotype most commonly involved in outbreaks and is consistently a virulent STEC serotype, but other serotypes can also cause disease. Most E coli O157:H7 isolates can presumably be identified when grown on sorbitol-containing selective media. Antimicrobial therapy: Most experts do not recommend prescribing antimicrobial therapy for children with E coli O157:H7 enteritis or a clinical or epidemiological picture strongly suggestive of STEC infection.
Fungal Diseases
Additional Fungal Diseases
Additional Fungal Diseases (continued)
Note the finely branched tubes of the fungus Exserohilum rostratum, which is the causative agent of pheohyphomycosis. This photomicrograph reveals the conidiophores with conidia of the fungus Pseudallescheria boydii from a slide culture. Trophozoites multiply by longitudinal binary fission and remain in the lumen of the proximal small intestine, where they can be free or attached to the mucosa by a ventral suction disc (4).
Gonococcal Infections
Specimens for N gonorrhoea culture from mucosal sites should be inoculated immediately on appropriate agar because the organism is extremely sensitive to desiccation and temperature changes. Caution should be exercised when interpreting the significance of isolation of Neisseria organisms because N gonorrhea can be confused with other Neisseria species that colonize the genitourinary tract or pharynx. At least 2 confirmatory bacteriological tests involving different biochemical principles should be performed by the laboratory.
