Ritabrata Kundu Professor of Pediatrics Institute of Child Health Kolkata, West Bengal, India [email protected]. Consultant pediatric neurologist Dr. Yewale's Hospital for Children Navi Mumbai, Maharashtra, India [email protected].
Prologue
It is a matter of great honor and pleasure for us to write the foreword for Atlas of Pediatric Infectious Diseases, a publication of the Infectious Diseases Chapter of the Indian Academy of Pediatrics. The Infectious Diseases Chapter of the Indian Academy of Pediatrics is also dedicated and focused on the noble mission. Infectious Diseases Chapter of Indian Academy of Pediatrics has decided to come out with a landmark publication Atlas of Pediatric Infectious Diseases.
Experts and stalwarts of national and international repute have contributed to this noble cause, initiated by the Infectious Diseases Chapter of the Indian Academy of Pediatrics. The Infectious Diseases Chapter of the Indian Academy of Pediatrics is proud to present the first edition of the Atlas of Pediatric Infectious Diseases. There is no known publication such as the Atlas of Pediatric Infectious Diseases in children from a developing country.
It offers a rich gallery of spotters in the field of various infectious diseases that occur in the tropical countries. We appreciate the efforts of the office bearers of Indian Academy of Pediatrics and IAP Infectious Diseases Chapter.
Preface
The book's publication was encouraged by the immediate popularity and widespread acceptance gained by the release of the IAP Color Atlas of Pediatrics, a brainchild of Dr. A Parthasarathy, Editor-in-Chief, in the year 2012. This book focuses exclusively on pediatric infectious diseases, unlike the IAP Color Atlas of Pediatrics, which covered all subspecialties of pediatrics from neonatology to adolescent health care. The book provides a pictorial calculation aid for infections, both common and unusual, that the healthcare provider encounters in daily practice.
Each image is accompanied by a brief and precise description of the clinical feature as well as suggested handling of the same. We gratefully acknowledge the officers of the Indian Academy of Pediatrics and Infectious Diseases Chapter for the motivation, encouragement, commitment and support with which the publication has seen the light of day. We appreciate the help provided by Dr. Rajendra Saoji (Consultant Pediatric Surgeon), Nagpur, Maharashtra, India, for compilation of the Gastrointestinal Infections section.
We also thank Mr. Somashekhar for secretarial assistance in compiling the Respiratory Tract Infections section. We also record our sincere appreciation for the assistance rendered by the local branch managers of the Jaypee Brothers—.
Acknowledgments
Infections in Neonates 1
Respiratory Tract Infections 29
- Upper Respiratory Tract Infections 31
- Lower Respiratory Tract Infections 34
Contents
Gastrointestinal Infections 49
- Gastrointestinal Infections 51
Urinary Tract Infections 57
- Clinical Features and Procedures 59
- Abnormalities on DMSA Scan 63
Infections in Central Nervous System 71
Skin and Soft Tissue Infections 85
- Lid and Orbital Infections 99
- Retinal and Posterior Segment Infections 104
Ear, Nose and Throat Infections 105
Infections in Musculoskeletal System 123
- Acute Hematogenous Osteomyelitis 127
- Sequelae of Acute Osteomyelitis 128
- Sequelae of Septic Arthritis 131
Infections Requiring Surgical Care 135
- Gastrointestinal Infections 142
Infections in the
Infections in Neonates
Section Editors
Contributors
Superficial Infections 1.2 Systemic Infections
Section Outline
Superficial Infections
SUPERFICIAL INFECTIONS Acute Otitis Media
Bacille Calmette-Guérin Abscess
Breast Abscess
Cellulitis
Conjunctivitis
Gangrene
Impetigo
Neonatal Scabies
Oral Thrush
Pustules
Umbilical Sepsis
Brain Abscess
SYSTEMIC INFECTIONS
