Feigin and Cherry's Textbook of Pediatric Infectious Diseases Copyright Page Dedication Ralph D. Feigin, MD April 3, 1938–August 14, 2008 Editors photos page Contributors Preface 1 Molecular Determinants of Microbial Pathogenesis Colonization Pilus Adhesins Nonpilus Adhesins Other Mechanisms of Adherence Tissue Tropism Biofilms Cell Entry and Intracellular Life Invasion Intracellular Survival Viral Cell Entry Cell-to-Cell Spread Damage to the Host Bordetella pertussis Toxins Hemolytic-Uremic Syndrome and Shiga Toxins Tissue-Degrading Toxins Evasion of Immunity Antiphagocytic Factors Evasion of Complement Activity Evasion of Humoral Immunity Encapsulation Viral Immune Suppression and Latency Conclusion New References Since the Seventh Edition References 2 Normal and Impaired Immunologic Responses to Infection Host-Pathogen Interactions General Features of Host-Pathogen Interactions Main Features of Host Responses to Specific Classes of Infectious Agents Viruses Bacteria Fungi Parasites Features of Normal Immune Function Innate Immune Responses Epithelia, Defensins, and Other Antimicrobial Peptides Toll-Like Receptors Cytokines Chemokines Natural Killer Cells Complement System Complement activation. Classical pathway. Alternative pathway. Mannan-binding lectin pathway. Effector functions of complement in host defense. Opsonic activity. Inflammation. Microbicidal activity. Immune regulation. Phagocytes Phagocyte recruitment to infected sites. Phagocytosis. Phagocyte microbicidal mechanisms. Important Interactions Among Innate Immune Mechanisms Adaptive Immune Responses Antigen Presentation and Specific Cell-Mediated Immunity Class I major histocompatibility complex. Class II major histocompatibility complex. CD1 family of antigen-presenting molecules. Plasmacytoid dendritic cells. T Lymphocytes Regulatory T cells. T-cell memory. T-cell activation by superantigens. B Lymphocytes and Immunoglobulins B lymphocytes. Immunoglobulin. Immunoglobulin isotypes. Clinical Conditions Associated With Deficient Host Responses to Infection Immature Host Responses of the Newborn Infant Cell-Mediated Immunity B Cells and Antibody B cells. Antibody. Complement Phagocytes Primary and Heritable Immunologic Deficiencies Antibody Deficiencies X-linked agammaglobulinemia. IgG subclass deficiency. IgA deficiency. Transient hypogammaglobulinemia of infancy. Antibody deficiency with normal or elevated levels of immunoglobulins. Defects of Cell-Mediated Immunity: DiGeorge Syndrome Combined Defects of Cellular and Humoral Immunity Severe combined immunodeficiency disease. Common variable immunodeficiency. Hyper–immunoglobulin M syndrome. Wiskott-Aldrich syndrome. Ataxia-telangiectasia. Defects of the Interferon-Gamma (IFN-γ) and Interleukin-12 (IL-12) Pathways Complement Deficiencies Disorders of Phagocyte Function General features of phagocyte disorders. Intrinsic disorders of cell migration Type 1 leukocyte adhesion deficiency. Type 2 leukocyte adhesion deficiency. Type 3 leukocyte adhesion deficiency (integrin activation defect). Specific granule deficiency. Chédiak-Higashi syndrome. Neutrophil actin dysfunction. Glycogen storage disease type 1B. Extrinsic or secondary defects of polymorphonuclear leukocyte migration Defective neutrophil chemotaxis associated with serum inhibitors of cell function. Hyper-immunoglobulin E syndrome. Other secondary or poorly defined disorders of polymorphonuclear leukocyte migration. Defects in phagocyte microbicidal activity. Chronic granulomatous disease. Deficiencies of glucose-6-phosphate dehydrogenase, glutathione peroxidase, and glutathione synthetase. Myeloperoxidase deficiency. Important Examples of Secondary Immunodeficiency (Excluding Human Immunodeficiency Virus