Transcript Pediatric infectious diseases Vaccination programs

Pediatric infectious diseases
Vaccination programs
Sallai Ágnes MD, Ph.D.
Localizing symptoms
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Skin
Upper respiratory
Lower respiratory
Genitourinary
Gastrointestinal
CNS
Skeletal
Cardiovascular
Hepatic
Characteristics in infants and
children
• Neonates, infants: non-specific initial
symptoms (irritability, lethargy, poor
feeding)
• Specific rashes
• Sites of infection
• Prevention: vaccination/ immunization
Group A Streptococcal infections
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Acute pharyngitis
Impetigo
Cellulitis
Scarlat fever
Pneumonia
Septic arthritis
Osteomyelitis
Meningitis
Tonsillopharyngitis
streptococcica
• Treatment: Penicillin for 10 days
• Other bacteria: S. aureus,
H. influenzae positive in throat
microbiological cultures are not
pathogenic. - Antibiotic treatment is not
necessary!
• Aminopenicillin antibiotics are not
recommended – possible infectious
mononucleosis
Complications
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Abscess of the cervical lymphnodes
Peritonsillar abscess
Sepsis
Late: rheumatic fever, acute diffuse
glomerulonephritis
Scarlet fever
(Group A Streptococcus, erythrogenic toxin,
fine papular exanthem)
Scarlet fever
• Skin: diffusely erythematous („sandpaper
rash)
• Petechiae on the soft palate, on the upper
abdomen and trunk
• Circumoral pallor
• Desquamation on the face: end of the first
week, then generalized
• Strawberry tongue
Erysipelas
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Superficial inflammation of the skin
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acute cellulitis and lymphangitis
Streptococcus pyogenes,
Staphylococcus aureus
Complication/ infants: sepsis
Impetigo
• Papule, vesiculation, then it breaks
• Denuded area, covered by a honeycolored crust
Cellulitis (phlegmone)
• Inflammation of the
subcutaneous connective
tissue – may lead to abscess
• Streptococcus pyogenes,
Staphylococcus aureus,
Haemophilus influenzae (<2 yrs)
• Therapy: penicillin + clindamycin
Infectious diseases with rash
• Stadium incubationis: in general no symptom
• Stadium prodromum: non-specific
symptoms
• Stadium floritionis
Measles (Rubeola)
• Paramyxovirus, RNA virus
• Rash: retroauricular, temporal region, then on
the face, spreads over most of the body in 24
hours - maculo-papulous exanthemes (Koplik
spots on the buccal mucosa opposite the lower molars)
• Complications: otitis media, interstitial
pneumonia, encephalitis, cerebellitis, subacute
sclerotizing panencephalitis
Rubella
• Togavirus, RNA
• maculopapular rash
• Painful lymphadenopathy:
– retroauricular, cervical, occipital region:
Theodor - Klatsch symptom
• Peeling
• Congenital rubella syndrome
Congenital rubella syndrome
• Infection of seronegative mother during
pregnancy
• Risk of fetal infection
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I. trimenon: 75-90%
II. trimenon: 20-40%
III.trimenon: 25-50%
Fetal lesion
• 1-8. gest. week: 80%
• 9-12. gest. week: 30%
• 13-20. gest. week: 10%
Rubella vaccination is prohibited during pregnancy!
Congenital rubella syndrome
• Gestation
– 14-60. days: embryopathy – cataracta,
microphthalmia, hearing loss, congenital heart
disease, microcephalia, thymus hypoplasia
Roseola (exanthema subitum)
(Human Herpesvirus-6, maculopapular rash)
Varicella (chickenpox)
Varicella (chickenpox)
(Varicella-Zoster virus, vesicles)
Varicella (toxic)
Infectious mononucleosis
(Epstein-Barr virus infection)
Infectious mononucleosis
(Epstein-Barr virus, enanthema=pharyngeal
petechiae)
Infectious mononucleosis
Lyme disease
(Borrelia Burgdorferi, erythema chronicum
migrans)
Immunization schedule
Hungary - 2016
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BCG
DTPa+IPV+Hib+PCV
DTPa+IPV+Hib
DTPa+IPV+Hib+PCV
PCV
MMR
DTPa+IPV+Hib
DTPa+IPV
MMR
dTap
Hepatitis B
Birth to 4 week
2 mo
3 mo
4 mo
12 mo
15 mo
18 mo
6 yr
11 yr (6. school yr)
11 yr (6. school yr)
12 yr (7. school yr)
PCV: pneumococcal conjugate vaccine , a: acellular, i: inactivated
Types of vaccines
• Live attenuated viruses (measles, mumps,
rubella, varicella, polio)
• Inactivated viruses (polio, hepatitis B,
influenza)
• Inactivated bacteria (pertussis, diphtheria,
tetanus, H. influenzae type b,
pneumococcus)
Non-mandatory vaccines
(but recommended)
• Polysaccharid vaccines
– Meningococcus A, B, C, W-135, Y serotypes
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Hepatitis A, A+B
Human papillomavirus (HPV) – 12 yr (girls: 7. school yr)
Influenza
Tick - borne encephalitis
Rotavirus (from 6 weeks till 6-8 mo)
Chickenpox (varicella) - > 1 yr
RSV (premature babies)
Antibiotic prophylaxis to prevent
endocarditis I.
• For all patients with significant cong. heart defect
(unoperated, palliated or repaired)
• Rheumatic valve lesions
• Prosthetic heart valves
• Mitral heart prolapse
• Subaortic stenosis
• Transvenous pacemaker leads
• Previous endocarditis
• NOT indicated: isolated secundum ASD, repaired sec.
ASD and VSD 6 mo after patch placement, ligated PDA
6 mo after repair
Antibiotic prophylaxis to prevent
endocarditis II.
• During dental / respiratory procedures :
oral amoxicillin, 50 mg/kg 1 hr before
• During gastrointestinal / genitourinary
procedures: oral amoxicillin or parenteral
ampicillin + gentamicin, iv. 30 min before
• For patients allergic to penicillin:
clindamycin, 20 mg/kg
Oral-dental procedures requiring
endocarditis prophylaxis
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Extractions
Periodontal procedures
Dental implant placement
Root canal surgery beyond the apex
Subgingival placement of orthodontic bands but
not brackets
• Prophylactic cleaning of teeth / bleeding is
anticipated
• Intraligamentary local anesthetic injections
Kawasaki disease
(Multisystem vasculitis)
Tetanus
(Clostridium tetani exotoxins)
AIDS
• Occurrence is rare in children
• 80% intrauterine, intra partum, breast
feeding, 10-15% blood and blood
products, 5% unknown origin
• Risk of children of HIV
infected mother: 20-40%
AIDS / clinical forms
• Rapidly progressing: intrauterine infection
• Repeated, severe infections with classical and
opportunistic pathogens (Pneumocystis carinii,
Cryptosporidium, Candida, HSV, EBV, CMV)
• Failure to thrive, enlargement of parotid gland,
lymphadenopathy, cortical atropy,
demyelinisation of the brain, death at the age of
3 yrs
• BCG sepsis!
AIDS / clinical forms
• Slowly progressing form: intra partum,
post partum infection
• Frequent and severe infections after
latency (1-2 yrs)
• Lymphoid interstitial pneumonitis,
hypergammaglobulinemia
• Death before the age of 6 yrs in 60%
AIDS / prevention
• Antiviral treatment of infected mother
during pregnancy
• Isolation of newborn baby from infected
mother
• No breast feeding
• BCG vaccination is prohibited!