Curbside Consultation in Pediatric Infectious Disease 49 Clinical Questions

Acknowledgments

About the Editor

Contributing Authors

Preface

Foreword by Janet R. Gilsdorf, MD

Introduction

Section I?Urinary Tract Infection

Question 1 Is It Appropriate to Treat a Suspected Urinary Tract Infection

Based on an In Office Urine Dipstick Result, or Should the Specimen

Be Sent for Culture? Does the Age of the Patient Have Anything to Do With the Decision?

Rene Vandevoorde, MD

Question 2 When Should You Attempt to Obtain a Catheter Specimen Versus a

Clean Catch Specimen in the Setting of a Suspected Urinary Tract Infection?

Rene Vandevoorde, MD

Question 3 When Is Imaging, Such As voiding cystourethrogram (VCUG)

and Renal Ultrasound, Necessary for Children With a First

Urinary Tract Infection?

Rene Vandevoorde, MD

Question 4 Is Prophylaxis Recommended for All Patients With

Vesicoureteral Reflux?

Rene Vandevoorde, MD

Section II?Methicillin-Resistant Staphylococcus Aureus

Question 5 When Is Oral Antibiotic Therapy Necessary in the Setting

of Recurrent Methicillin-resistant Staphylococcus Aureus (MRSA)

Skin Infection/Boils?

Emily A. Thorell, MD

Question 6 Are Bleach Baths or Chlorhexidine Plus Mupirocin Ointment Useful to Decolonize Patients With Recurrent Methicillin-resistant Staphylococcus Aureus (MRSA) Infections? What Topical Recommendations Are Useful for Patients With Recurrent MRSA Infections?

Emily A. Thorell, MD

Question 7 In What Settings Is Methicillin-resistant Staphylococcus

Aureus (MRSA) Spread?

Emily A. Thorell, MD

Question 8 Are There Environmental Cleaning or Personal Hygiene Interventions That Can Be Used To Reduce Recurrences of Methicillin-resistant Staphylococcus Aureus (MRSA) Infections?

Emily A. Thorell, MD

Section III?Tinea Capitis

Question 9 How Long Does Tinea Capitis Need To Be Treated in Order

to Be Sure the Infection Has Cleared?

Jennifer Goldman, MD and Susan Abdel-Rahman, PharmD

Question 10 What Are the Methods by Which Tinea Capitis Can Be

Spread From Person To Person?

Jennifer Goldman, MD and Susan Abdel-Rahman, PharmD

Question 11 Do There Need to Be Visible Lesions to Diagnose Tinea Capitis?

Jennifer Goldman, MD and Susan Abdel-Rahman, PharmD

Question 12 What Organisms Are Responsible for Causing Tinea Capitis?

Jennifer Goldman, MD and Susan Abdel-Rahman, PharmD

Section IV?Tick-Borne Illness

Question 13 What Are the Best Prophylactic Measures To Tell Families

To Use To Prevent Tick Bites? At What Age Are Agents Such as

DEET and Picaridin Safe To Use?

Jos\u00e9 R. Romero, MD, FAAP and Kimberly C. Martin, DO

Question 14 When Are Tick-borne Infections Typically Seen in the

United States, and When Does the Peak Time Occur?

Jos\u00e9 R. Romero, MD, FAAP and Kimberly C. Martin, DO

Question 15 What Is the Best Empiric and/or Prophylactic Therapy

for a Child in Whom You Suspect a Tick-borne Infection?

Jos\u00e9 R. Romero, MD, FAAP and Kimberly C. Martin, DO

Question 16 In What Parts of the United States Is Lyme Disease Seen, How Is Diagnosis Confirmed, and What Is the Appropriate Treatment?

Jos\u00e9 R. Romero, MD, FAAP and Kimberly C. Martin, DO

Section V?Atypical Pneumonia

Question 17 Can You Make a Diagnosis of Atypical Pneumonia by Clinical Presentation, or Is Laboratory Evaluation Required?

Christopher R. Cannavino, MD

Question 18 What Are the Most Common Ages, Presenting

Symptoms, and Common Organisms Associated With

Cases of Atypical Pneumonia?

Christopher R. Cannavino, MD

Section VI?Otitis Media

Question 19 What Is the Recommended Specific Treatment of Otitis

Media Due To Multidrug-Resistant Pneumococcus?

Christopher J. Harrison, MD

Question 20 When Should Middle Ear Effusion Fluid Be Obtained?

Christopher J. Harrison, MD

Question 21 What Do You Do for a Patient Who Has Ear Tubes and Has

Continuous Ear Drainage?

Question 22 What Is the Recommended Specific Treatment of Acute

Otitis Media Due To Multidrug-Resistant Pneumococcus?

Christopher J. Harrison, MD

Section VII?Pharyngitis

Question 23 Is a Throat Culture Necessary in the Setting of a

Negative Rapid Streptococcal Antigen Test?

Kevin B. Spicer, MD, PhD, MPH and Preeti Jaggi, MD

Question 24 What Is the Best Treatment Option for Group A Streptococcal Pharyngitis? What if the Patient Is Allergic to

Beta-Lactam Antibiotics?

