• 70% of all people will have at least 1 episode of OM, OM accounts for ~ 30% of all "sick" visits to pediatricians
• Clinical Manifestations
• Acute otitis media with effusion
• "Presence of fluid in the middle ear accompanied by a sign of acute illness", Otalgia, otorrhea, hearing loss, Ear pulling, Systemic symptoms (Fever, irritability, lethargy, vomiting, diarrhea) Infants: irritability, vomiting and diarrhea
• Otitis media with effusion
• "Presence of fluid in the middle ear without signs or symptoms of acute infection"
• Prevalence following acute OM: 2 wks - 70%, 1 month - 40%, 2 months - 20%, 3 months - 10%
• Chronic = weeks to months after acute OM. Decreased hearing
• Etiology
• 25 - 50% Streptococcus pneumoniae, more severe, less likely to remit spontaneously
• 15 - 30% Haemophilus influenzae (nontypable), less severe, more likely to remit spontaneously
• 3 - 20% Moraxella catarrhalis, less severe, more likely to remit spontaneously
• 2 - 3% Streptococcus pyogenes, Staphylococcus aureus
• 20% Respiratory viruses alone, "sterile otitis media" (RSV, Rhinovirus, Influenza)
• Epidemiology
• Age: peak 6 to 18 months, in kids the estuation tube is more parallel (more prone to reflux)
• Risk factors: Acquired- Day care, Smoking in home, 1st episode less than 1 year, "Early and often", 1st episode Streptococcus pneumoniae, predominance fall and winter. Congential - craniofacial abnormality
• Diagnosis
• history: presence or absence of systemic symptoms and ear pain
• PE: Pneumatic otoscopy of tympanic membrane, Position (neutral, bulging, retracted), Color (pearly gray, red, pale, Degree of translucency (shiny, dull), Mobility, Tympanometry (air pump varies canal pressure), TM compliance, Middle ear pressure, Tympanocentesis, air-fluid level.
• Treatment
• Antibiotics (usually oral), Increased resistance in pneumococci
• Myringotomy- surgery to put in tubes
• Complications
• Chronic otitis with effusion, Deafness, Speech and developmental problems, Mastoiditis, Meningitis, brain abscess, Lateral sinus thrombosis, Otitic hydrocephalus (treat otitis and hydrocephalus goes away), Cholesteatoma (soft tissue formation in inner ear) Labyrinthitis
• Prevention
• Breast-feeding (> 3 months), Not propping bottles, Prophylactic antibiotics
• Tympanostomy tubes
• Þ Otitis media may be the result of bacterial superinfection of viral infection - therefore, preventing viral respiratory infections by immunization against RSV, influenza, parainfluenza, etc, may prove to have a greater impact on OM than immunization against Streptococcus pneumonia, nontypable Haemophilus influenzae, and Moraxella catarrhalis

• Etiologic Agent: RNA virus, Paramyxovirus family, genus Morbillivirus Highly infectious (need a Ý % of population vaccinated)
• Clinical Manifestations
• "Measley-looking", Fever, Rash, Head first, nonspecific maculopapular, older rash is brownish
• Four "K's"
• Cough (always present)
• Conjunctivitis (pink eye)
• Coryza (runny nose)
• Koplik spots
• Complications
• SUPER INFECTIONÞ Otitis media, Pneumonia, Croup, Diarrhea
• Severe Complications
• Encephalomyelitis: ~ 1/ 1000 cases
• "Black measles" - severe hemorrhagic
• Subacute sclerosing panencephalitis (SSPE) post infectious, ~1/100,000 cases, slowly progressing, behavioral and intellectual deterioration, Fatal within 6 months, Mortality ~ 3/1000 cases
• Transmission: Contact with infectious droplets, Airborne
• Diagnosis: by clinical presentation (4 "K's")
• Treatment: Vitamin A – kids getting Vit A do better
• Prevention: Vaccine (need >85 % of population vaccinated) Adverse effects of vaccine – fever several days later, febrile convulsions. Immune globulin – given to immunocompromised patients

