Common Bacterial Infections in Infancy and Childhood

Paediatrics is distinguished from general medicine by the different spectrum of disease encountered, and the interplay of disease and development within the growing child. Thus, clinical management taxes acumen, experience, and factual knowledge in a particularly challenging way. Infectious disease problems and their attendant pressures continue to dominate paediatric practice. As improvements in care ap­ proach marginal proportions, the onus on clinicians to provide prompt diagnosis and appropriate treatment gains increasing importance. Newcomers are often impressed by the pace of evolving syndromes, indicating the need for repeated examination and balanced judgement at all phases of illness. This book considers common bacterial syndromes from a modern perspective. The authors' attitudes and opinions reflect their experience of paediatric infectious disease in a large teaching hospital. Thus, we are daily concerned with an overall minority of patients who fail to respond to domicilary measures. or who develop a specific complication. We believe this perspective will have particular relevance for community practitioners who take satisfaction in the care of sick children, and for house officers faced with the dual problems of an ill child and alarmed parents. M.J. Marks Montreal, January, 1979 v Contributors Ahronheim. Gerald A. Assistant Professor of Paediatrics, McGill University, Montreal. Marks. Melvin I. Associate Professor of Paediatrics and Assistant Professor of Microbiology and Immunology, McGill University, Montreal. Spratt. H. Cl(fford Lecturer in Paediatrics, McGill University, Montreal.

1 Principles of Antibacterial Therapy in Infants and Children.- 1. Factors Influencing the Selection of Antibacterial Drugs.- 1.1 Characteristics of Infection.- 1.2 Drug Allergies.- 1.3 Susceptibility of Bacteria.- 1.4 Patient Age.- 1.5 Other Host Factors.- 1.6 Bacteriostatic or Bactericidal Drugs?.- 1.7 Indications for Prophylactic Antibacterial Therapy.- 2. Factors Influencing Dosage.- 2.1 Characteristics of Infection.- 2.2 Susceptibility of Bacteria.- 2.3 Patient Age.- 2.4 Other Host Factors.- 3. Factors Influencing the Choice of Route.- 3.1 Indications for Oral Therapy.- 3.2 Indications for Intramuscular Therapy.- 3.3 Indications for Intravenous Therapy.- 4. Factors Influencing the Duration of Treatment.- II Respiratory Infections.- 1. Otitis Media.- 1.1 Pathogenic Organisms.- 1.2 Clinical Features and Diagnosis.- 1.3 Complications.- 1.4 Treatment.- 1.4.1 Acute Otitis Media.- 1.4.2 Recurrent Otitis Media.- 2. Acute Sinusitis.- 2.1 Pathogenic Organisms.- 2.2 Clinical Features and Diagnosis.- 2.3 Complications.- 2.4 Treatment.- 3. Orbital Cellulitis.- 3.1 Pathogenic Organisms.- 3.2 Clinical Features and Diagnosis.- 3.3 Complications.- 3.4 Treatment.- 4. Pharyngitis and Tonsillitis.- 4.1 Pathogenic Organisms.- 4.2 Complications.- 4.3 Treatment.- 5. Epiglottitis.- 5.1 Pathogenic Organisms.- 5.2 Clinical Features and Diagnosis.- 5.3 Complications.- 5.4 Treatment.- 6. Pertussis.- 6.1 Pathogenic Organisms.- 6.2 Clinical Features and Diagnosis.- 6.3 Complications.- 6.4 Treatment.- 6.5 Role of Immunisation.- 7. Pneumonia.- 7.1 Pathogenic Organisms.- 7.2 Clinical Features and Diagnosis.- 7.3 Complications.- 7.4 Treatment.- 7.4.1 Pneumococcal Pneumonia.- 7.4.2 Staphylococcal Pneumonia.- 7.4.3 H. influenzae Pneumonia.- 7.4.4 Neonatal Pneumonia.- 7.4.5 Mycoplasmal Pneumonia.- 7.4.6 Chlamydial Pneumonia.- 8. Pleural Empyema.- 8.1 Pathogenic Organisms.- 8.2 Clinical Features and Diagnosis.- 8.3 Treatment.- 9. Croup, Bronchiolitis and Bronchitis.- 9.1 Pathogenic Organisms.- 9.2 Treatment.- 10. Pulmonary Tuberculosis.- 10.1 Diagnostic Considerations.- 10.2 Treatment.- 10.2.1 Isoniazid.- 10.2.2 Streptomycin.- 10.2.3 Ethambutol.- 10.2.4 Rifampicin.- 10.2.5 Duration of Therapy.- 10.2.6 Period of Infectivity.- III Infections of the Central Nervous System.- 1. Pyogenic Meningitis.- 1.1 Neonatal Meningitis.- 1.1.1 Pathogenic Organisms.- 1.1.2 Treatment.- 1.2 Purulent Meningitis of Childhood.