Kevin B. Spicer, MD, PhD, MPH and Preeti Jaggi, MD

Question 25 Why do We Treat Streptococcal Pharyngitis When It Is a

Self-limited Illness?

Kevin B. Spicer, MD, PhD, MPH; Preeti Jaggi, MD;

and Angela L. Myers, MD, MPH

Question 26 Should I Treat the Asymptomatic Siblings of the Patient

Who Has a Positive Rapid Streptococcal Antigen Test?

Kevin B. Spicer, MD, PhD, MPH; Preeti Jaggi, MD;

and Angela L. Myers, MD, MPH

Question 27 What Are the Best Clinical Indicators That My Patient

May Have Streptococcal Pharyngitis?

Kevin B. Spicer, MD, PhD, MPH and Preeti Jaggi, MD

Section VIII?Viral Testing

Question 28 How Sensitive and Specific Are the ­Office-Based Rapid

Respiratory Syncytial Virus and Rapid Influenza Tests?

Rebecca C. Brady, MD

Question 29 If I Have a 3-Month-Old Infant in the Office With Respiratory

Symptoms and Negative Viral Testing, Should I Proceed With a

Sepsis Evaluation?

Archana Chatterjee, MD, PhD

Question 30 If I Have a 5-Week-Old Infant With Positive Rapid Viral Testing

Who Does Not Need Hospital Admission, Is a Sepsis

Evaluation Necessary?

Archana Chatterjee, MD, PhD

Section IX?Diarrhea

Question 31 When Are Antibiotics Indicated for a Child With a Bacterial

Cause of Diarrhea?

Amber Hoffman, MD

Question 32 What Is Likely To Be the Most Common Viral Pathogens

Causing Diarrhea Since the Decrease in Rotavirus Cases

With Increase in Vaccine Uptake?

Amber Hoffman, MD

Section X?Upper Respiratory Tract Infection/Sinusitis

Question 33 When Should I Be Worried About Immune Deficiency

in the Setting of Recurrent Upper Respiratory Tracts Infections?

Adam L. Hersh, MD, PhD

Question 34 What Are the Most Common Viral Respiratory Pathogens

in Infants in the First Year of Life?

Adam L. Hersh, MD, PhD

Question 35 What Antibiotics Are Recommended Empirically for Acute Bacterial Sinusitis in a Patient Who Has Not Received Antibiotics Recently?

Adam L. Hersh, MD, PhD

Question 36 What Antibiotics Are Recommended to Treat Acute Bacterial

Sinusitis in the Patient Who Had a Course of Amoxicillin

Within the Last Few Weeks for Otitis Media?

Adam L. Hersh, MD, PhD

Section XI?Community-Acquired Pneumonia

Question 37 What Is the Most Common Pathogen Involved in

Community-Acquired Pneumonia, and the Empiric

Therapy of Choice in the Preschool–Aged Child With Fever

to 102\u00baF, Rales, and a Lobar Infiltrate on Chest Radiograph?

Christopher R. Cannavino, MD

Question 38 For What Clinical Presentation Should Concern Arise About Staphylococcus aureus as the Cause for Pneumonia in My Patient?

Christopher R. Cannavino, MD

Section XII?Epstein-Barr virus/Cytomegalovirus

Question 39 When Are Steroids Indicated in the Setting of Known Acute

Epstein-Barr virus (EBV) Infection?

Masako Shimamura, MD and Rebecca Widener, MD

Question 40 What Laboratory Test(s) Should Be Obtained in the

Setting of Suspected Congenital Cytomegalovirus (CMV) Infection?

Masako Shimamura, MD and Rebecca Widener, MD

Question 41 When Should Serologic Testing Be Performed Instead of

a Monospot, and How Do I Interpret Results of Epstein-Barr

virus (EBV) Serologies?

Masako Shimamura, MD and Rebecca Widener, MD

Question 42 What Should I Tell a Pregnant Mother of a 2-Year-Old

Who Has Recently Been Diagnosed With Congenital

Cytomegalovirus (CMV) Infection About Her Risk

for Developing Infection As Well As Prevention Techniques?

Masako Shimamura, MD and Rebecca Widener, MD

Section XIII?Lymphaden

Biography

Angela L. Myers, MD, MPH, FAAP, is a board-certified pediatric infectious diseases ­physician and is currently an Assistant Professor of Pediatrics at the University of Missouri-Kansas City School of Medicine. She is the pediatric infectious diseases fellowship director at Children's Mercy Hospital & Clinics. Dr. Myers received her undergraduate and medical degree from the University of Missouri-Kansas City School of Medicine in the combined 6-year program, and completed her pediatrics residency and pediatric infectious diseases fellowship at Children’s Mercy Hospitals & Clinics. Active in research, her main interests revolve around childhood and adult vaccine knowledge, attitudes, and beliefs, as well as using novel health information technologies to improve vaccination rates for influenza. She currently oversees several funded studies evaluating vaccine beliefs as well as implementation of various strategies to increase immunization rates of both children and adults. She is the author of 2 book questions and more than 15 publications in pediatric journals and is also actively involved in committee work for the Pediatric Infectious Diseases Society program training committee and the graduate medical education council at her affiliated medical school.