Infection) Asplenia Sickle-Cell Disease Cystic Fibrosis Ciliary Dyskinesia Evaluation for Immunodeficiency in the Child With Recurrent or Severe Infections History Physical Examination Laboratory Studies Prevention of Infection Prospects for Correction of Serious Primary Immunodeficiencies New References Since the Seventh Edition References 3 Host Response to Infections Introduction Host Responses for Improving the Diagnosis of Infectious Diseases Genomics Basics of the Genomics Approach Genomics in Infectious Diseases Epigenetics Basics of the Epigenetics Approach Epigenetics in Infectious Diseases In Vitro Studies In Vivo Studies Transcriptomics Basics of the Transcriptomics Approach Microarray Analyses RNA Seq Use of Transcriptomics in Infectious Diseases In Vitro Studies In Vivo Human Studies Areas for Improved Diagnosis in Pediatrics Lower Respiratory Tract Infections (LRTI)/Pneumonia Febrile Infant Without a Source Differentiating Infection Versus Colonization Proteomics Basics of the Proteomics Approach Protein Separation Strategies Nonprotein Separation Strategies Proteomics in Infectious Diseases In Vitro Studies Human Studies C-Reactive Protein Procalcitonin Metabolomics Basics of the Metabolomic Approach Metabolomics in Infectious Diseases In Vitro and Animal Model Studies Human Studies Future Perspectives New References Since the Seventh Edition References 4 Fever: Pathogenesis and Treatment Normal Body Temperature Thermoregulation Pathogenesis of Fever Effects of Fever Adverse Effects Beneficial Effects Clinical Thermometry Types of Thermometers Measurement Site Treatment Indications Antipyretics External Cooling Summary New References Since the Seventh Edition References 5 The Human Microbiome Introduction Development in Early Life Through Childhood Impact of Environmental Factors: Diet and Medications Body Metabolism and Immunity Microbiome at Different Body Sites Airway and Respiratory Tract Microbiome Gastrointestinal Microbiome Skin and Vaginal Microbiomes Summary New References Since the Seventh Edition References 6 Epidemiology and Biostatistics of Infectious Diseases Epidemiologic Studies Design of Studies Overview and Definitions Elements of an Analytic Study Types of Studies Experimental Studies Observational Studies Cohort studies. Case-control studies. Cross-sectional studies. Analysis of Epidemiologic Studies Cohort Studies Case-Control and Cross-Sectional Studies Summary Statistics Continuous Variables Categorical Variables Bias Causes of Disease Historical Perspectives General Concepts Factors Related to the Infectious Agent Intrinsic Properties Epidemiologic Properties Relating to the Host Infectivity. Pathogenicity. Virulence. Immunogenicity. Factors Related to Relationship Between Infectious Agent and Host Reservoirs of infectious agents. Mechanisms of transmission. Factors Related to the Host Biologic Factors Age Sex, Race, and Ethnicity General Health Status Immunity and Immune Response Human Behavior Factors Related to the Environment Geographic and Geologic Factors Climate Socioeconomic Conditions Occurrence of Disease in Populations Infection and Disease in the Individual Infection and Disease in Populations Sources of information. Relating infection and disease to personal characteristics. Relative usefulness and importance of characteristics. Age patterns. Age adjustment of rates. Sex patterns. Ethnic or racial patterns. Disease patterns in kinships. Family episodes of infection and disease. Socioeconomic patterns. Relating Infection and Disease to Place Global variation. Local patterns of infection and disease. Temporal Patterns of Infection and Disease Definitions. Time clusters. Short-term patterns Epidemics. Seasonal and cyclic variations. Long-term