Necrotizing Enterocolitis
Neonatal Candidiasis
Neonatal Osteomyelitis
Neonatal Meningitis
Pneumonia with Pneumatoceles
Sclerema Neonatorum
Septic Shock
CONGENITAL INFECTIONS Congenital Cytomegalovirus
Congenital HIV
Congenital Rubella Syndrome
Congenital Syphilis
Congenital Toxoplasmosis
Congenital Tuberculosis
Neonatal Chickenpox
Neonatal Tetanus
MISCELLANEOUS Hand Washing
Sepsis Screen
Fever with Rash
Erythema Nodosum
Necrotizing Fasciitis
Erythema Marginatum
Hand-Foot-and-Mouth Disease
Henoch-Schönlein Purpura
Herpes Zoster
Janeway Lesion
Meningococcal Lesion
Toxic Epidermal Necrolysis
Toxic Shock Syndrome
Urticaria
Herpetic Gingivostomatitis
Systemic Lupus Erythematosus
Aplastic Anemia
Post Kala-Azar Dermal Leishmaniasis
Conjunctivitis with Coryza
Classical Rash of Dengue Fever
Petechial Spots on Lower Limb with Occasional Macules
Measles Rash
Black Discoloration and Hyperpigmentation
Erythematous Changes on Sole and Tip of the Toe
Red Ear Due to Chikungunya Fever
Freckle-like Pigmentation at Recovery
Multiple Purpurae with Blueberry Muffin Rash
Pale Rose Red Blanching Macules and Papules on the Palm
Vasculitis with Gangrenous Changes in Same Patient of Rickettsia
Respiratory Tract Infections
Lower Respiratory Tract Infections
Upper Respiratory Tract Infections
UPPER RESPIRATORY TRACT INFECTIONS
Membranous Tonsillopharyngitis due to Klebsiella Pneumoniae
Pansinusitis—Sphenoidal, Frontal, Maxillary Sinusitis—CT Paranasal Sinuses
Oral Candidiasis
Croup Syndrome
Retropharyngeal Abscess
Epiglottitis
Pertussis with Subconjunctival Hemorrhage
LOWER RESPIRATORY TRACT INFECTIONS Round Pneumonia
Thymus
Consolidation: Left Lower Lobe
Consolidation: Right Upper Lobe
Unilateral Hilar Lymphadenopathy
Chest Indrawing
Acute Bronchiolitis
Acute Bronchiolitis with Segmental Collapse of the Left Lower Lobe
Bronchiolitis with Multiple Atelectatic/Pneumonic Patches
Wheeze Associated Lower Respiratory Infection
Viral Croup with WALRI
Pneumomediastinum with Surgical Emphysema in WALRI
Pneumomediastinum with Surgical Emphysema in WALRI-Clinical Profile
Collapse-Consolidation RUL
Collapse-Consolidation RUL in GB Syndrome with Palatopharyngeal Paralysis
Parapneumonic Effusion—Left
Dengue Fever with Right Pleural Effusion
Empyema Left Side—Soft Tissue Bulge
Empyema Right Side
Measles with Right-sided Empyema
Pulmonary Tuberculosis
Cavitary Tuberculosis with Necrotizing Bronchopneumonia
HIV with Tuberculosis
HIV with Pneumocystis jiroveci (carinii) Pneumonia—Early
HIV with Pneumocystis jiroveci (carinii) Pneumonia—Late
Lung Abscess with Bronchopneumonia
Lung Abscess with Right-Middle Lobe Consolidation
Congenital Pneumonia
Calcified Hilar Node—Tuberculosis
Multiple Cysts Left Side
Mass Lesion in Right Hemithorax
Pneumonia both Lower Lobes
Pneumonia with Parapneumonic Effusion
Tension Pneumothorax with Pneumatoceles with Subcutaneous Emphysema
Postcardiac Repair State—Atelectasis both Lower Lobes Endobronchial Tuberculosis
Gastrointestinal Infections
Hepatobiliary Infections
Gastrointestinal Infections
Ascariasis (Roundworms)
Pseudomembranous Colitis
GASTROINTESTINAL INFECTIONS
Colitis
Esophageal Candidiasis
Abdominal Tuberculosis
Appendicitis
Hydatid Cyst
HEPATOBILIARY INFECTIONS
Amebic Liver Abscess
Pyogenic Liver Abscess
Urinary Tract Infections
Clinical Features and Procedures 5.2 Abnormalities on US Scan
Clinical Features and Procedures
CLINICAL FEATURES AND PROCEDURES
PU Valves Presenting Late
Voiding Disorder—Underactive Bladder
Voiding Disorder—Overactive Bladder
Clinical examination of the abdomen and bladder can be very informative in any child presenting with impaired renal function (Fig. 5.1.1). Amikacin by injection 15 mg/kg can be administered 30 minutes before the procedure to prevent a UTI. Urine collection is always the most difficult challenge in diagnosing urinary tract infection (UTI).