• Etiologic Agent: RNA virus, Paramyxovirus family, Subgroup - parainfluenza
• Clinical Manifestations: Asymptomatic (30-40%), Fever, headache, anorexia, malaise, Swollen salivary glands (60-70%), swollen Parotid gland (cannot see angle of jaw)
• Complications: Paroditis, Meningeal signs (10-30%) Encephalitis (~1/ 6000), Fatality 1.4%, Orchitis (Common after puberty; can lead to Sterility), rarely other glands (pancreatitis, oophoritis, thyroiditis), Hearing impairmen, or Mortality.
• Transmission: Direct contact via respiratory route
• Diagnosis: Clinical presentation: Parotid swelling. Consider other etiologies. Can use culture or serology to confirm
• Treatment: Supportive
• Prevention: Vaccine

• Etiologic Agent: RNA virus, Togaviridae family, Rubivirus
• Clinical Manifestations: Asymptomatic (25-50%), Mild disease, Malaise, sore throat, cough, Fever (mild)
• Rash: Head first Nonspecific red maculopapular
• Lymphadenopathy (Postauricular, suboccipital, cervical)
• Complications: Rare Polyarthralgia and polyarthritis seen in young adults (esp women), rarely Encephalitis or Thrombocytopenia
• Congenital Rubella
• Transmission:Contact with nasopharyngeal secretions transplacentally
• Diagnosis: NOT clinical presentation, Culture Serology
• Treatment: Supportive
• Prevention: Vaccine, Target women of child-bearing age, Immune globulin (not commonly used)
• Infection in early pregnancy Þ birth defects and deaths (Glucoma, Cataracts, Deafness, Heart defects (PDA), Retardation, Microcephaly, Low birth weight, TTP, Heptosplenomegaly). "Blueberry muffin rash"

• Etiologic Agent: DNA herpesvirus, Varicella-zoster virus (VZV)
• Clinical Manifestations: Mild systemic symptoms, Mild fever, Pruritic, Vesicular rash, All stages simultaneously
• Complications (Nonviral): Bacterial superinfections: Cellulitis, Otitis media, Pneumonia, Meningitis, Reye syndrome (salicylates)
• Complications (VZV): Pneumonia, Hepatitis, Encephalitis, Herpes Zoster ("Shingles"), Reactivation of latent VZV, Dermatomal distribution, Fetal infection, Chronic skin disease, Disseminated Varicella or Zoster seen in Immunocompromised hosts (esp pregnant women) and is often fatal.
• Transmission: Direct contact, Airborne, Transplacental
• Diagnosis: Clinical (definitive), Culture, Rapid diagnosis (DFA or PCR), Serology (very useful to determine susceptibility)
• Treatment: Acyclovir- Oral for normal hosts, Parenteral - Compromised hosts
• Prevention: Vaccine, Varicella-zoster immune globulin (VZIG

Human Herpesvirus 6 – HHV-6, Roseola, Exanthem Subitum, Sixth Disease, "Baby Measles"

• Etiologic Agent: RNA virus Family –Reoviridae, Groups A to E
• Clinical Manifestations: "Wintertime vomiting and diarrhea disease of childhood"
• DIARRHEA, (Watery stools, No blood, leukocytes, mucus), Vomiting, Fever, Cough and runny nose
• Complications: Dehydration and Starvation
• Most common cause of diarrhea in children 6 to 24 months
• Most common cause of diarrhea requiring hospitalization
• Most important cause of nosocomially acquired diarrhea
• Diagnosis: Enzyme immunoassay or Electron microscopy
• Treatment: Rehydration, Oral or Intravenous, and Oral immunoglobulin
• Prevention: Breast-feeding (milder disease), Hygiene, Exclude from day care
• Vaccine is no longer available because in post-vaccine trials kids were getting intussusception