trends. Emerging infections. Biostatistics Statistical Significance Hypothesis Testing Type I Error, Type II Error, and Statistical Power Multiple Comparisons Tests of Statistical Significance Continuous Variables Categorical Values Confidence Intervals Adjustment for Potential Confounding Variables Meta-Analysis Diagnostic Tests What Is Normal? Accuracy of a Diagnostic Test Predictive Value of a Diagnostic Test Assessment of the Protective Efficacy of a Vaccine (or of Any Intervention) Clinical Trials Observational Cohort Studies Case-Control Studies Quality Improvement New References Since the Seventh Edition References 1 ■ Upper Respiratory Tract Infections 7 The Common Cold History Etiologic Agents Epidemiology Pathophysiology Clinical Presentation Differential Diagnosis Specific Diagnosis Treatment Prognosis Prevention New References Since the Seventh Edition References 8 Infections of the Oral Cavity Microbiologic Considerations in Dental Infections Normal Flora Pathogenic Organisms Anatomic Considerations Treatment of Odontogenic Infections General Therapeutic Principles Nursing Bottle Caries Periapical Abscess Periodontal Infections Pericoronitis Oral Manifestations of Human Immunodeficiency Virus Infection in Children Oral Care of Children With Cancer Complications of Odontogenic Infections Fascial Space Infections Necrotizing Fasciitis Odontogenic Sinusitis Buccal and Periorbital Cellulitis Orbital and Intracranial Complications Osteomyelitis of the Jaws in Children Predisposing Factors Microbiology Clinical Findings Suppurative Osteomyelitis Infantile Osteomyelitis Garré Sclerosing Osteomyelitis Herpes Simplex Virus Infections Intraoral and Perioral Piercings New References Since the Seventh Edition References 9 Pharyngitis (Pharyngitis, Tonsillitis, Tonsillopharyngitis, and Nasopharyngitis) History Nasopharyngitis Etiologic Agents Epidemiology Pathophysiology Clinical Presentation Pharyngitis, Tonsillitis, and Tonsillopharyngitis Etiologic Agents Epidemiology Pathophysiology Clinical Presentation General Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Adenitis Differential Diagnosis Specific Diagnosis Treatment Complications Prognosis Prevention New References Since the Seventh Edition References 10 Uvulitis Etiology Epidemiology Pathogenesis Clinical Manifestations Diagnosis Differential Diagnosis Treatment New References Since the Seventh Edition References 11 Peritonsillar, Retropharyngeal, and Parapharyngeal Abscesses Keywords Epidemiology of Head and Neck Space Infections in Children Peritonsillar Abscess (Quinsy) Clinical Manifestations Treatment Retropharyngeal Abscess (Posterior Visceral Space, Retrovisceral Space, and Retroesophageal Space Abscesses) Clinical Manifestations Treatment Parapharyngeal Abscess (Pterygomaxillary, Pharyngomaxillary, Lateral, and Pharyngeal Space Abscesses) Clinical Manifestations Treatment Microbiology of Deep Neck Abscesses New References Since the Seventh Edition References 12 Cervical Lymphadenitis Epidemiology Pathophysiology Clinical Presentation Differential Diagnosis Specific Diagnosis Treatment Prognosis Prevention New References Since the Seventh Edition References 13 Parotitis Pathophysiology Etiology Clinical Presentation and Diagnosis Human Immunodeficiency Virus and Parotid Enlargement Differential Diagnosis Treatment Complications Prevention New Reference Since the Seventh Edition References 14 Rhinosinusitis Keywords: History Anatomy Pathophysiology Etiology Epidemiology Clinical Presentation Complications Differential Diagnosis Specific Diagnosis Treatment Acute and Subacute Sinusitis Chronic and Recurrent Sinusitis Prognosis Prevention New References Since the Seventh Edition References 15 Otitis Externa