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Manual of
Childhood
Infections
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Infectious Disease Epidemiology
Manual of Childhood Infections 4e
Manual of
Childhood
Infections
Fourth edition

Chief Editor
Mike Sharland
Professor of Paediatric Infectious Diseases,
St George’s Hospital, London, UK

1
1
Great Clarendon Street, Oxford, OX2 6DP,
United Kingdom
Oxford University Press is a department of the University of Oxford.
It furthers the University’s objective of excellence in research, scholarship,
and education by publishing worldwide. Oxford is a registered trade mark of
Oxford University Press in the UK and in certain other countries
© Royal College of Paediatrics & Child Health & European Society of Paediatric
Infectious Diseases 2016
The moral rights of the author‌have been asserted
First Edition published as Manual of Childhood Infections, 1996
Second Edition published as Manual of Childhood Infections, 2001
Third Edition published 2011
Fourth Edition published 2016
Impression: 1
All rights reserved. No part of this publication may be reproduced, stored in
a retrieval system, or transmitted, in any form or by any means, without the
prior permission in writing of Oxford University Press, or as expressly permitted
by law, by licence or under terms agreed with the appropriate reprographics
rights organization. Enquiries concerning reproduction outside the scope of the
above should be sent to the Rights Department, Oxford University Press, at the
address above
You must not circulate this work in any other form
and you must impose this same condition on any acquirer
Published in the United States of America by Oxford University Press
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British Library Cataloguing in Publication Data
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Library of Congress Control Number: to follow
ISBN 978–0–19–872922–8
Printed in Great Britain by
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Oxford University Press makes no representation, express or implied, that the
drug dosages in this book are correct. Readers must therefore always check
the product information and clinical procedures with the most up-to-date
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and the most recent codes of conduct and safety regulations. The authors and
the publishers do not accept responsibility or legal liability for any errors in the
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contained in any third party website referenced in this work.
 v

Foreword to
the fourth edition
We are very pleased to write a foreword for the fourth edition of the Blue
Book on Childhood infections. The last edition was around five years ago
and this new edition has again been re-written and updated. The book
provides a clinical evidence-based handbook approach to the management
of both common and unusual infections in children. The Editorial Board
has nearly 200 authors writing the 120 chapters of this new edition. The
book has been written by paediatricians, microbiologists, and a wide range
of international experts in paediatric infectious disease. The book is aimed
at both trainee and practising hospital- and community-based paediatricians,
nursing, and other medical staff caring for children in the United Kingdom,
Europe, and internationally. It aims to provide an up-to-date reference guide
including common differential diagnoses, medical management, and infor-
mation on over 100 medicines.
The aim of the book is to improve the evidence-based management to
a child’s infection. This new edition has short abstracts, key references,
and key learning points which are now fully updated. Recent immunisation
campaigns have substantially reduced rates of serious bacterial infection in
children yet new and emerging infections remain a very serious concern.
Rates of hospital-acquired infection are now a serious threat to children and
much remains to be done to reduce nosocomial infection. Antimicrobial
resistance has been flagged by the World Health Organization as one of
the three greatest threats to human health. New chapters on antimicrobial
stewardship demonstrate the way forward for reducing the inappropriate
antibiotic prescribing that drives this very serious problem.
The development of an eBook format now provides a bedside approach
to the practical management of common infections. All paediatricians
should be encouraged to manage a child’s infection using this practical, sim-
ple evidence-based approach.
The European Society for Paediatric Infectious Diseases is very pleased
to be working in partnership with the Royal College of Paediatrics and Child
Health. This edition has an ever-increasing international focus. There is still
considerable variation of practice and management of children’s infection.
Much of this reflects cultural differences and child care practice across
Europe. There is still some variation in practice that cannot necessarily be
explained just by altered prevalence of infections and resistance pattern.
Although evidence-based guidelines will vary across European countries,
the manual is an attempt to be a synthesis of published evidence of sys-
tematic reviews providing the core basic evidence. The Blue Book has been
produced as a teaching tool for trainees internationally and for practising
paediatricians. It can be used as a source to look up, check, or think about
management plans, differential diagnosis, or recent epidemiology. In most
chapters, sections define what is new and what is coming. The Blue Book
also acts to identify future research priorities and aims to encourage collab-
oration across Europe.
vi FOREWORD TO THE FOURTH EDITION

