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.

Categories
Infectious Diseases Respiratory

Bronchiolitis

I’m sure that you’ll probably see a case of bronchiolitis this winter. Call it a hunch. In this episode of PEM Currents you’ll learn why suctioning and ensuring hydration are still the mainstays of therapy, and why albuterol, racemic epinephrine, steroids and more don’t have a place in routine cases. And if you read any publication to supplement this podcast make it the most recent American Academy of Pediatrics Guideline on Bronchiolitis.

Check out more Pediatric Emergency Medicine educational content at PEMBlog.com

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Categories
Infectious Diseases

Community Acquired Pneumonia

Fever, tachypnea and rales – it must be a community acquired pneumonia… right? Learn more about the diagnosis and management of this common problem in the Pediatric Emergency Department.

Essential Reading

Bradley JS, Byington CL, Shah SS, Alverson B, Carter ER, Harrison C, Kaplan SL, Mace SE, McCracken GH Jr, Moore MR, St Peter SD, Stockwell JA, Swanson JT; Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Executive summary: the management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011 Oct;53(7):617-30. PMID: 21890766.

Categories
Infectious Diseases

Rabies

This edition of PEM Currents is a bite-sized rundown on rabies, or more accurately rabies post-exposure prophylaxis since most of you will never see it clinically, but will encounter a kid who meets an unscrupulous animal.

Categories
Infectious Diseases Podcast

Strep Pharyngitis

This may be a bit hard to swallow, but not every disease process in the Emergency Department is exciting. Streptococcal pharyngitis is an incredibly common condition, especially in the Pediatric Emergency Department and I wanted to take this opportunity to answer some common questions. Who knows, perhaps after listening to this edition of PEM Currents you too will start treating strep throat with once a day dosing of Amoxicillin.

Categories
Infectious Diseases

The Febrile Newborn

This episode of PEM Currents tackles a bread and butter issue in Pediatric Emergency Medicine, the newborn with fever. I discuss management, specifically how it differs for babies under 28 days of age as well as when to get labs and how to interpret them. I also reference procalcitonin, and touch on its emerging role. Read more at PEMBlog.com.

Categories
Infectious Diseases Podcast

An interview with Todd Florin on bronchiolitis, hypertonic saline and more

I’m delighted to share the latest PEM Currents podcast! I recently sat down with Todd Florin, one of the faculty physicians at Cincinnati Children’s Hospital Medical Center and talked about bronchiolitis, delving into the controversies around the use of hypertonic saline, albuterol and more. Todd also recommended that all of my listeners check out the current AAP Bronchiolitis Guideline, which I’ve linked here. AAP Bronchiolitis Guideline