Transcript 13- 2012common_child..

Childhood Infectious
Diseases
Dr Elham Bukhari
Assistant Professor & Consultant
Pediatric Infectious Diseases
King Khalid University Hospital
King Saud University, Riyadh
Common Viral Infecions
Measles
Mumps
Rubella
Chicken pox
Erythema infectiousum (Fifth Disease)
Roseola infantum(Sixth Disease)
Rashes caused by childhood infections.
Macular/papular /maculopapular:
Macules-red/pink discrete flat areas,blanch on
pressure ex rubella,measles..ect
Papules –solid raised hemispherical
lesions,usually tiny ,also blanch on
perssure.ex scarlet fever,kawasaki
disease.
Purpuric/petechial:
Non-blanching red/purple spots.ex
meningococcal.
Vesicular:
Raised hemispherical lesions,<0.5 cm
diameter,contain clear fluid.ex chicken
pox
Pustular/bullous:
Raised hemispherical lesions,>0.5cm
diameter,contain clear or purulent fluid.
ex Imptigo
Cont……
Desquamation:
Dry and flaky loss of surface epidermis,
often peripheries. ex Kawasaki disease.
Measles
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RNA Virus
Incubation Period: 6 – 12 days
Clinical Features.fever,rash,coryza
Complications:
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Respiratory: pneumonia,om
Neurological:febrile
conv.encephalitis,SSPE
Others:diarrhoea,hepatitis
Treatment;symptomatic
Isolation & Infectivity: 2 days
before till 6 days after rash
CLINICAL MANIFESTATIONS
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1.Incubation period is approximately
6~18days,10days is the most common.
(3-4weeks)
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2 .predromal phase
3~4 days.
1. Fever.
2. Catarrhal inflammation of URT.
3. Koplik’s spots.
4. Transient prodromal rashes.
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3. Eruption stage
1. Time: the 3~5 days after fever ; but the 4th day is most
common;
2 . Shape: maculopapular
3. Sequence: behind the ear→along the
hairline→face→neck→chest→back→abdomen→limbs→hand
and feet(palm , sole)
4 . The temperature rise continuously and accompanied with the
toxic symptoms .
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4 . Convalescent stage
brown staining.
fine desquamation.
course:10-14 days
COMPLICATIONS :
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1 .Bronchopneumonia.
2 .Myocarditis.
3 .Laryngitis.
4 .Neurologic complications:
Encephalitis and SSPE .
subacute sclerosing panencephalitis
Persistent infection of the brain.
Rare,psychologic.neuro deterioration.
Personality changes,seziure,coma.
Measles (cont.)
Koplik’s spots
Measles
(Cont.)
Measles vs. Scarlet fever
DIAGNOSIS.
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1 .Epidemiologic data.
2 .Clinical manifestations.
3. Laboratory findings:
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1 .Multinucleated giant cells are detected in
nasopharyax mucosa secretions.
2 .Measles virus can be isolated in tissues culture.
3 . Antibody titer. specific antibody IgM.
4 . Other Ag and multinucleated giant cells
EPIDEMIOLOGY
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1.Source of infection
The patients are the only source of infection.
2 .Routes of transmission
air-borne
3. Susceptibility of population
1 . All age person is susceptible; 90% of contact people
acquire the disease.
2 .The permanent immunity acquire after disease.
4.Epidemic features
season:winter and spring
age:6 months to 5 years old
DIFFERENTIAL DIAGNOSIS
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1 .Rubella (German measles)
2. scarlet fever.
3 .Roseola infantum (infant subitum,exanthem
subitum)
4. Drug rashes.
Mumps
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RNA Virus
Incubation Period: 14 – 21 days
Clinical Features:fever,sweeling
Complications:
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Glandular
Non glandular
Isolation & Infectivity: 9 days after
onset of parotid swelling
Clinical manifestation of mumps are:
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Parotid inflammation (or parotitis) in 60–70% of infections and
95% of patients with symptoms Parotitis causes swelling and
local pain, particularly when chewing. It can occur on one side
(unilateral) but is more common on both sides (bilateral) in about
90% of cases.
