Categories
Infectious Diseases

Lyme Disease

Update 6/6/22 – there is ongoing work to determine the optimal treatment for meningitis in Lyme between doxy and ceftriaxone. The original episode recording did not make this clear – my apologies. The 2021 IDSA guideline suggests that you could use either agent. This episode was edited to reflect this change.

Lyme disease prevalence continues to rise – especially in places where we didn’t see it before (like Ohio!). this podcast episode focuses on making the diagnosis, the different stages of disease, as well as when to prophylaxis, treat, and how testing works – all in under 15 minutes.


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Helpful Diagnostic Resources

CDC Lyme Disease Resource

CDC Tick ID – which tick bit me?

References

Shapiro ED. Lyme disease. N Engl J Med 2014; 371:684.

Lantos PM, Rumbaugh J, Bockenstedt LK, et al. Clinical Practice Guidelines by the Infectious Diseases Society of America (IDSA), American Academy of Neurology (AAN), and American College of Rheumatology (ACR): 2020 Guidelines for the Prevention, Diagnosis, and Treatment of Lyme Disease. Arthritis Rheumatol 2021; 73:12.

American Academy of Pediatrics. Lyme disease. In: Red Book, 31, Kimberlin DW, Brady MT, Jackson MA, Long SS (Eds), 2018. p. 515.

Nigrovic LE, Bennett JE, Balamuth F, Levas MN, Chenard RL, Maulden AB, Garro AC; for Pedi Lyme Net. Accuracy of Clinician Suspicion of Lyme Disease in the Emergency Department. Pediatrics. 2017 Dec;140(6):e20171975. doi: 10.1542/peds.2017-1975. PMID: 29175973; PMCID: PMC5703778.

Categories
Infectious Diseases

Toxic Shock Syndrome

Toxic Shock Syndrome can be hard to recognize and differentiate from clinical entities such as Kawasaki, MIS-C, and DRESS. This brief podcast episode will raise awareness of situations in which TSS can occur and drive home important management pearls – like why you need to add Clindamycin.


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References

Gaensbauer JT et al. Epidemiology and Clinical Relevance of Toxic Shock Syndrome in US Children. Pediatr Infect Dis J. 2018 Dec;37(12):1223-1226. PMID: 29601458. 

Javouhey et al. Similarities and Differences Between Staphylococcal and Streptococcal Toxic Shock Syndromes in Children: Results From a 30-Case Cohort. Front Pediatr. 2018 Nov 28;6:360. PMID: 30547021

Rodríguez-Nuñez et al. Streptococcal Toxic Shock Syndrome collaborative group of Spanish Society of Pediatric Intensive Care. Clinical characteristics of children with group A streptococcal toxic shock syndrome admitted to pediatric intensive care units. Eur J Pediatr. 2011 May;170(5):639-44. PMID: 20981441.

Categories
Infectious Diseases

Mastoiditis

Does mastoiditis always present with the classic triad of swelling behind the ear, otalgia, and protrusion of the auricle? Do you need to get a CT to make the diagnosis? What is the exact relationship with acute otitis media? Can swimmer’s ear turn into mastoiditis? These questions and more are why I recorded this episode of PEM Currents: The Pediatric Emergency Medicine Podcast.

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References

Geva et al. Conservative management of acute mastoiditis in children. Int J Pediatr Otorhinolaryngol. 2008;72(5):629.

Groth et al. Acute mastoiditis in children aged 0-16 years–a national study of 678 cases in Sweden comparing different age groups. Int J Pediatr Otorhinolaryngol. 2012;76(10):1494.

Leskinen et al. Complications of acute otitis media in children. Curr Allergy Asthma Rep. 2005;5(4):308.

Thompson et al. Effect of antibiotics for otitis media on mastoiditis in children: a retrospective cohort study using the United kingdom general practice research database. Pediatrics. 2009;123(2):424.

van den Aardweg  et al. A systematic review of diagnostic criteria for acute mastoiditis in children. Otol Neurotol. 2008;29(6):751. 

Categories
Infectious Diseases

Multisystem Inflammatory Syndrome in Children

Multisystem Inflammatory Syndrome in Children (MIS-C) is an evolving clinical entity that is occurring, possibly in association with or following a COVID-19 infection. This episode of PEM Currents expands upon a recent PEMBlog post, as well as includes information from two studies published in The Lancet as well as included in a recent CDC webinar. This episode also provides recommendations on lab workup and the evolving criteria for diagnosis and the current case definition from the CDC.

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References

CDC Webinar: Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 (COVID-19). May 19, 2020.

CDC Health Alert Network: Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 (COVID-19). Accessed May 15, 2020.

Riphagen et al. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet. 2020. Advance online publication, doi: 10.1016/S0140-6736(20)31094

Verdoni et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet. 2020. Advance online publication, doi: 10.1016/ S0140-6736(20)31129-6 

Categories
Infectious Diseases

Talking with patients and families about the flu

I recently had the pleasure of sitting down with the always delightful Dr. Patricia Chambers to talk about influenza. In our conversation we reviewed how to discuss testing or not for the flu, as well as why antivirals are not always indicated. I firmly believe that perhaps the most important thing that we do in the Pediatric Emergency Department is communicating with patients and their families. Ultimately, they must understand why we do what we do (or don’t do). Patricia is an expert in this realm and I hope that you will learn as much as I did by listening to this episode of PEM Currents: The Pediatric Emergency Medicine Podcast.

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References

Grohskopf et al. et al. Prevention and Control of Seasonal Influenza with Vaccines: Recommendations of the Advisory Committee on Immunization Practices — United States, 2019–20 Influenza Season. CDC recommendations and Reports. August 23, 2019. https://www.cdc.gov/mmwr/volumes/68/rr/rr6803a1.htm?s_cid=rr6803a1_w. Accessed December 18, 2019.