Epidemiology Normal Anatomy Protective Mechanisms of the External Ear Normal Bacterial Flora Acute Otitis Externa History and Physical Examination Pathogens in Acute Otitis Externa Management of Acute Otitis Externa Chronic Otitis Externa Otomycosis Necrotizing Otitis Externa Differential Diagnosis Prevention Conclusion New References Since the Seventh Edition References 16 Otitis Media Incidence and Epidemiology of Acute Otitis Media Risk Factors Microbiology of Acute Otitis Media in the Pneumococcal Conjugate Vaccine Era Etiology in Neonates Pathophysiology Tympanic Membrane Eustachian Tube Pathogenesis Diagnosis Symptoms and Clinical Manifestations of AOM Diagnostic Signs of Acute Otitis Media Examination of the Ear Otoscopy Tympanometry Acoustic Reflectometry Audiometric Testing Tympanocentesis and Myringotomy Radiography Management of Acute Otitis Media Tympanocentesis as Treatment Watchful Waiting Pain Management Duration of Treatment Treatment in the Penicillin-Allergic Child Management of Otitis Media With Effusion Biofilms Recurrent Acute Otitis Media Immunology Prevention Advising Parents Vaccinations to Prevent Acute Otitis Media Pneumococcal Vaccines Influenza Virus Vaccines Respiratory Syncytial Virus Vaccine Complications and Sequelae Hearing Loss Mastoiditis Petrositis Labyrinthitis Meningitis Facial Paralysis Other Suppurative Complications Vestibular Dysfunction Effects of Otitis Media on Development of the Child Perforation of the Tympanic Membrane and Chronic Suppurative Otitis Media Cholesteatoma Adhesive Otitis Media Tympanosclerosis and Tympanic Atrophy Surgical Options Myringotomy and Tympanocentesis Myringotomy, Tympanostomy Tubes, and Adenoidectomy Importance of Official Guidelines for Management of Middle Ear Disease Randomized Controlled Trials Otitis Media With Effusion Guidelines: Myringotomy, M&T, and Adenoidectomy for Chronic Otitis Media With Effusion Recurrent Acute Otitis Media Guidelines: Myringotomy and Tympanostomy Tube Placement for Recurrent Acute Otitis Media Tympanostomy Tube Placement and Physiologic Functions of the Eustachian Tube Other Indications for Placement of Tympanostomy Tubes When Should Tympanostomy Tubes Be Removed? Complications and Sequelae Other Surgical Procedures New References Since the Seventh Edition References 17 Mastoiditis Keywords: History Anatomy and Pathophysiology Microbiology Clinical Presentation Complications Differential Diagnosis Specific Diagnosis Treatment Prognosis Prevention New References Since the Seventh Edition References 18 Croup (Laryngitis, Laryngotracheitis, Spasmodic Croup, Laryngotracheobronchitis, Bacterial Tracheitis and Laryngotracheobronchopneumonitis) and Epiglottitis (Supraglottitis) Keywords: Historical Aspects Terminology Etiology of Croup Syndromes Etiology of Supraglottitis Epidemiology of Croup Epidemiology of Supraglottitis Pathology and Pathogenesis of Croup Anatomy and Pathophysiology of Supraglottitis Clinical Presentation Acute Laryngitis Acute Laryngotracheitis Acute Laryngotracheobronchitis and Laryngotracheobronchopneumonitis (Bacterial Tracheitis) Spasmodic Croup Supraglottitis Differential Diagnosis Specific Diagnosis in Croup Syndromes Specific Diagnosis in Supraglottitis Treatment of Croup Acute Laryngotracheitis and Spasmodic Croup Laryngotracheobronchitis and Laryngotracheobronchopneumonitis (Bacterial Tracheitis) Laryngitis Treatment of Supraglottitis Securing the Airway Antibiotics Other Supportive Measures Prognosis Prevention of Croup Prevention of Epiglottitis Caused by Haemophilus influenzae Type B New References Since the Seventh Edition References 2 ■ Lower Respiratory Tract Infections 19 Acute Bronchitis Keywords: Etiology Epidemiology Pathophysiology and Pathology