- 1.2.1 Pathogenic Organisms.- 1.2.2 Treatment.- 1.3 Tuberculous Meningitis.- 1.3.1 Treatment.- 1.3.2 Treatment of Resistant Strains.- 2. Brain Abscess.- 2.1 Pathogenic Organisms.- 2.2 Treatment.- 2.3 Adjunctive Therapy.- 3. Epidural Abscess.- 4. Subdural Empyema.- 4.1 Pathogenic Organisms.- 4.2 Treatment.- 5. Cerebrospinal Fluid Shunt Infections.- 5.1 Pathogenic Organisms.- 5.2 Treatment.- IV Genitourinary Infections.- 1. Urethritis.- 1.1 Pathogenesis.- 1.2 Clinical Features.- 1.3 Diagnosis.- 1.4 Treatment.- 1.4.1 Gonococcal Urethritis.- 1.4.2 Non-gonococcal Urethritis and Post-gonococcal Urethritis.- 1.4.3 Other Forms of Infectious Urethritis.- 1.4.4 Non-infectious Urethritis.- 2. Cystitis.- 2.1 Pathogenesis.- 2.2 Clinical Features.- 2.2.1 Asymptomatic Bacteriuria.- 2.2.2 Viral Cystitis.- 2.3 Predisposing Factors.- 2.4 Other Causes of Cystitis.- 2.5 Diagnosis.- 2.5.1 Collection of Urine.- 2.5.2 Urinalysis.- 2.5.3 Urine Culture.- 2.6 Treatment.- 2.6.1 Curative Therapy.- 2.6.2 Prophylactic Therapy.- 2.7 Prognosis.- 3. Upper Urinary Tract Infection.- 3.1 Pathogenesis.- 3.2 Clinical Features.- 3.3 Clinical Features.- 3.4 Radiological Examination.- 3.5 Treatment.- 3.5.1 Curative Therapy.- 3.5.2 Prophylactic Therapy.- 3.6 Prognosis.- V Skin and Wound Infections.- 1. Impetigo.- 1.1 Pathogenesis.- 1.2 Clinical Features and Diagnosis.- 1.3 Treatment.- 1.4 Buttons Impetigo.- 2. Staphylococcal Scalded Skin Syndrome.- 2.1 Pathogenesis.- 2.2 Clinical Features and Diagnosis.- 2.3 Treatment.- 3. Cellulitis.- 3.1 Pathogenesis.- 3.2 Clinical Features and Diagnosis.- 3.3 Treatment.- 4. Furunculosis.- 4.1 Pathogenesis.- 4.2 Treatment.- 4.2.1 Treatment of Recurrent Lesions.- 5. Acne Vulgaris.- 5.1 Pathogenesis.- 5.2 Treatment.- 6. Wound Infections.- 6.1 Diagnosis and Treatment.- 6.2 Antibiotic Prophylaxis.- 7. Special Hosts: Treatment Considerations.- 7.1 Neonates.- 7.2 Eczema and Burn Patients.- VI Infections of the Skeletal System.- 1. Osteomyelitis.- 1.1 Pathogenesis and Aetiology.- 1.2 Clinical Features.- 1.3 Diagnosis.- 1.4 Treatment.- 1.4.1 Initial Therapy.- 1.4.2 Alternative Therapy.- 1.4.3 Duration of Therapy.- 1.4.4 Monitoring of Therapy.- 1.4.5 Surgical Treatment.- 2. Septic Arthritis.- 2.1 Aetiology.- 2.2 Clinical Features.- 2.3 Diagnosis.- 2.4 Treatment.- 2.4.1 Initial Therapy.- 2.4.2 Continuing Therapy.- 2.4.3 Duration of Therapy.- 2.4.4 Surgical Treatment.- 3. Other Infections.- 4. Conclusions.- VII Enteric Infections.- 1. Salmonella Gastroenteritis and Enteric Fever.- 1.1 Salmonella Gastroenteritis.- 1.1.1 Pathogenesis and Clinical Features.- 1.1.2 Treatment.- 1.2 Enteric Fever.- 1.2.1 Pathogenesis and Clinical Features.- 1.2.2 Diagnosis.- 1.2.3 Treatment.- 2. Yersinia Enterocolitis.- 2.1 Pathogenesis and Clinical Features.- 2.2 Treatment.- 3. Shigellosis.- 3.1 Pathogenesis and Clinical Features.- 3.2 Treatment.- 4. Escherichia coli Enterocolitis.- 4.1 Pathogenesis and Clinical Features.- 4.2 Treatment.- 5. Gastroenteritis due to Other Bacteria.- 6. General Aspects of Treatment.- VIII Neonatal Infections.- 1. Factors Predisposing to Neonatal Infections.- 2. Pathogenic Organisms.- 2.1 Gram-negative Bacteria.- 2.2 Gram-positive Bacteria.- 3. Principles of Management.- 3.1 Choice of Initial Antibiotic Therapy.- 3.2 Continuing Therapy.- 4. Septicaemia.- 4.1 Clinical Features and Diagnosis.- 4.2 Treatment.- 5. Meningitis.- 5.1 Clinical Features and Diagnosis.- 5.2 Treatment.- 5.3 Prognosis.- 6. Pneumonia.- 6.1 Pathogenic Organisms.- 6.2 Diagnosis.- 6.3 Treatment.- 7. Enteritis.- 7.1 Pathogenic Organisms.- 7.2 Treatment.- 8. Urinary Tract Infections.- 8.1 Clinical Features and Diagnosis.- 8.2 Treatment.- 8.3 Prognosis.- 9. Osteomyelitis.- 9.1 Clinical Features and Diagnosis.- 9.2 Treatment.- l0. Septic Arthritis.- 10.1 Clinical Features and Diagnosis.- 10.2 Treatment.- 10.3 Prognosis.- 11. Congenital Syphilis.- 11.1 Clinical Features and Diagnosis.- 11.2 Treatment.- 12. Conjunctivitis.- 12.1 Pathogenic Organisms.- 12.2 Diagnosis.- 12.3 Treatment.- 12.4 Prognosis.- 13. Skin Infections.- 14. Umbilical Infection.