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Highlights from the National Pediatric Infectious Disease Seminar (NPIDS)

Highlights from the National Pediatric Infectious Disease Seminar (NPIDS). Kalpesh Patel, MD Department of Pediatric Emergency Medicine May 2, 2007. Saturday, April 14. Parasitology for the Pediatriciain Gary D. Overturf, MD Univ of New Mexico HSC

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Highlights from the National Pediatric Infectious Disease Seminar (NPIDS)

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  1. Highlights from the National Pediatric Infectious Disease Seminar (NPIDS) Kalpesh Patel, MD Department of Pediatric Emergency Medicine May 2, 2007

  2. Saturday, April 14 • Parasitology for the Pediatriciain • Gary D. Overturf, MD • Univ of New Mexico HSC • AIDS Update: Global Impact of HIV/AIDS Pandemic • Octavio Ramilo, MD • UT Southwestern and advisor to Ministry of Health in Spain • Visual Diagnosis Part 2 • James H. Brien, DO • Scott and White Hospital, Temple, Texas

  3. Parasitology for the Pediatrician • Intestinal Protozoa • Giardia • Transmission at high altitude ski areas in U.S. • New agents for treatment: Nitazoxanide (Alinia) • No oral absorption of active compound, only active metabolites in blood. Absorption decreased by food • Cryptosporidia • New agents Alinia and Albendazole (Albenza) • Albendazole – broad spectrum antiparasitic • Includes giardia, hydatic cyst disease and neurocysticercosis

  4. Parasitology for the Pediatrician • Cyclosporiasis • Similar to Cryptosporidiosis • Tx with TMP/SMX • Amoebae • Naegleria fowleri – primary meningoencephalitis • Balmuthia mandrillasis – granulomatous encephalitis • Acanthomoeba spp. – chronic recurrent keratitis • Treatment of Amoebae is poor • E. histolytica – treatment unchanged with metronidazole

  5. Parasitology for the Pediatrician • Malaria prophylaxis • Chloroquine-Sensitive areas: • Chloroquine 5mg/kg/wk, 1 wk before departure and 4 wks after return • Chloroquine-Resistant Areas: • Mefloquine, weekly. 1 wk before and 4 wks after • Doxycycline (>7yrs) 2mg/kg or 100mg/day, 2 days before and 4 wks after • Atovaquone-proguanil • Alternative tx to above

  6. Parasitology for the Pediatrician • Pinworms: Enterobius vermicularis • Asymptomatic carriage in 5-30% • Eggs infectious within 6 hours, viable for 3 weeks • Treatment with single dose mebendazole, albendazole, or pyrantel pamonate (repeat in 2 wks) • Sushi • Sparganosis – subcutaneous swellings • Anisakiasis – causes eosinophilic granulomas of bowel and possibly acute abdomen • Eustrongyloides – large larvae invade abdominal cavity and cause acute abdomen

  7. Parasitology for the Pediatrician • Cutaneous Larval Migrans • Strongyloides and Ancylostoma spp. • Creeping eruption with serpiginous lesions • Treatment – symptomatic + topical thiabendazole or PO albendazole • Visceral Larval Migrans • Toxocara canis and catis, ascaris • Hypereosinophilia, hepatomegaly, fever, pneumonitis • Treatment – supportive + albendazole and/or corticosteroids

  8. AIDS Update: Global Impact of HIV/AIDS Pandemic • Facts 1990-2005 • 38.6 million living with HIV • 24.5 million in sub-Saharan Africa • Rates stabilized in all areas except South Africa • 4.1 million new infections/year • 2.8 million deaths/year

  9. AIDS Update: Global Impact of HIV/AIDS Pandemic • AIDS ABC’s • Abstain • Be faithful • Circumcision, Condoms, Counseling and testing • Circumcised men 3X less likely to become infected • Diaphragms • Exposure prophylaxis • Female-controlled microbicides • Genital tract infection control • HSV-2 suppressive treatment • Immunization

  10. AIDS Update: Global Impact of HIV/AIDS Pandemic • Recommended prophylaxis for all people (infected + uninfected) as a cost effective measure • 2 promising vaccines • HVTN 502/Merck 023 • Adenovirus vectors • Phase 2b trial in progress in US, Puerto Rico + 5 other countries • NIAID/VRC DNA/rAd5 Candidate Vaccine • Uses multiclade multigene constructs – DNA, plasmid vector prime, + adenoviral vector • Phase 2 human trials

  11. Visual Diagnosis Part 2 • Case 10 • 15 y/o with epididymitis, Group A strep pharyngitis and Herpes cold sore • Case 11 • 6 year old with rash, LAD, 18K WBC, Tx with Keflex X 5 days • 4X4 cm right inguinal LAD • Rash involves lips, but no other mucous membranes • Rash on palms and soles • Dx: Erythema Multiforme (EM)

  12. Visual Diagnosis Part 2 • Urticaria usually have central clearing, EM has central darkening • EM shows perivenular inflammation or vacuolar interface dermatitis on skin biopsy • Steven’s Johnson – Must have at least 2 mucous membranes involved • Case 12 • 6 month old acute febrile illness • Brudinski’s sign not very accurate • Case 13 • Chronic Osteomyelitis in a fractured/refractured arm not healing

  13. Visual Diagnosis Part 2 • Case 14 • 11 mo old admitted for RSV bronchiolitis, improving and D/C’d on hospital day 3 • Developed secondary fever to 104F and resp distress and readmitted • Mediastinal mass found on CXR and CT Chest • How do you treat mediastinal abscess? • 1. Azithromycin + Ceftriaxone • 2. Clindamycin + Ceftriaxone • 3. Vancomycin + Azithromycin • 4. Ceftriaxone + Vancomycin

  14. Visual Diagnosis Part 2 • Answer: 4. Ceftriaxone + Vancomycin + surgical drainage/debridement

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