Clinical Presentation Differential Diagnosis and Specific Diagnosis Treatment Prognosis Prevention New References Since the Seventh Edition References 20 Chronic Bronchitis Differential Diagnosis Asthma Acute Infections Cystic Fibrosis Ciliary Dyskinesia Primary Immunodeficiency Secondary Immunodeficiency (Including HIV Infection) Airway Blockage Noxious Agents Epidemiology and Etiology Treatment New References Since the Seventh Edition References 21 Bronchiolitis and Infectious Asthma Definitions History Etiologic Agents Epidemiology Clinical Presentation Pathophysiology Differential Diagnosis Diagnosis Treatment Prevention Complications and Prognosis New References Since the Seventh Edition References 22 Pediatric Community-Acquired Pneumonia Etiology Viral Pathogen Bacterial Pathogens Epidemiology Pathogenesis Clinical Manifestations Diagnosis Outpatient Setting Inpatient Setting Management Prevention New References Since the Seventh Edition References 23 Empyema and Lung Abscess Empyema Epidemiology Pathophysiology Microbiology Diagnosis Clinical Presentation Imaging Pleural Fluid Analysis Additional Diagnostic Studies Management Prognosis and Long-Term Outcome Lung Abscess Pathophysiology Microbiology Clinical Features Differential Diagnosis Diagnosis Treatment Prognosis Additional Complications New References Since the Seventh Edition References 24 Children’s Interstitial Lung Disease and Hypersensitivity Pneumonitis Classification Postinfectious Bronchiolitis Obliterans Organizing Pneumonia Infections Hypersensitivity Pneumonitis Toxic Inhalation Eosinophilic Pneumonias Pulmonary Vasculitis Syndromes Collagen-Vascular Diseases Sarcoidosis Drug Hypersensitivity Nonspecific Lymphoproliferation Clinical Presentation Diagnostic Evaluation High-Resolution Computed Tomography Bronchoalveolar Lavage Lung Biopsy Treatment Outcome Hypersensitivity Pneumonitis Pathology and Pathogenesis Etiology Clinical Presentation Diagnosis Treatment and Outcome New References Since the Seventh Edition References 25 Cystic Fibrosis Keywords: Clinical Manifestations Diagnosis Pathogenesis Specific Cystic Fibrosis Pathogens Viral Pathogens Nontypeable Haemophilus influenzae Staphylococcus aureus Pseudomonas aeruginosa Burkholderia cepacia Complex Stenotrophomonas maltophilia Achromobacter xylosoxidans Anaerobic Bacteria Fungal Species Nontuberculous Mycobacteria Treatment of Pathogens in Cystic Fibrosis Patients Prophylaxis to Prevent Acquisition of Staphylococcus aureus Early Eradication of Methicillin-Resistant Staphylococcus aureus Early Eradication of Pseudomonas aeruginosa Treatment of Pulmonary Exacerbations Pseudomonas aeruginosa Staphylococcus aureus and Methicillin-Resistant Staphylococcus aureus Burkholderia cepacia Complex Stenotrophomonas maltophilia and Achromobacter xylosoxidans Allergic Bronchopulmonary Aspergillosis Nontuberculous Mycobacteria Long-Term Suppressive Therapy Inhaled Antibiotics Macrolide Antibiotics Lung Transplantation Antiinflammatory Therapy CFTR Modulators Prevention Immunizations Infection Control Precautions Conclusion New References Since the Seventh Edition References 26 Infective Endocarditis Epidemiology Pathophysiology Clinical Manifestations Laboratory Findings Microbiology Streptococci Staphylococci Gram-Negative Organisms Gram-Positive Bacilli Other Organisms Fungi Treatment Prevention New References Since the Seventh Edition References 27 Infectious Pericarditis Anatomy and Function Bacterial Pericarditis Population and Incidence Etiology Pathology and Pathogenesis Clinical Manifestations Diagnosis Differential Diagnosis Treatment Prognosis Viral Pericarditis Etiology Clinical Manifestations Investigative Techniques Course and Prognosis New References