Fever
Headache
Pancreatitis: inflammation of the affected pancreas.
Orchitis: painful inflammation of the testicles
Diagnosis:
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Person infected with mumps is contagious from
approximately 6 days before the onset of symptoms until
about 9 days after symptoms start.
Usually the disease is diagnosed on clinical grounds and
no confirmatory laboratory testing is needed
Rubella
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RNA Virus
Incubation Period: 14 – 21 days
Clinical Features:fever ,rash.
Complications:
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Acquired ;arthritis,encephalitis,
Congenital:fetal damage.
Isolation & Infectivity: 7 days from
onset of rash
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Congenital Rubella: until 1 year of age
Rubella
Symptoms include: low grade fever, swollen glands (sub
occipital & posterior cervical lymphadenopathy), joint
pains, headache and conjunctivitis.
The swollen glands or lymph nodes can persist for up to a
week and the fever rarely rises above 38 oC (100.4 oF).
The rash of German measles is typically pink or light red.
The rash causes itching and often lasts for about three
days.
Rubella (Cont.)
Congenital rubella syndrome
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Rubella can cause CRS in the newly born. The syndrome
(CRS) follows intrauterine infection by the Rubella virus
and comprises cardiac, cerebral, ophthalmic and auditory
defects.
It may also cause prematurity, low birth weight, and
neonatal thrombocytopenia, anaemia and hepatitis.
The risk of major defects or organogenesis is highest for
infection in the first trimester.
Congenital Rubella Syndrome
Chicken Pox (Varicella)
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DNA Virus(VZV).
Incubation Period: 10 – 21 days
Clinical Features:Papules-vesicles-pusulescrusts.
Complications:
 2nd bacterial infection:staph.strep
 Neurological :cerebellitis, encephalitis
 Reye syndrome
 Disseminated:immunocompromised
Treatment: (Acyclovir).ZIG.
Isolation & Infectivity: 2 days before rash till
all skin lesions have crusted (6th day of rash)
Cont. Chicken Pox
Cont. Chicken Pox
Rubella, Smallpox, Chickenpox
Poliovirus
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Incubation Period: 7 – 21 days
Clinical Features: <1% classical
paralytic polio
Complications: aseptic
meningitis.
Treatment
Isolation & Infectivity: several
weeks
What is Poliomyelitis?
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polio= gray matter
Myelitis= inflammation of the spinal cord
This disease result in the destruction of motor
neurons caused by the poliovirus.
Polio is causes by a virus that attacks the nerve
cells of the brain & spinal cord although not all
infections result in sever injuries and paralysis.
How is polio transmitted?
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Poliovirus is transmitted through both oral and
fecal routes with implantation and replication
occurring in either the oropharyngeal and or in the
intestine of mucosa.
Polio cases are most infected for 7-10 days before
and after clinical symptoms begin.
What are the symptoms?
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Many include fever, pharyngitis, headache,
anorexia, nausea, and vomiting. Illness may
progress to aseptic meningitis and
menigoencephalitis in 1% to 4% of patients. These
patients develop a higher fever, myalgia and sever
headache with stiffness of the neck and back.
Can it cause paralytic disease?
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Paralytic disease occurs 0.1% to 1% of those who become
infected with the polio virus.
Paralysis of the respiratory muscles or from cardiac arrest
if the neurons in the medulla oblongata are destroyed.
Patients have some or full recovery from paralysis usually
apparent with proximally 6 months
Physical therapy is recommended for full recovery.
Polio Vaccines
IPV
OPV
Vaccine
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Polio vaccine first appeared to be licensed in the United States in
1955.
Advantages:
Ease to administration
Good local mucosal immunity
Disadvantage:
Strict cold shipping & storage requirements
Multiple doses required to achieve high humeral conservation rates
against all virus types
Vaccine (continuation)
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Babies are given 4 doses through out their infancy.
Adolescents and adults should get vaccinated as well.
