Microbial Challenges in Paediatric Settings

Children often present with fever, and signs and symptoms of various infectious diseases. The most common presentations are respiratory (i.e. upper or lower respiratory infections), gastrointestinal, or associated with the urinary tract (cystitis or pyelonephritis). Not common, but always life-threatening are infections of the nervous system (such as meningitis or encephalitis). In this step, Professor Johannes Huebner discusses these challenges in more detail.

Since respiratory and gastrointestinal infections are most often mild and usually do not need specific anti-infective treatment, the major challenge here is to identify the causative pathogen to avoid treating viral infections with antibiotics. Another important aspect is the identification of certain pathogens that would necessitate specific infection control measures for children admitted to the hospital.

Respiratory Infections

The major pathogens that are of concern are influenza virus and respiratory syncytial virus (RSV).

Although usually not severe, influenza infections can also lead to hypoxia, secondary pneumonia, and subsequent hospital admission. When these children are admitted they need to be isolated or grouped. Severely ill children or children with underlying diseases may be treated with the antiviral oseltamivir.

RSV is another pathogen that can result in severe diseases in infants and small toddlers. Children with underlying diseases such as bronchopulmonary dysplasia or congenital heart disease are at an increased risk. Although there is no specific treatment, these children also need to be isolated in the hospital – so knowledge of the pathogen is important for management.

Rapid detection of a viral infection should lead the treating physician to withhold antibiotics.

Common Gastrointestinal Infections

The challenge here is mostly related to infection control and source-tracking.

Common pathogens such as rotavirus and norovirus require strict infection control in the hospital but are usually not associated with a serious and life-threatening disease. Infections with Salmonella spp., Yersinia spp., and Campylobacter spp. also require strict infection control and result in specific source-tracking through public health authorities. Clostridium difficile can present as a severe disease and several therapeutic options are available.

CNS Infections

These are always serious, and potentially life-threatening. The rapid identification of the causative pathogen is important because effective treatment must be initiated immediately (i.e. within less than one hour) to avoid serious, and often life-long, damage or death.

Pathogens can be bacterial (e.g. meningococcal or pneumococcal) or viral (e.g. herpes simplex), so treatment must be specified (or empirical treatment covering all possible pathogens has to be started).