Since the Seventh Edition References 28 Myocarditis Epidemiology Etiologies Pathology Pathogenesis Pathophysiology Clinical Manifestations Diagnosis Chest Radiography Electrocardiogram Echocardiography and Cardiac MRI Endomyocardial Biopsy Molecular Diagnostic Studies Polymerase Chain Reaction Virologic and Bacteriologic Studies Serum Biomarkers Differential Diagnosis Treatment Standard Approaches Immune-Modulating Agents Prognosis Myocarditis in Cases of Human Immunodeficiency Virus Infection Parasitic Myocarditis Chagas Disease Other Parasitic Causes of Myocarditis New References Since the Seventh Edition References 29 Acute Rheumatic Fever Epidemiology Pathogenesis Vaccine Development Rheumatic Fever in Developing Countries Pathology Clinical Course Laboratory Findings Diagnosis Differential Diagnosis Treatment Cardiac Surgery Prognosis Prevention Conclusion New References Since the Seventh Edition References 30 Mediastinitis Acute Mediastinitis Mediastinitis Due to Esophageal Perforation Mediastinitis Due to Extension of Infection From Adjacent Structures Postoperative Mediastinitis Chronic Mediastinitis New References Since the Seventh Edition References 31 Bacterial Meningitis Beyond the Neonatal Period Incidence and Epidemiology Epidemiology of Meningitis Caused by Streptococcus pneumoniae Epidemiology of Meningococcal Meningitis Epidemiology of Haemophilus influenzae Meningitis Pathophysiology Organisms Encountered Routes of Infection Pathogenesis Mucosal Colonization Bacteremia Bacterial Traversal of the Blood-Brain Barrier BBB Dysfunction and Intracranial Inflammation Neuronal Injury Factors Predisposing the Host to Bacterial Meningitis Pathology Clinical Manifestations and Pathophysiologic Relationships Differential Diagnosis Diagnosis Treatment Antimicrobial Therapy Adjunctive Therapy Antiinflammatory Therapy Corticosteroids Glycerol Supportive Care Prognosis and Sequelae Prevention Pneumococcal Infection Chemoprophylaxis Immunoprophylaxis Meningococcal Infection Chemoprophylaxis Immunoprophylaxis Haemophilus influenzae Meningitis Chemoprophylaxis Immunoprophylaxis New References Since the Seventh Edition References 32 Parameningeal Infections Brain Abscess Pathogenesis and Pathology Clinical Manifestations Rupture of Brain Abscess Into the Ventricular System Laboratory Diagnosis Diagnosis Treatment Adjunctive Agents Subdural Empyema Clinical Manifestations Diagnosis Treatment Epidural Abscess Spinal Epidural Infections Sources of Infection Clinical Manifestations Phase 1: Spinal Ache Phase 2: Root Pain Phases 3 and 4: Weakness and Paralysis Diagnosis Treatment New References Since the Seventh Edition References 33 Fungal Meningitis Epidemiology Diagnosis Clinical Manifestations Infection With Specific Organisms Candidal Meningitis Cryptococcosis Histoplasmosis Coccidioidomycosis Blastomycosis Aspergillosis Sporotrichosis Mucormycosis Other Fungal Infections New References Since the Seventh Edition References 34 Eosinophilic Meningitis Introduction Epidemiology Pathogenesis Clinical Manifestations Diagnosis Treatment Course and Prognosis Prevention New References Since the Seventh Edition References 35 Aseptic Meningitis and Viral Meningitis History Etiology Epidemiology Clinical Manifestations Enteroviruses Aseptic Meningitis Caused by Other Agents Recurrent Aseptic Meningitis (Mollaret Meningitis) Differential Diagnosis Specific Diagnosis Treatment Prognosis Prevention New References Since the Seventh Edition References 36 Encephalitis and Meningoencephalitis History Etiology Viruses Enteroviruses and Human Parechoviruses Herpesviruses Arboviruses Vaccine-Preventable Viruses Rare and/or Newly Emerging Viruses Bacteria Parasites and Free-Living Amoebae Fungi Other