Adolescents younger than 18 should receive the routine
four doses.
You should get it if you travel outside places where polio
id still an epidemic
Treatment
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Bed rest with close monitoring of respiratory and
cardiovascular functioning is essential during the
acute stage of poliomyelitis along with fever
control and pain relievers for muscle spasms.
Mechanical ventilation, respiratory therapy may be
needed depending of the severity of patients.
Croup
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Parainfluenza
Incubation Period: 2 – 6 days
Clinical Features
Complications
Treatment
Isolation & Infectivity: contact
precaution in hospital, infective
up to 3 weeks
Croup
(or laryngotracheobronchitis)
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is a respiratory condition that is usually triggered
by an acute viral infection of the upper airway.
The infection leads to swelling inside the throat,
which interferes with normal breathing and
produces the classical symptoms of a "barking"
cough, stridor, and hoarseness
croup
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Croup is characterized by a "barking" cough, stridor,
hoarseness, and difficult breathing which usually worsens
at night.
The "barking" cough is often described as resembling the
call of a seal or sea lion.
The stridor is worsened by agitation or crying, and if it
can be heard at rest, it may indicate critical narrowing of
the airways. As croup worsens, stridor may decrease
considerably
Diagnosis
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The first step is to exclude other obstructive conditions of the upper
airway, especially epiglottitis, an airway foreign body, subglottic
stenosis, angioedema, retropharyngeal abscess, and bacterial
tracheitis.
Diagnosis
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A frontal X-ray of the neck is not routinely performed, but
if it is done, it may show a characteristic narrowing of the
trachea, called the steeple sign, because of the subglottic
stenosis, which is similar to a steeple in shape
steeple sign.
Croup treatment:
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Corticosteroids, such as dexamethasone and budesonide,
have been shown to improve outcomes in children with all
severities of croup, single dose is usually all that is
required.
Moderate to severe croup may be improved temporarily
with nebulized epinephrine
Bronchiolitis
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Respiratory Syncytial Virus
Incubation Period: 2 – 8
days
Clinical Features
Complications
Treatment
Isolation & Infectivity: 3 – 8
days (up to 4 weeks in
infants)
Bronchiolitis
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most often affects infants and young children because their
small airways can become blocked more easily than those
of older kids or adults
typically occurs during the first 2 years of life, with peak
occurrence at about 3 to 6 months of age
is more common in males, children who have not been
breastfed, and those who live in crowded conditions.
Signs & Symptoms
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Sudden breathing difficulty, usually preceded by fever and
a mild common cold and cough, and characterized by the
following:
Wheezing.
Rapid, shallow breathing (60 to 80 times a minute).
Retractions (seesaw movements) of the chest and
abdomen, and nasal flaring.
Fever (occasionally).
Blue discoloration of skin or nails (severe cases).
Treatment General Measures
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Keep the humidity in the child's room as high as possible,
preferably with an ultrasonic cool-mist humidifier. Clean
humidifier daily. If you don't have a humidifier, run cold
or hot water in the shower with windows and doors closed
to produce a high-humidity room. Hold the child in this
room for 20 minutes several times a day, especially at
bedtime. If the child awakens at night with wheezing or
shortness of breath, repeat the process.
Erythema Infectiosum
(Fifth Disease)
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Parvovirus B19
Incubation Period:
4 – 21 days
Clinical Features:fever,,slapped
cheek rash.
Complications:aplastic crises
Treatment
Isolation & Infectivity: droplet
precautions for 7 days
Fifth
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disease symptoms
Bright red cheeks are a defining symptom of the infection
in children (hence the name "slapped cheek disease").
Occasionally the rash will extend over the bridge of the
nose or around the mouth.
In addition to red cheeks, children often develop a red,
lacy rash on the rest of the body, with the upper arms and
legs being the most common locations.
Fifth disease
Roseola (Sixth Disease)
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HHV-6
Incubation Period: 9 –
10 days
Clinical Features:fever
followed by macular
rash as fever wanes.