A urine bag is one of the common methods of urine collection used to diagnose UTI (Figure 5.1.5). Adequate precautions should be taken when using a urine bag to minimize the level of contamination. When using a urine bag, proper care should be taken to ensure the following precautions are taken.
The genital area should be cleaned with normal soap and water and then dried. The baby should be standing until the urine passes to minimize contamination that occurs after the urine comes into contact with the skin. As soon as the urine passes, the bag should be removed and the urine poured into the collection bottle.
Remember, the first part of the urine is also collected in the urine bag and therefore not a midstream sample.
Bladder Catheterization
Urine Sample Collection using Urine Bag
ABNORMALITIES ON US SCAN USG showing Dilated Ureter
Here the ureteric dilatation is seen on the right side along with the thickened bladder wall. Note that comments on bladder thickness should only be made when the bladder is full. The sizes and shapes of the kidneys can be determined, as well as the presence of ureteral and pelvic enlargement.
Urine Collection by Suprapubic Aspiration
Hydronephrosis due to PUJ Obstruction
USG showing Ureterocele
After treatment was completed, she had a DMSA scan around 6-8 weeks after the UTI episode. As areas of decreased uptake can be seen in both kidneys, it was labeled as scarring. Dimercaptosuccinic acid (DMSA) scan was repeated in the same girl mentioned above 6 months after UTI (Fig. 5.3.2).
This showed normal kidneys with no evidence of decreased uptake in either kidney. The changes seen on a DMSA scan may only be present in the acute phase of a UTI. Therefore, DMSA scanning should be performed at least 4-6 months after an episode of UTI to look for scarring or long-term changes.
It shows the differential function of each kidney relative to the overall function of the kidneys.
DMSA Scan showing Scarred Ectopic Kidney
DMSA Abnormalities 6 Months After UTI5.3 ABNORMALITIES ON DMSA SCAN
ABNORMALITIES ON MCUG
Spinning Top Bladder
PUV with Trabeculated Bladder and Grade V Reflux
Christmas Tree Bladder
MCUG showing Vesico-colic Fistula
MCUG showing Severe VUR
MCUG showing Bilateral VUR Grade 3
OTHER STUDIES
Nephrostogram in an Infant
DRCG showing VUR
Infections in
Central Nervous System
Viral CNS Infections 6.2 Bacterial CNS Infections
Viral CNS Infections
Bacterial CNS Infections
Japanese B Encephalitis
Herpes Simplex Virus Encephalitis
VIRAL CNS INFECTIONS
Acute Disseminated Encephalomyelitis
Subacute Sclerosing Panencephalitis
Viral Encephalitis
Minimal Encephalopathy with Reversible Splenial Lesion
Intrauterine Infection—Cytomegalovirus Illness
Postherpes Zoster Facial Palsy
Human Immunodeficiency Virus Encephalopathy
Postinfectious Transverse Myelitis
Antibiotics should be chosen based on polymicrobial etiology and specific organism suspected based on predisposing condition and should be given for 4-6 weeks.
Ventriculitis
BACTERIAL CNS INFECTIONS
Recurrent Meningitis
Subdural Empyema
Tuberculous Meningitis
Tuberculoma with Hydrocephalus
Neurocysticercosis
PARASITIC CNS INFECTIONS
Multiple Neurocysticercosis
Axial postcontrast CT shows a well-defined fluid-dense cyst with a thin wall and a hyperdense nodular area in the dependent part of the cyst, consistent with a hydatid cyst (Figures 6.3.3A and B). Usually, the hydatid cyst in the brain does not show an enhancing nodule or scolex as in the hydatid cyst in the liver). The patients with intracranial hydatid cysts usually present with focal neurological symptoms and features of increased intracranial pressure and few patients present with seizures. The treatment of a hydatid cyst is surgical and the aim of the surgery is to excise the cyst in its entirety without rupturing the cyst, to prevent recurrence and anaphylactic reaction.
Studies have shown complete disappearance of multiple intracranial hydatid cysts with albendazole therapy in a daily dose of 10 mg/. Better effectiveness of the drug therapy is more effective in recurrent cases and in cases with rupture during surgery.
