Infectious Disease
Smallpox, Anthrax, and plague —could be used in bioterrorism attacks.

Military Vaccination for Smallpox which was stopped is now restarted. It is a live Vaccine.
Eczema in self or household is a contraindication for vaccine.

Small pox produces centrifugal rash. The rash becomes raised and umbilicated, and it
eventually crusts or scabs.

Anthrax cases black eschars and Tularemia causes ulcero-glandular fever.
Per American Academy of Pediatric Guidelines, there may be no acceptable alternative to
SPA for boys with moderate or severe phimosis or girls with tight labial adhesions.

A two-step process for urinary tract screening may be considered in children aged 6 to 24
months in whom evaluation for urinary tract infection is indicated.
Bioterrorism
Suspected UTI
Pseudomonas species is a common etiology of osteomyelitis in the setting of a plantar
puncture wound through rubber-soled footwear.

Plain radiographs are useful for identifying radiopaque foreign bodies. Ultrasonography is
useful for identifying all foreign body types. If there is continued concern about a retained
foreign body or about osteomyelitis, magnetic resonance imaging or computed tomography
may be of use.
Plantar puncture wound
Lymphadenitis
The first step when faced with lymphadenitis is to perform a thorough examination of the
surrounding region to inspect for a cause of the inflammation.

Ultrasonography is the test of choice to confirm that the mass is, in fact, a lymph node.

Noncervical lymphadenitis requires close follow-up as they may be oncologic or unusual
infectious or inflammatory causes.
Following an acute environmental exposure to aerosolized anthrax spores, initial
postexposure prophylaxis with ciprofloxacin or doxycycline in children and adults is
recommended.

As the spore is the infective agent, person-to-person transmission does not occur and
healthcare workers providing patient care do not require postexposure prophylaxis or
personal protective equipment and N95 or other respirator masks.

Alcohol-based hand sanitizers are not effective against the spores and should not be used.
Anthrax
Immunocompromised Host
Once varicella infection has manifested in a transplant patient, appropriate treatment
includes intravenous acyclovir therapy. Intravenous acyclovir will have the most benefit if
initiated early in the course of illness. Oral acyclovir has poor bioavailability and should not
be used to treat immunocompromised patients.

Varicella-zoster immunoglobulin can be administered to patients without evidence of
immunity or who are at risk of serious disease and have been exposed to an individual with
active varicella disease for up to 5 days, but ideally within 72 hours of the exposure.
However, it is not an effective treatment for active disease.

Fever can be the presenting sign for infection and acute rejection in organ transplant
patients.
Airborne precautions (particles smaller than 5 micron) limit the spread of infections that are
disbursed by small air particles and could require a negative pressure room. Tuberculosis,
measles, and varicella are examples.

Droplet precautions are indicated for large droplet infections (greater than 5 microns)
scattered by coughing or sneezing (such as influenza or Neisseria meningitidis).

Contact isolation is indicated for infections that are spread by contact with skin or other
surfaces.
Transmission Precautions
Paronychia
Inflammation or abscess of the lateral or posterior nailfold
Occurs after minor local trauma
Treatment – warm soaks -Antistaph abx- If abscess I&D

Felon
Abscess of the digital pulp – pad of the fingertip
Closed compartment abscess
Treatment - I&D- Immobilize - Abx
Risk of osteomyelitis and necrosis of the finger tip
Paronychia and Felon