Complications;associate
e febrile convulsion
Treatment
Roseola
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Typically the disease affects a child between six months and two
years of age, and begins with a sudden high fever (39–40 °C; 102.2104 °F).
This can cause, in rare cases, febrile convulsions (also known as
febrile seizures or "fever fits") due to the sudden rise in body
temperature, but in many cases the child appears normal.
After a few days the fever subsides, and just as the child appears to
be recovering, a red rash appears. This usually begins on the trunk,
spreading to the legs and neck. The rash is not itchy and may last 1
to 2 days
Infectious Mononucleosis
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Epstein-Barr Virus
Incubation Period: 30 – 50 days
Clinical Features:fever
,tonsillopharngitis.cx
lymphadenopathy,rash.
Complications:
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Hepatitis
Hemolytic Anemia
GBS
Splenic rapture
Myocarditis
Malignacy
Treatment
COMMON BACTERIAL
INFECTIONS
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Staphyloccoacl and Group A streptoccocal
infections.
By direct effect –abscess,celluitis ,imptigo,orbital
celluitis.
Toxin mediated:toxic shock syndrome
Toxic epidermial necrolysis.
Continue….
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Group A streptococcus:
Direct effect.tonsillitis ,osteomyelitis,om,celluitis
Toxin mediated:toxic shock like syndrom,scarlet
fever
Post infectious.rheumatic fever,glomerulonephritis.
Haemophilus influenzae type b
(Hib)
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Clinical Features
Complications
Treatment
Isolation & Infectivity:
droplet precautions for 24
hours after starting
antimicrobial therapy
Vaccine
Cerebrospinal fluid culture positive
for Hib (Gram stain)
Hib (Cont.)
Pertusis (Whooping Cough)
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Bordetella Pertusis
Incubation Period: 7 – 14 days
Clinical Features
Complications:
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Pneumonia & Bronchiectasis
Haemorrhage
Hernia
Hypoxia
Treatment
Isolation & Infectivity: up to 6 weeks,
but with treatment => 5 days after
starting therapy
Vaccine
Diagnosis
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Isolation by culture
 Media: Regan-Lowe, Bordet-Gengou, or charcoal agar
Polymerase Chain Reaction PCR
 Kids & Children
Direct fluorescent antibody (DFA)
 NO Freezer or Refrigeration of samples
Route of Transmission
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Spread through direct contact of respiratory secretions.
Most contagious during first few stages of infection
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Resides in upper airway pathways, mostly the trachea and bronchi.
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Very contagious
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Progession of Whooping Cough
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Incubation period 4-21 days
3 Stages
 1st Stage- Catarrhal Stage 1-2 weeks
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2nd Stage- Paroxysmal Stage 1-6 weeks
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runny nose, sneezing, low fever, and a mild cough (common mistaken for cold)
whooping cough, which consists of bursts or paroxysms of numerous, rapid coughs, severity
of the infection is at its greatest
3rd Stage- Covalescent Stage weeks-months
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gradual recovery starts
Complications
Adults
Pneumonia
Rib Fracture
Weight Loss
Children
Hernias
Hypoxia
Urinary Incontinence
Apnea
Pneumonia
Seizures
Treatment
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Antibiotic Therapy
 Erythromycin
 Azithromycin
 Clarithromycin
Prevention
Good hygiene
CDC recoomends children be
given the Diphtheria, Tetanus,
and Pertussis (DTaP) vaccine
as early as 6 weeks but no
later than 6 y/o.
Cover mouth/nose when coughing and
sneezing.
Diphtheria
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Corynebacterium diphtheriae
Incubation Period: 2 – 7 days
Clinical Features
Complications:
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Thrombocytopenia
Myocarditis
Vocal cord paralyses
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Treatment
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Isolation & Infectivity: up to 6
weeks, but with treatment
communicable for fewer than 4
days
Vaccine
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Diphtheria
is an upper respiratory tract illness caused by
Corynebacterium diphtheriae, a facultative anaerobic, Grampositive bacterium.
