Download Diseases

Infectious Diseases
(Communicable diseases)
Start with an activity
• What does infectious mean?
• How many infectious diseases in children can
you list?
• How are they transmitted (passed on)?
• Are the diseases you have named preventable
through vaccination?
Worldwide causes of death in children under 5 years old (WHO, 2011)
Today’s focus....
• Meningitis
• Pneumococcal disease
• Measles
• Mumps
• Rubella
• Impetigo
• Varicella
Remember...
• Meningitis is like a symptom caused by a
pathogen (virus or bacteria)
• Any vaccines developed have to be aimed at
the pathogen
• There is not one vaccine which protects
against all causes of meningitis
3 main causes of meningitis in children
(historically)
• Neisseria meningitidis (meningococcal)
• Haemophilus influenzae type B (Hib)
• Streptococcus pneunomaie (pneumococcal)
Presentation
•
•
•
•
•
•
•
•
•
•
Headache
Fever
Cold hands and feet
Stiff neck
Photophobia
Lethargy
Drowsiness
Loss of consciousness
Shock – tachycardia, tachyapnoea
Purpuric /petechial rash (meningococcal disease only)
These are not in any particular order and you must remember that the
age of the child will impact on the assessment
Meningococcal disease (HPA,2012)
• Caused by infection with Bacteria Neisseria
meningitidis
• Gram negative diplococci, divided into 13 serogroups
• -Groups B and C are most common in the UK
• -Less common serogroups include A, Y, W135, and Z
• Healthy individuals carry the bacteria in their nose and
throat without symptoms
• Transmission occurs through frequent and prolonged
contact with respiratory secretions of a carrier from
coughing, sneezing, kissing
• Most common presentation of meningococcal
disease is meningitis and septicaemia
• Disease onset is sudden
• 1 in 8 people who recover are left with long
term complications
• Case fatality rate is high but varies with age,
serogroup, clinical presentation and prompt
treatment
Meningococcal septicaemia
Impact of the introduction of Meningitis C
vaccination (DH, 2010)
Prognosis & Complications
•
•
•
•
•
10% mortality in UK
Higher in cases with septicaemia
25% of survivors experience reduced QOL
10-20% permanent sequelae
Common are skin scars, hearing loss, limb
amputations, seizures and brain damage
Pneumococcal disease (HPA)
• Caused by infection with bacteria Streptococcus pneumoniae
• This bacterium (also called the pneumococcus) is responsible for causing
pneumococcal disease
• The bacteria are carried in the nose and throat
• Transmitted through infected droplets through coughing, sneezing & close
contact
• Asymptomatic carriage possible
• Whether infection develops or not depends on immune system and on
virulence of serotype acquired
• Over 90 serotypes identified (based on differences in polysaccharides in
outer coating)
• Not all 90 serotypes cause disease – about 80% invasive infections in UK
children caused by just 8-10 of these types
Spectrum of pneumococcal infection
Meningitis
Sinusitis
(common)
Invasive Pneumococcal
Disease (bacteramia)
Soft Tissue Infection (rare)
Arthritis (rare)
Otitis Media
Pneumonia
Peritonitis (rare)
Pneumococcal meningitis incidence rate per 100,000 population by age
group, England and Wales, 1996-2005 (HPA)
Management
• Antibiotics – type depends on pathogen
• Commonly cephalosporin group (e.g.
cefotaxime, ceftriaxone)
• Treatment of symptoms
• Anti-pyretics
• Analgesia
Measles, mumps and rubella
• All are viral infections
• All spread by airborne or droplet transmission
• Varying incubation periods
• Immunisation using MMR vaccine
Measles
• Extremely contagious viral illness caused by
Morbillivirus
• Most common in 1-4 year olds
• Spread by contact with nose and throat
secretions and in airborne droplets released
when an infected person sneezes or coughs
• Transmission period is from beginning of first
symptoms to 4 days after appearance of the rash
• Incubation period ranges from 7 to 18 days
Symptoms
•
-
Early symptoms include:
runny nose
cough
red and watery eyes
and
- small white spots
inside the cheeks
(Koplik’s spots)
More symptoms
• Followed by:
•
- A slightly
raised rash develops,
spreading from the face
and upper neck to the
body and then to the
hands and feet over a
period of three days
• - Rash lasts 5-6 days
• - Loss of appetite and
loose stools
Measles
Complications
•
•
•
•
•
Common complications
Otitis media
Pneumonia
Diarrhoea
Convulsions
• Rare complications
• Encephalitis
• SSPE
• Death
• In 2008, nobody died from measles in the UK
• In India there were over 81,000 deaths in children
under 5 years (Black et al. 2010)
Mumps
• Acute viral illness caused
by paramyxovirus
• Transmitted through the
air when infected person
coughs or sneezes
• Incubation period 14-25
days
• Transmissible for several
days before the parotid
swelling to several days
after it appears
Symptoms
• Headache and fever
• Parotid swelling which
may be unilateral or
bilateral
• Photophobia, neck
stiffness (meningism) can
develop
• At least 30% of cases in
children have no
symptoms
• Most severe in adults
Rubella – German measles
• Caused by Toga virus
• Transmitted through direct
or droplet contact with
nasopharyngeal secretions
• Incubation period is 14 – 21
days
• Infectivity period from 1
week before until 5-7 days
after the onset of rash
• The peak incidence of
infection is late winter and
early spring
• Often a mild illness
• May begin with swollen
lymph glands, low grade
fever, malaise &
conjunctivitis
• Maculo-papular discreet
rash develops on face, neck
and body
• Swollen joints and joint pain
common in adults
Congenial rubella syndrome
• Risk for unprotected pregnant women
• Risk of foetal damage is estimated at:
•
- 90% in first 10 weeks
•
- 10-20% by 16 weeks
•
- Rare after 20 weeks
• Defects include cardiac, auditory, ophthalmic,
neurological problems
How do we treat these infections?
• There are no treatments for these infections
• The symptoms are treated
• Prevention is immunisation
• Remember: Measles is a major cause of child
death in developing countries
What are these?
Impetigo
•
•
•
•
Highly contagious
Bacterial
localised
Caused by staphlococcal
or streptococcal skin
infection
• Nasal carriage
important
• Local and/or systemic
antibiotic treatment
Varicella – chicken pox
• Caused by the varicella
zoster virus
• Vesicles are infectious
until they are ‘dry’
• Infectious prior to
vesicles appearing
• Contact or droplet
spread (virus in
nasopharynx)
• Danger in pregnancy
• So common in
childhood that 90% of
adults are immune
• Vaccine available
• Can be complications
especially in adults
• The shingles connection
• There are many infectious diseases some more or
less common in children
• We will come across more tomorrow when we
look at vaccination
• There are global variations
• Nursing care means considering transmission to
others
• Some children may be more susceptible to
infections
References/further reading
• Department of Health (2006) Immunisation
against Infectious disease. London:TSO
• Health Protection Agency website
http://www.hpa.org.uk/HPAwebHome/
• Lissauer, T. & Clayden, G. (2012) Illustrated
Textbook of Paediatrics 4th ed. Oxford:Elsevier