Categories
Infectious Diseases

Sinusitis

Did you know that up to 9% of URIs are eventually complicated by acute sinusitis in children? This episode of PEM Currents, the Pediatric Emergency Medicine podcast focuses on making the diagnosis of acute bacterial rhinosinusitis clinically and when to pull the antibiotic prescription trigger.

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References

Chow AW, Benninger MS, Brook I, Brozek JL, Goldstein EJ, Hicks LA, Pankey GA, Seleznick M, Volturo G, Wald ER, File TM Jr, Infectious Diseases Society of America. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis. 2012;54(8):e72.

Hicks CW, Weber JG, Reid JR, Moodley M. Identifying and managing intracranial complications of sinusitis in children: a retrospective series. Pediatr Infect Dis J. 2011;30(3):222.

Wald ER, Applegate KE, Bordley C, Darrow DH, Glode MP, Marcy SM, Nelson CE, Rosenfeld RM, Shaikh N, Smith MJ, Williams PV, Weinberg ST, American Academy of Pediatrics. Clinical practice guideline for the diagnosis and management of acute bacterial sinusitis in children aged 1 to 18 years. Pediatrics. 2013;132(1):e262.

Wald ER, Milmoe GJ, Bowen A, Ledesma-Medina J, Salamon N, Bluestone CD. Acute maxillary sinusitis in children. N Engl J Med. 1981;304(13):749.

Categories
gastroenterology Infectious Diseases

Probiotics for Gastroenteritis

This episode of PEM Currents features an in-depth interview with the lead author on the recent New England Journal paper on the use of probiotics in gastroenteritis. David Schnadower was kind enough to sit down with me and James Gray, a Pediatric Emergency Medicine Fellow from Cincinnati Children’s to talk about the study and its implications for the care of children with infectious gastroenteritis. You will find a full transcript of the podcast on PEMBlog.com.

Read the full article from the New England Journal of Medicine.

References

Freedman et al. Multicenter Trial of a Combination Probiotic for Children with Gastroenteritis. N Engl J Med 2018; 379:2015-2026. DOI: 10.1056/NEJMoa1802597.

Schnadower et al. Lactobacillus rhamnosus GG versus Placebo for Acute Gastroenteritis in Children. NEJM 2018; 379:2002-2014. DOI: 10.1056/NEJMoa1802598.

Categories
Infectious Diseases

Acute Flaccid Myelitis

Acute Flaccid Myelitis is a rare but serious disease characterized by rapid onset of muscle weakness. Diagnosis also requires an MRI with lesions in multiple spinal levels or CSF pleocytosis. cases have been reported over the past several years and though a specific cause is unknown strains of enterovirus are suspected culprits.

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References

AAP – Acute Flaccid Myelitis in Children

CDC / Council of State and Territorial Epidemiologists: Revision to the Standardized Surveillance and Case Definition for Acute Flaccid Myelitis

CDC: Acute Flaccid Myelitis

Categories
Infectious Diseases

Acute Otitis Media

OK, so this is the least exciting topic in Pediatric Emergency Medicine… With that being said, you will all see it. And we need to be good at looking at ears, diagnosing acute otitis media, and appropriately choosing when and which antibiotic to prescribe.

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References

Karma PH, et al., Pneumatic otoscopy and otitis media: The value of different tympanic membrane findings and their combinations. In: Recent advances in otitis media: proceedings of the Fifth International Symposium, Lim DJ, Bluestone CD, Klein JO, et al (Eds), Decker, Burlington, Ontario 1993. p.41.

Lieberthal et al., The Diagnosis and Management of Acute Otitis Media. Pediatrics, March 2013, Volume 131 / Issue 3.

Rothman et al., Does this child have acute otitis media? JAMA. 2003;290(12):1633.

Shaikh et al., Development of an algorithm for the diagnosis of otitis media. Acad Pediatr. 2012;12(3):214. Epub 2012 Mar 28.

Thompson M, et al., Duration of symptoms of respiratory tract infections in children: systematic review. TARGET Programme BMJ. 2013;347:f7027. Epub 2013 Dec 11.

Venekamp RP, et al., Antibiotics for acute otitis media in children. Cochrane Database Syst Rev. 201.

Categories
Infectious Diseases Podcast

Testing for Influenza

You don’t need a flu test to diagnose the flu! But there are situations where rapid antigen testing or PCR is valuable. Listen to this episode of PEM Currents, the Pediatric Emergency Medicine podcast, to learn more about the test characteristics of common assays and when to obtain testing when prevalence rates for the flu are high.

Check out the companion post (basically show notes) on PEMBlog.

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References

CDC: Rapid Diagnostic Testing for Influenza

CDC: Guidance for Clinicians on the Use of RT-PCR and Other Molecular Assays for Diagnosis of Influenza Virus Infection

Silvennoinen H, Peltola V, Lehtinen P, VainionpääR, Heikkinen T. Clinical presentation of influenza in unselected children treated as outpatients. Pediatr Infect Dis J. 2009;28(5):372. 

Merckx J, Wali R, Schiller I, Caya C, Gore GC, Chartrand C, Dendukuri N, Papenburg J. Diagnostic Accuracy of Novel and Traditional Rapid Tests for Influenza Infection Compared With Reverse Transcriptase Polymerase Chain Reaction: A Systematic Review and Meta-analysis. Ann Intern Med. 2017 Sep 19;167(6):394-409. doi: 10.7326/M17-0848. Epub 2017 Sep 5.

Mansour et al. Comparative Cost Analysis Between PCR Testing and DFA Testing for Diagnosing Respiratory Virus Infections. American Journal of Clinical Pathology, Volume 144, Issue suppl_2, 1 October 2015, Pages A209.