Table Of ContentPaediatric
Infectious
Diseases
A practical guide and cases
Yhu-Chering Huang
Ping-Ing Lee
Po-Yen Chen
Editors
123
Paediatric Infectious Diseases
Yhu-Chering Huang
Ping-Ing Lee • Po-Yen Chen
Editors
Paediatric Infectious
Diseases
A practical guide and cases
Editors
Yhu-Chering Huang Ping-Ing Lee
Pediatrics Pediatrics
Chang Gung Memorial Hospital, National Taiwan University Children’s
Chang Gung University Hospital, National Taiwan University
Taoyuan, Taiwan Taipei, Taiwan
Po-Yen Chen
Pediatrics
Taichung Veterans General Hospital,
National Chung Hsing University
Taichung City, Taiwan
ISBN 978-981-19-7275-1 ISBN 978-981-19-7276-8 (eBook)
https://doi.org/10.1007/978-981-19-7276-8
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Preface
Infectious diseases are among the most common diseases making children
seek medical care. Most pathogens of infectious diseases in pediatric patients
are viruses and the illness is usually self-limited. However, certain infectious
diseases may be severe and even fatal. Pediatric patients are also character-
ized by uncertain subjective symptoms and obscure objective signs that may
delay making a correct diagnosis. An early recognition of serious infections
that need special management is crucial for managing pediatric patients with
symptoms and signs of infection. Being pediatric infectious disease special-
ists for more than 30 years, we have encountered many such conditions. To
share our experiences with all readers, we collected and chose 50 cases from
our careers of clinical practice and drafted them in this book, hoping to assist
all physicians who are taking care of pediatric patients.
We thank all the contributors who were committed to drafting manuscripts
in this book. Without these commitments, we cannot complete this work.
Lastly, we would like to show our greatest gratitude to all patients who have
inspired us in the appropriate management of children with infectious dis-
eases. Here, with these sharing experiences, we deeply hope that more and
more clinicians can learn from you, making all children in the world more
and more healthy.
Taoyuan, Taiwan Yhu-Chering Huang
Taipei, Taiwan Ping-Ing Lee
Taichung, Taiwan Po-Yen Chen
v
Contents
Part I Neonatal Infection
Case 1. A 6-Day-Old Female Newborn with Fever
and Decreased Appetite and Activity: Enteroviral
Infection in Neonates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Yhu-Chering Huang
Case 2. 17-Day-Old Female Baby with Fever
and Decreased Appetite and Activity: Herpes
Simplex Virus Infection in Neonates and Children . . . . . . . . . . . . . . . 7
Yu-Yu Chuang and Yhu-Chering Huang
Case 3. A Premature Newborn with Respiratory
Distress and Poor Activity: Bacterial Meningitis
in Neonates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Chen-Yen Kuo
Part II Central Nervous System Infection
Case 4. A 6-Year-Old Boy with Fever for 10 Days
and Lethargy: Tuberculous Meningitis . . . . . . . . . . . . . . . . . . . . . . . . . 19
Ming-Han Tsai and Yhu-Chering Huang
Case 5. A 2-Year-Old Girl with Fever, Lethargy,
and Bilious Vomiting and Petechiae and Purpura:
Meningococcal Meningitis and Sepsis . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Chien-Yu Lin and Yhu-Chering Huang
Case 6. A 2-Year-Old Boy with Fever, Hand-Foot-Mouth
Disease, and Myoclonic Jerk: Enterovirus A71 Infection . . . . . . . . . . 29
Kuan-Ying A. Huang
Case 7. A 15-Year-Old Adolescent with Right Upper
Limb Weakness Following Upper Respiratory Infection:
Acute Flaccid Myelitis Caused by Enterovirus D68 . . . . . . . . . . . . . . 33
Jainn-Jim Lin and Wing-Lung Cheng
Case 8. A 7-Year-Old Girl with Acute Onset of Hallucinations
and Unsteady Gait: Acute Necrotizing Encephalopathy
of Childhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Jainn-Jim Lin
vii
viii Contents
Case 9. A 5-Year-Old Girl with Acute Onset of Generalized
Tonic-Clonic Seizures for Ten Minutes:
Mycoplasma Pneumoniae- Associated Encephalitis . . . . . . . . . . . . . . . . 43
Jainn-Jim Lin
Case 10. A 1-Year-Old Boy with Fever, Progressive