Putative Agents of Encephalitis Postimmunization Encephalitis Postinfectious Encephalitis Chronic Encephalitic or Encephalopathic Illnesses Epidemiology Pathogenesis Pathology Clinical Manifestations Differential Diagnosis Evaluation of a Patient With Encephalopathy or Possible Encephalitis Neuroimaging Electroencephalography Diagnosis Treatment Prognosis Prevention New References Since the Seventh Edition References 37 Parainfectious and Postinfectious Disorders of the Nervous System 37A ■ Parainfectious and Postinfectious Demyelinating Disorders of the Central Nervous System Acute Disseminated Encephalomyelitis Epidemiology Diagnostic Criteria Clinical Manifestations Clinical Variants Pathology and Pathogenesis Role of Infection Role of Immunization Immunologic Factors Pathogenesis Clinical Evaluation Treatment Outcome and Prognosis New References Since the Seventh Edition References 37B ■ Infection-Associated Myelitis and Myelopathies of the Spinal Cord Acute Transverse Myelitis Diagnostic Criteria Epidemiology Clinical Presentation Radiologic Features Lumbar Puncture Differential Diagnosis Conditions That Mimic Acute Transverse Myelitis Extramedullary Lesions Intramedullary Lesions Peripheral Lesions Disease-Associated Acute Transverse Myelitis Role of Infections in Transverse Myelitis Infectious Myelopathies Postinfectious Acute Transverse Myelitis Role of the Immune System in Idiopathic Acute Transverse Myelitis Treatment Outcome and Prognosis Recurrences Disability New References Since the Seventh Edition References 37C ■ Guillain-Barré Syndrome Epidemiology Clinical Manifestations Subtypes Differential Diagnosis Pathogenesis Clinical Evaluation Treatment Outcome and Prognosis New References Since the Seventh Edition References 5 ■ Genitourinary Tract Infections 38 Urethritis Epidemiology Pathophysiology Clinical Presentation Differential Diagnosis Noninfectious Infectious Specific Diagnosis Treatment Prognosis Prevention New References Since the Seventh Edition References 39 Cystitis and Pyelonephritis Epidemiology Risk for Urinary Tract Infection Risk Factors for Urinary Tract Infection Uncircumcised Boys Dysfunctional Voiding Constipation Sexual Activity Catheters Pathogenesis Bacteriology Virulence Factors Clinical Presentation Cystitis Pyelonephritis Physical Examination Asymptomatic Bacteriuria Differential Diagnosis Infectious Noninfectious Diagnosis Collection of a Urine Specimen Diagnosis of Urinary Tract Infection Microscopy Urine Dipsticks Determining the Site of Infection Imaging Renal Ultrasonography Renal Scintigraphy Magnetic Resonance Imaging Voiding Cystourethrography Computed Tomography Treatment Antibiotics for Treatment of Acute Infection Corticosteroids Dysfunctional Voiding Antibiotic Prophylaxis Vesicoureteral Reflux Epidemiology Natural History Management Antimicrobial Prophylaxis Surgery Prognosis Prevention New References Since the Seventh Edition References 40 Renal Abscess Clinical Findings Diagnostic Evaluation Therapeutic Considerations Conclusion New References Since the Seventh Edition References 41 Prostatitis Conclusion New References Since the Seventh Edition References 42 Genital Infections General Approach to Evaluation of Prepubertal Child Normal Vaginal Flora Lower Genital Tract Infections Vulvovaginitis Prepubertal Postpubertal Nonspecific Vulvovaginitis Prepubertal. Vulvovaginitis secondary to poor perineal hygiene. Vulvovaginitis secondary to intestinal parasites. Vulvovaginitis secondary to vaginal foreign bodies. Specific Non–Sexually Transmitted Vulvovaginitis Vulvovaginitis secondary to respiratory pathogens Streptococcus pyogenes (group A Streptococcus) vulvovaginitis. Vulvovaginitis secondary to other nasopharyngeal bacteria. Vulvovaginitis