The Blue Book also recognizes that antimicrobial dosing varies consid-
erably across Europe. For this new edition an evidenced approach to the
formulary has been produced and for the first time will provide information
about grading the level of evidence for antimicrobials. The Blue Book again
does not aim to replace national or local formularies but provides a prag-
matic and reasonable summary of the evidence base for each drug.
Professor Neena Modi (RCPCH)
Professor Adam Finn (ESPID)
 vii

Contents

Section editors xii

Contributors xiv
Symbols and abbreviations xxi

Section 1 Clinical syndromes

1 Antibacterials   3
2 Antifungals   11
3 Antiparasitics   23
4 Antivirals   31
5 Antimicrobial stewardship   43
6 Bacterial meningitis   49
7 Bone and joint infections   65
8 Cardiac infections   70
9 Central venous catheter infections   93
10 Chronic fatigue syndrome 100
11 Congenital infections 103
12 Diarrhoea and vomiting 112
13 Emerging infections and pandemic preparedness 117
14 Encephalitis 125
15 Enlarged lymph nodes 135
16 Ocular infections 148
17 Immunocompromised children with infection 160
18 Immunization of the immunocompromised child 171
19 Infection control in the community 183
20 Infection control in the hospital 188
21 Laboratory diagnosis of infection 199
22 Lower respiratory tract infection 210
viii CONTENTS

23 Neonatal infections 220

24 Hereditary autoinflammatory diseases 228
25 Pyrexia of unknown origin 234
26 Rash 242
27 Gram-positive bacteria 257
28 Gram-negative infections 263
29 Refugees and internationally adopted children 269
30 The unwell child returning from abroad 274
31 Sepsis syndrome 281
32 Sexually transmitted infections 293
33 Skin and soft tissue infections 300
34 Investigating the child with possible
immunodeficiency 309
35 Invasive fungal infection 326
36 Toxic shock syndrome 334
37 Trauma, bites, and burns 344
38 Travelling abroad with children 350
39 Urinary tract infection 357
40 Upper respiratory tract infections 366
41 Zoonoses 377

Section 2 Specific infections

42 Adenovirus 389
43 Amoebiasis 396
44 Anaerobic infections 402
45 Arboviruses 411
46 Ascariasis 420
47 Aspergillosis 429
48 Botulism 442
49 Brucellosis 446
 CONTENTS ix

50 Campylobacter 450
51 Candidiasis 454
52 Cat scratch disease 461
53 Chickenpox—varicella-zoster 464
54 Chlamydia pneumoniae infection 474
55 Chlamydia psittaci infection 477
56 Chlamydia trachomatis infection 479
57 Cholera 484
58 Clostridium difficile 488
59 Conjunctivitis 497
60 Cryptosporidiosis 504
61 Cytomegalovirus 507
62 Dermatophytoses: tinea capitis, corporis,
pedis, and unguium 513
63 Diphtheria 520
64 Enteroviruses (including rhinoviruses)
and parechoviruses 524
65 Rhinovirus 533
66 Giardiasis 537
67 Gonococcal infection 541
68 Haemolytic–uraemic syndrome 545
69 Haemophilus influenzae 554
70 Viral haemorrhagic fevers 560
71 Hand, foot, and mouth disease 568
72 Helicobacter pylori 572
73 Hepatitis A and E 576
74 Hepatitis B 582
75 Hepatitis C 589
76 Herpes simplex virus 1 and 2 594
77 Human immunodeficiency virus infection 602
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