Consciousness Change, and Seizure: Eosinophilic
Meningoencephalitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Hao-Ting Hsu and Po-Yen Chen
Part III Respiratory Tract Infection
Case 11. A 14-Year-Old Boy with Nasal Congestion
and Cough for Days Followed by a Tender Bulging
Mass on the Forehead: Acute Bacterial Sinusitis
and Associated Complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Yi-Ching Chen and Yhu-Chering Huang
Case 12. A 1-Year-3-Month-Old Boy with Cough,
Rhinorrhea, Bilateral Eye Discharge, Fever, and Ear
Discharge: Mastoiditis and Conjunctivitis-Otitis
Media Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61
Ping-Ing Lee
Case 13. A 3-Year-9-Month-Old Girl with Painful
Swelling Over Left Face for 1 Week: Acute Parotitis . . . . . . . . . . . . . 65
Chih-Ho Chen
Case 14. A 5-Year-Old Boy with Fever, Sore Throat,
Odynophagia, and Torticollis: Deep Neck Infection . . . . . . . . . . . . . . 69
Ming-Ru Lin and Yhu-Chering Huang
Case 15. A 5-Year-Old Boy with Fever and a Painful
Enlarging Erythematous Left Neck Mass: Pyriform
Sinus Fistula with Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73
Kuan-Ta Ho and Yhu-Chering Huang
Case 16. A One-Month-Old Infant with Episodic Upward Gaze and
Cyanotic Lips in 1 Day Following a 2-Day Cough: Pertussis with
Encephalopathy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Chun Yi Lee and Yhu-Chering Huang
Case 17. A 6-Year-Old Girl with Fever for 1 Week, Productive
Cough, Running Nose, Decreased Appetite, and Activity:
Severe Lower Respiratory Tract Infection Due to Adenovirus . . . . . . 81
Ming-Ru Lin and Yhu-Chering Huang
Case 18. A 9-Year-Old Girl with Fever, Cough Followed
by Hemoptysis and Dyspnea: Severe Influenza Virus Infections . . . . 85
Tsung Hua Wu, Chun Yi Lee, and Yhu-Chering Huang
Case 19. A One-Year-Old Girl with Fever, Cough, and Posttussive
Vomiting: Respiratory Syncytial Virus Infection . . . . . . . . . . . . . . . . . 93
Hsin Chi and Ping-Ing Lee
Contents ix
Case 20. A 4-Month-Old Male Infant with Dry Cough,
Progressive Shortness of Breath: Cytomegalovirus
Pneumonitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99
Ting-Yu Yen and Yhu-Chering Huang
Case 21. A 4-Year-Old Boy with Fever, Aggravated Cough,
and Persistent Abdominal Pain: Pneumonia Presenting as
Acute Abdomen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Ping-Ing Lee
Case 22. A 2-Year-Old Girl with Community-Acquired
Pneumonia Followed by Thrombocytopenia and Anemia:
Streptococcus pneumoniae Associated with Hemolytic
Uremic Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Wan-Chun Lai, Yu-Chia Hsieh, and Yhu-Chering Huang
Case 23. A Cluster of Community-Acquired Pneumonia in
Two Siblings of School Age: Macrolide-Resistance
Mycoplasma pneumoniae Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115
Huei-Min Hung, Yu-Chia Hsieh, and Yhu-Chering Huang
Case 24. A 13-Year-Old Girl with Fever for 13 Days and
Cough and Dyspnea for 7 Days: Miliary Tuberculosis . . . . . . . . . . . . 121
Ping-Ing Lee
Part IV Heart Infection
Case 25. A 12-Year-Old Female Adolescent with Fever,
Vomiting, Abdominal Pain, Right-Hand Purpura, and
Headache: Infective Endocarditis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
Wan-Chun Lai and Yhu-Chering Huang
Case 26. A 7-Year-Old Girl with General Weakness, Fatigue,
and a Feeling of Discomfort Following Influenza: Influenza
Associated Myocarditis and Pericarditis . . . . . . . . . . . . . . . . . . . . . . . 135
Yi-Ching Chen and Yhu-Chering Huang
Case 27. A 9-Year-Old Boy with Abdominal Pain, Vomiting,
Lethargy, Headache, and Fever for 2 Days: Coxsackievirus
Myocarditis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Yi-Jung Chang
Part V Gastrointestinal Tract Infection
Case 28. A 14-Year-Old Male Adolescent with Progressive
Lethargy, Nausea, Shortness of Breath, and Weight Loss:
Liver Abscess . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
Pai-Jui Yeh and Hsun-Chin Chao
Case 29. A 5-Month-Old Female Infant with Fever, Lethargy,
Bulging Anterior Fontanelle Following Acute Gastroenteritis