secondary to specific enteric pathogens. Vulvovaginitis secondary to skin infections. Mycotic (fungal) vulvovaginitis Prepubertal. Postpubertal. Diagnosis. Treatment. Specific Sexually Transmitted Vulvovaginitis Gonorrhea Prepubertal Diagnosis Treatment Chlamydia Prepubertal Diagnosis Treatment Trichomoniasis Prepubertal Postpubertal Diagnosis Treatment Bacterial Vaginosis Prepubertal Postpubertal Diagnosis Treatment Infections of the Clitoris Urethritis Bartholinitis and Bartholin Abscess Vulvovaginal Lesions, Ulcerations, and Granulomatous Infections Human Papillomavirus and Genital Warts Prepubertal Postpubertal Diagnosis Treatment Molluscum Contagiosum Ulcerations and Granulomatous Infections Lymphogranuloma Venereum Cervicitis Prepubertal Postpubertal Diagnosis Treatment Chlamydia Gonorrhea Upper Genital Tract Infections Pelvic Inflammatory Disease Endometritis Salpingitis Diagnosis Treatment Perihepatitis Tubo-ovarian Abscess Oophoritis New References Since the Seventh Edition References 6 ■ Gastrointestinal Tract Infections 43 Esophagitis Pathophysiology and Causative Organisms Clinical Features Differential Diagnosis Diagnosis Barium Esophagography Esophagoscopy Prevention Treatment Candida Esophagitis Other Causes of Fungal Esophagitis Viral Esophagitis Bacterial Esophagitis Prognosis New References Since the Seventh Edition References 44 Approach to Patients With Gastrointestinal Tract Infections and Food Poisoning Epidemiology Epidemiologic Categories of Diarrhea Diarrhea Acquired in Institutional Centers: Childcare Centers Antimicrobial-Associated Diarrhea Diarrhea in Immunosuppressed Host Traveler’s Diarrhea Food- and Waterborne Diseases: Food Poisoning Foodborne disease due to bacteria, viruses, and parasites. Food poisoning by chemicals. Prevention of foodborne disease. Waterborne disease. Clinical Classification of Diarrhea Episodes Organisms That Cause Diarrhea Viruses Rotaviruses Noroviruses Astroviruses Enteric Adenoviruses Bacteria Shigella Salmonella Campylobacter Diarrheagenic Escherichia coli Shiga toxin–producing E. coli. Enteropathogenic E. coli. Enterotoxigenic E. coli. Enteroinvasive E. coli. Enteroaggregative E. coli. Diffusely adherent E. coli. Adherent invasive E. coli. Vibrio cholerae Vibrio parahaemolyticus Yersinia enterocolitica Aeromonas hydrophila Plesiomonas shigelloides Clostridium difficile Clostridium perfringens Staphylococcus aureus Bacillus cereus Listeria monocytogenes Parasites Entamoeba histolytica Giardia intestinalis Cryptosporidium Isospora belli Cyclospora Microsporidia Strongyloides stercoralis Diagnosis Macroscopic Stool Examination Microscopic Examination Fecal Leukocytes Ova and Parasites Special Stains for Coccidia Stool Cultures Immunologic Methods Molecular Methods Treatment Fluid and Electrolyte Therapy Nutritional Management Antimicrobial Therapy Therapy for Dysentery Shigella Campylobacter Salmonella Shiga Toxin–Producing E. coli Therapy for Other Bacterial Agents Diarrheagenic E. coli Cholera Therapy for Intestinal Parasites Entamoeba histolytica Giardia Cryptosporidium Cyclospora Microsporidia Strongyloides Additional Therapy Zinc Probiotics Antisecretory Agents Antiemetics Prevention Vaccines Rotavirus Vaccine Vaccines for Other Enteric Viruses Vaccines for Enteric Bacteria New References Since the Seventh Edition References 45 Antibiotic-Associated Colitis History Epidemiology Pathogenesis Clinical Manifestations Laboratory Studies Differential Diagnosis Treatment Prevention and Control New References Since the Seventh Edition References 46 Whipple Disease History Epidemiology Etiology and Pathogenesis Clinical Manifestations Acute Infection Gastroenteritis Bacteremia Pneumonia “Classic” Whipple Disease Gast