Toxoplasmosis
Skin and Soft Tissue Infections
Section Editor
Bacterial Skin Infections 7.3 Fungal Skin Infections
Viral Skin Infections
VIRAL SKIN INFECTIONS
Herpes Zoster in a One-and-Half-Year-Old Boy
Herpes Zoster in a 2-Year-Old Child
Molluscum Contagiosum
Giant Molluscum Contagiosum in an HIV Child
Herpes Simplex
Furunculosis
BACTERIAL SKIN INFECTIONS
Impetigo with Staphylococcal-Scalded Skin Syndrome
Cutaneous Tuberculosis—Lupus Vulgaris
Impetigo-Cellulitis
FUNGAL SKIN INFECTIONS Pityriasis Versicolor
Pityriasis Versicolor on Forehead
Tinea Capitis
Kerion—A Type of Tinea Capitis
Scabies
Cutaneous Larva Migrans
PARASITIC SKIN INFECTIONS
Acne Vulgaris
MISCELLANEOUS
Ophthalmic Infections
Lid and Orbital Infections 8.2 Lacrimal Sac Infections
Retinal and Posterior Segment Infections
Lid and Orbital Infections
Conjunctival Infections
LID AND ORBITAL INFECTIONS
Blepharitis
Hordeolum Internum
Preseptal Cellulitis
Bilateral preseptal cellulitis due to a left forehead folliculitis (Fig. 8.1.3C) and resolution after systemic antibiotics in a 3-year-old male child (Fig. 8.1.3D). Treatment of the infective limb lesion with topical antibiotic ointment and systemic antibiotics and nonsteroidal anti-inflammatory drug (NSAID) therapy.
Orbital Cellulitis
Orbital Myocysticercosis
Lid Abscess
Tuberculous Lid Mass
LACRIMAL SAC INFECTIONS Congenital Dacryocele
Acute Dacryocystitis
CONJUNCTIVAL INFECTIONS
Viral Pseudomembranous Conjunctivitis
CORNEAL INFECTIONS Bacterial Corneal Ulcer
Fungal Corneal Ulcer
Herpes Simplex Keratitis
Herpes Zoster Ophthalmicus
RETINAL AND POSTERIOR SEGMENT INFECTIONS Toxoplasma Retinitis
Cytomegalovirus Retinitis
Ear, Nose and Throat Infections
Ear 9.2 Nose
Nose
Early Acute Otitis Media
Acute Otitis Media
Resolving Acute Otitis Media
Acute Otitis Media with Perforation (Acute Suppurative Otitis Media)
Acute Bullous Myringitis
Otitis Media with Effusion
Atelectasis
Myringotomy Tube (Grommet and Ventilating Tube)
Perforation
Subtotal Perforation
Primary Acquired Cholesteatoma
Cholesteatoma
Facial Palsy
Aural Polyp
Otitis Externa
Infected Wax Granuloma
Otomycosis
Mastoid Abscess
Preaurical Sinus
Preauricular Abscess
NOSE
Epistaxis from Little’s Area
Granuloma in Little’s Area
Nasal Vestibulitis
Early Vestibulitis
Vestibular Abscess
Allergic Rhinosinusitis
Septal Hematoma/Septal Abscess
Orbital Abscess
Rhinosporidiosis
Lacrimal Fistula
THROAT Tonsils
Follicular Tonsillitis
Membranous Tonsillitis
Quinsy (Peritonsillar Abscess)
Granular Pharyngitis
Diphtheria
Adenoids
Radiology Adenoid Hypertrophy
Cold Abscess Neck
Laryngeal Papillomatosis
Erythema Multiforme
Palatal Perforation
Musculoskeletal System
Acute Septic Arthritis
Acute Hematogenous Osteomyelitis 10.3 Sequelae of Acute Osteomyelitis
Sequelae of Septic Arthritis
ACUTE SEPTIC ARTHRITIS
Acute Septic Arthritis of Right Hip Joint
Neonatal Hip Joint Infection
Treatment of Hip Joint Septic Arthritis
Late Presentation of Hip Septic Arthritis
Shoulder Joint Septic Arthritis
ACUTE HEMATOGENOUS OSTEOMYELITIS Acute Osteomyelitis Left Proximal Femur
Acute Osteomyelitis Left Distal Femur
SEQUELAE OF ACUTE OSTEOMYELITIS
Chronic Osteomyelitis with Sequestration and Gap Nonunion of Femur
Chronic Osteomyelitis with Sequestrum
Bone Loss of the Tibia following Osteomyelitis
Bone Loss and Gap Nonunion of Humerus following Osteomyelitis
SEQUELAE OF SEPTIC ARTHRITIS
Complete Destruction of Proximal Femoral Epiphysis following Osteomyelitis and Septic Arthritis
Dislocation of the Hip Joint following Septic Arthritis
Tom Smith’s Arthritis causing Bilateral Loss of Capital Femoral Epiphysis
Reconstructive Options for Tom Smith’s Arthritis of Right Hip
Sequel of Septic Arthritis of Knee
Infections Requiring Surgical Care
Contributor
- General Infections 11.2 Chest and Thorax
- Gastrointestinal Infections
- Urological Conditions causing Urinary Infections
- General Infections
- GENERAL INFECTIONS Scalp Abscess
Large abscesses, associated cellulitis or newborn babies – may require admission and intravenous antibiotics, otherwise oral antibiotics, warm excitement, analgesics and antipyretics.