2 Weeks Ago: Nontyphoidal Salmonella Enterocolitis with
Invasive Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Ming-Han Tsai and Yhu-Chering Huang
x Contents
Case 30. A 6-Year-Old Boy with Fever, Abdominal Pain,
and Diarrhea Followed by Progressive Abdominal Distention:
Salmonella Enterocolitis Complicated with Toxic Megacolon . . . . . . 157
Wei-Hsuan Lin and Yhu-Chering Huang
Case 31. A 14-Year-Old Girl with Prolonged Fever:
Typhoid Fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Hao-Ting Hsu and Po-Yen Chen
Case 32. A 10-Year-Old Girl with Progressive Abdominal
Distension and Intermittent Fever for 2 Months: Abdominal
Tuberculosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167
Wah-Tin Tiew and Yhu-Chering Huang
Part VI Urinary Tract Infection
Case 33. An 8-Month-Old Female Infant with Fever
and Pyuria: Acute Lobar Nephronia . . . . . . . . . . . . . . . . . . . . . . . . . . . 173
Chi-Hui Cheng
Case 34. A 2-Year-Old Girl with Fever for 2 Weeks despite
Oral Antibiotic Therapy: Renal Abscess in Children . . . . . . . . . . . . . 177
Chi-Hui Cheng
Part VII Bone and Joint Infection
Case 35. An 11-Month-Old Infant with Limping Gait
for 1 Week: Osteomyelitis Caused by Bacillus Calmette–Guérin
(BCG) Vaccine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183
Chih-Jung Chen
Case 36. A 12-Year-Old Adolescent with Fever, Vomiting,
General Skin Rash Following a Preceding Minor Trauma
Over Left Hip: Disseminated Community- Associated
Methicillin-Resistant Staphylococcus Aureus Infection . . . . . . . . . . . 187
Yhu-Chering Huang
Part VIII Skin and Soft Tissue Infection
Case 37. A 4-Year-Old Boy with Left Leg Pain and Limping
Gait Following Mucoid Diarrhea 2 Weeks Ago: Salmonella
Pyomyositis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195
Ping-Ing Lee
Part IX Other Specific Infection/Syndrome
Case 38. A 6-Year-Old Boy with Fever, Sore Throat, and a
Crusted Wound on the Left Flank: Scrub Typhus . . . . . . . . . . . . . . . . 201
Hsin Chi
Contents xi
Case 39. A 5-Month-Old Infant with Repeated
Community- Acquired Pneumonia and Failure to
Thrive: Pediatric Human Immunodeficiency Virus Infection . . . . . . 205
Wah Tin Tiew and Yhu-Chering Huang
Case 40. A 6-Year-Old Girl with Fever and Neck
Lymph Nodes Enlargement: Kikuchi-Fujimoto Disease . . . . . . . . . . . 211
Chih-Hsien Chuang
Case 41. A 2-Year-Old with Fever, Progressive Lethargy
and Skin Rash: Kawasaki Disease with Shock Syndrome . . . . . . . . . 215
Ching-Chia Kuo
Case 42. A 6-Year-Old Girl with Fever, Sore Throat,
Odynophagia, Dysphagia, and Cervical Mass:
Lymph-Node- First Presentation Kawasaki Disease. . . . . . . . . . . . . . . 221
Ming-Ru Lin and Yhu-Chering Huang
Case 43. An 8-Year-Old with Fever, Headache, Muscle Ache,
and Retro-Orbital Pain, Followed by Frequent Vomiting:
Dengue Fever with Shock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225
Tzong-Shiann Ho and Ching-Chuan Liu
Case 44. A 4-Year-Old Boy with Fever, Cough, Skin Rash,
and Difficulty in Breathing: Streptococcal Toxic Shock
Syndrome . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 231
Yu-Yu Chuang and Yhu-Chering Huang
Case 45. A 4-Year-Old Boy with Fever, General Skin Rash,
Vomiting, and Diarrhea, Following an Operation for Bone
Fracture: Staphylococcal Toxic Shock Syndrome . . . . . . . . . . . . . . . . 237
Yu-Yu Chuang and Yhu-Chering Huang
Case 46. A 3-Year-Old Girl with Fever and Pancytopenia:
Hemophagocytic Lymphohistiocytosis Associated with
Epstein-Barr Virus Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243
Chih-Jung Chen and Yhu-Chering Huang
Case 47. A 2-Month-Old Infant with Fever, Progressive
Skin Rash and Eosinophilia: Drug-Induced Fever
and Skin Rash in Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 247
Chun-Bing Chen, Hsi Yen, and Wen-Hung Chung
Case 48. A 4-Month-Old Infant with Fever, Diarrhea,
Followed by Abdominal Distention and an Ulcer-Like
Skin Lesion: Community-Acquired Pseudomonas aeruginosa
Sepsis (Shanghai Fever) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251
Chih-Hsien Chuang