It is characterized by sore throat, low fever, and an
adherent membrane (a pseudomembrane) on the tonsils,
pharynx, and/or nasal cavity.
Case classification
Probable: a clinically compatible case that is not
laboratory-confirmed and is not epidemiologically
linked to a laboratory-confirmed case
Confirmed: a clinically compatible case that is either
laboratory-confirmed or epidemiologically linked to a
laboratory-confirmed case
Empirical treatment should generally be started in a
patient in whom suspicion of diphtheria is high.
Antibiotics are used in patients or carriers to eradicate C.
diphtheriae and prevent its transmission to others. The
CDC recommends either:
Metronidazole
Erythromycin (orally or by injection) for 14 days (40
mg/kg per day with a maximum of 2 g/d), or
Procaine penicillin G given intramuscularly for 14 days
(300,000 U/d for patients weighing <10 kg and 600,000
U/d for those weighing >10 kg).
- Patients with allergies to penicillin G or erythromycin
can use rifampin or clindamycin.
Diphtheria (Cont.)
Tetanus
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Clostridium tetani
Incubation Period: 2 days to
months, most within 14 days
Clinical Features
Complications:
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Lock jaw
Neonatal mortality
Generalized muscle spasm
Treatment
Isolation: no person to person
transmission
Vaccines
Tetanus.
-medical condition characterized by a prolonged
contraction of skeletal muscle fibers.
-The primary symptoms are caused by tetanospasmin, a
neurotoxin produced by the Gram-positive, rod-shaped,
obligate anaerobic bacterium Clostridium tetani.
- Infection generally occurs through wound
contamination and often involves a cut or deep puncture
wound. As the infection progresses, muscle spasms
develop in the jaw (thus the name "lockjaw") and
elsewhere in the body
The wound must be cleaned. Dead and infected tissue
should be removed by surgical debridement.
Administration of the antibiotic metronidazole
decreases the number of bacteria but has no effect on
the bacterial toxin.
Penicillin was once used to treat tetanus, but is no
longer the treatment of choice, owing to a theoretical
risk of increased spasms.
Guide to Tetanus Prophylaxis in Routine Wound
Management
History of Adsorbed
Tetanus Toxoid (Doses)
Clean, Minor Wound
All Other Wounds*
Td
TIG
Td
TIG
Unknown or <3
Yes
No
Yes
yes
≥3§
No"
No
No¶
No
" yes if more than 10 years since last dose
¶ yes if more than 5 years since last dose
Tetanus can be prevented by vaccination with tetanus toxoid..
The CDC recommends that adults receive a booster vaccine
every ten years, and standard care practice in many places is to
give the booster to any patient with a puncture wound who is
uncertain of when he or she was last vaccinated, or if he or she
has had fewer than three lifetime doses of the vaccine
Thrush
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Candida Albicans
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Clinical Features
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Complications
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Treatment
Kawasaki disease
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Affect infant and young children
Clinical criteria
Fever >5days
Conjunctival injection
Red mucous membrane
Cervical lymphadenopathy
Rash
Oedema of palms & soles with peeling
Further Reading
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RED BOOK by Report of the committee on
Infectious Diseases.
Viral Hepatitis
Feature
Hepatitis A
Hepatitis B
Hepatitis C
Hepatitis D
Hepatitis E
Virus
HAV
HBV
HCV
HDV
HEV
Genome
RNA
DNA
RNA
RNA
RNA
15-50 days
45-160 days
7-9 weeks
2-8 weeks
15-60 days
Onset
Acute
Insidious
Insidious
Acute
Acute
Transmission
Oral
Parenteral
Perinatal
Parenteral
Parenteral
Oral
Rare
Uncommon
Uncommon
Yes
Yes
No
No
Yes
Yes
Yes
Yes
Yes
Yes
No
No
0.1-0.2 %
0.5-2 %
1-2 %
2-20 %
1-2 %
Incubation
Sequelae:
Fulminant
liver failure
Carrier
Chronic
hepatitis
Mortality