Axillary Abscess
Infected Branchial Cyst
Infected Thyroglossal Cyst
Umbilical Sepsis (Omphalitis)
CHEST AND THORAX Chest Wall Abscess
Pneumatocele
Empyema
Lung Abscess
Bronchiectasis
GASTROINTESTINAL INFECTIONS Necrotizing Enterocolitis
Figures 11.3.1A and B: (A) Tense, erythematous and shiny abdomen of a neonate with NEC. B) X-ray of the abdomen in an upright position, showing free air. Photo courtesy: Arbinder Kumar Singal, Navi Mumbai. Begins with abdominal distension, vomiting and later redness of the abdominal wall (Fig. 11.3.1A), tenderness, edema, anxiety, features of generalized sepsis and bleeding per rectum. If there is perforation, massive gastrointestinal bleeding, or evidence of a fixed loop, surgical exploration may be necessary.
Figures 11.3.2A and B: (A) USG shows a distended appendix with free fluid in the right iliac fossa; (B) Inflamed turgid appendix as seen postoperatively. Diagnosis is based on clinical findings, blood count, ultrasonography (Figure 11.3.2A – note the bulging appendix) and sometimes abdominal CECT may be required. Appendectomy (performed by conventional open or laparoscopic technique)—(Figure 11.3.2B shows an inflamed appendix with perforation).
Peritonitis
Ascariasis
UROLOGICAL CONDITIONS CAUSING URINARY INFECTIONS Antenatally Diagnosed Hydronephrosis
Figure 11.4.1A and B: (A) Normal antenatal appearance of kidneys on USG; (B) Hydro-nephrotic left kidney with enlarged pelvis Photo courtesy: Arbinder Kumar Singal, Navi Mumbai. Antenatal hydronephrosis can be diagnosed on USG at any time after 16 weeks (Fig. 11.4.1A shows unilateral left hydronephrosis with dilatation of the pelvis and calyx, the right kidney is normal; Severity of hydronephrosis is assessed by measuring the anteroposterior diameter (AP) of pelvis and cortical thickness.
Bilateral hydronephrosis (Fig. 11.4.1B) can lead to renal insufficiency and requires frequent antenatal scans to check for impending renal failure.
Pelvi-ureteric Junction Obstruction
Duplex System
Ureterocele
Vesico-ureteric Reflux
Posterior Urethral Valves
Bladder Diverticulum
Neuropathic Bladder
Dysfunctional Voiding
Epididymo-orchitis
Phimosis
Labial Adhesions
Urolithiasis
Infections in the
Immunocompromised Child
Bacille Calmette-Guérin Adenitis
BCG Adenitis: Histopathology
Disseminated BCGosis with Cutaneous Granulomatous Dermatitis
Recurrent Pulmonary Infections
Repeated Lower Respiratory Tract Infection and Absence of Thymic Shadow
Hemorrhagic Varicella
Liver and Skin Abscesses
Griscelli Syndrome
Severe Combined Immunodeficiency
Large Skin Ulceration without Abscess Formation
Recurrent Skin Abscesses
Persistent Mucosal and Cutaneous Fungal Infections
Pneumocystis jiroveci Pneumonia
Scrofuloderma
Axillary Lymphadenopathy
Index
