Red Book Atlas of Pediatric Infectious Diseases 5th Edition -2023 pdf

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The American Academy of Pediatrics (AAP) Red Book Atlas of Pediatric Infectious Diseases, 5th Edition, summarizes key disease information from the AAP Red Book: 2021–2024 Report of the Committee on Infectious Diseases. It is intended to be a study guide and visual resource for students, residents, practicing physicians, and other health care professionals who care for infants and children. The compilation of images of common and unusual features of infants and children with a broad range of infectious diseases can provide diagnostic clues that are not found in the print version of the Red Book. It is my hope that the juxtaposition of these images against text summarizing the clinical manifestations, epidemiological factors, diagnostic methods, and treatment information will be effective as a teaching tool and a quick reference. The Red Book Atlas is not meant to detail information on treatment and management of a disease but instead provide a big-picture approach that can be refined, as desired, by reference to authoritative textbooks, original articles, or infectious diseases specialists.  



 Complete disease and treatment information from the AAP can be found in the electronic version of the Red Book at The Red Book Atlas would not exist without the incredible support and assistance provided by Heather Babiar, Amanda Helmholz, and Theresa Wiener at the AAP and the generosity of the physicians who photographed disease manifestations in their patients and shared these with the AAP. Some diseases have disappeared in the world (ie, smallpox), and others are rare in the United States (eg, diphtheria, tetanus, congenital rubella syndrome) because of effective prevention strategies, especially immunization. Although photographs cannot replace hands-on familiarity, they are very helpful in considering the likelihood of alternative diagnoses, and I hope that this will be so for the reader. I also want to thank the many individuals at the Centers for Disease Control and Prevention who generously provided many images of etiologic agents, vectors, and life cycles of parasites and protozoa relevant to some of these infections. The study and practice of pediatric infectious diseases, through the dynamic nature of the specialty and the challenges that this brings, has brought me incredible fulfilment and joy. Simply put, it is one of the “best jobs in the world.” To be able to interact with patients and their families; gather physical examination, laboratory, and radiographic data; and put the pieces together to assign a diagnosis and develop a treatment plan leading to the complete recovery of the patient is one of the most exciting and gratifying parts of the job. Solving the medical puzzle peaks your curiosity and provides you with exposure to many diverse resources, intellectual stimulation, and immense satisfaction when you are able to help a patient and their family as they are dealing with the illness. It is my hope that readers will experience a bit of the enthusiasm that I have for infectious diseases after reading the fifth edition of the Red Book Atlas.



 Actinomycosis results from pathogen introduction following a breakdown in mucocutaneous protective barriers. Spread within the host are, by direct invasion of adjacent tissues, typically forming sinus tracts that cross tissue planes. The most common species causing human disease is Actinomyces israelii. There are 3 common anatomical sites of infection. Cervicofacial is most common, often occurring after tooth extraction, oral surgery, or other oral/ facial trauma or even from carious teeth. Localized pain and induration may progress to cervical abscess and “woody hard” nodular lesions (“lumpy jaw”), which can develop draining sinus tracts, usually at the angle of the jaw or in the submandibular region. Infection may contribute to recurrent or persistent tonsillitis. Thoracic disease is most commonly secondary to aspiration of oropharyngeal secretions but may be an extension of cervicofacial infection. It occurs rarely after esophageal disruption secondary to surgery or nonpenetrating trauma. Thoracic manifestation includes pneumonia, which can be complicated by abscesses, empyema, and, rarely, pleurodermal sinuses. Focal or multifocal mediastinal and pulmonary masses may be mistaken for tumors. Abdominal actinomycosis is usually attributable to penetrating trauma or intestinal perforation. The appendix and cecum are the most common sites; symptoms are like those of appendicitis. Slowly developing masses may simulate abdominal or retroperitoneal neoplasms. Intra-abdominal abscesses and peritoneal-dermal draining sinuses occur eventually. Chronic localized disease often forms draining sinus tracts with purulent discharge. Other sites of infection include the liver, pelvis (which, in some cases, has been linked to use of intrauterine devices), heart, testicles, and brain (which is usually associated with a primary pulmonary focus). Noninvasive primary cutaneous actinomycosis has occurred



A israelii and at least 5 other Actinomyces species cause human disease. All are slow-growing, microaerophilic or facultative anaerobic, gram-positive, filamentous branching bacilli. They can be part of normal oral, gastrointestinal tract, or vaginal flora. Actinomyces species are frequently copathogens in tissues harboring multiple other anaerobic and/or aerobic species. Isolation of Aggregatibacter (Actinobacillus) actinomycetemcomitans, frequently detected with Actinomyces species, may predict the presence of actinomycosis. EPI



Actinomyces species occur worldwide. Actinomyces species are opportunistic pathogens in the setting of disrupted mucosal barriers. Infection is uncommon in infants and children, with 80% of cases occurring in adults. The maleto-female ratio in children is 1.5:1. Although microbiologically confirmed infections caused by Actinomyces species are now less common, there are reports from patients who have undergone a transplant or are receiving biologics. The incubation period varies from several days to several years.  



Microscopic demonstration of beaded, branched, gram-positive bacilli in purulent material or tissue specimens suggests the diagnosis. Only specimens from normally sterile sites should be submitted for culture. Specimens must be obtained, transported, and cultured anaerobically on semiselective (kanamycin-vancomycin) media such as the modified Thayer-Martin agar or buffered charcoal–yeast extract agar. Acid-fast testing can distinguish Actinomyces species, which are acidfast negative, from Nocardia species, which are variably acid-fast positive staining. Yellow sulfur granules visualized microscopically or macroscopically in drainage or loculations of purulent material suggest the diagnosis. A Gram stain of sulfur granules discloses a dense aggregate of bacterial filaments mixed with inflammatory debris. A israelii forms spiderlike microcolonies on culture medium after 48 hours. Actinomyces species can be identified in tissue specimens by using polymerase chain reaction assay and sequencing of the 16S ribosomal RNA



Initial therapy should include intravenous penicillin G or ampicillin for 4 to 6 weeks followed by high doses of oral penicillin (up to 2 g/day for adults), usually for a total of 6 to 12 months depending on the extent of disease and success of surgical management (when indicated). Treatment of mild disease can be initiated with oral therapy. Amoxicillin and doxycycline are alternative antimicrobial choices. Amoxicillin-clavulanate, piperacillintazobactam, ceftriaxone, clarithromycin, linezolid, and imipenem-meropenem also show high activity in vitro, but the latter antimicrobials have extended spectrums, which may not always be required. All Actinomyces species appear to be resistant to ciprofloxacin and metronidazole. Doxycycline is not typically recommended for children younger than 8 years when therapy will continue beyond 21 days. Surgical drainage is often a necessary adjunct to medical management and may shorten, but does not obviate, antimicrobial therapy.







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