* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Download 13- 2012common_child..
Traveler's diarrhea wikipedia , lookup
Sarcocystis wikipedia , lookup
Chagas disease wikipedia , lookup
Gastroenteritis wikipedia , lookup
Whooping cough wikipedia , lookup
Human cytomegalovirus wikipedia , lookup
Henipavirus wikipedia , lookup
Neonatal infection wikipedia , lookup
Hospital-acquired infection wikipedia , lookup
Onchocerciasis wikipedia , lookup
Yellow fever wikipedia , lookup
Trichinosis wikipedia , lookup
Poliomyelitis wikipedia , lookup
Typhoid fever wikipedia , lookup
African trypanosomiasis wikipedia , lookup
West Nile fever wikipedia , lookup
Orthohantavirus wikipedia , lookup
Oesophagostomum wikipedia , lookup
Visceral leishmaniasis wikipedia , lookup
Middle East respiratory syndrome wikipedia , lookup
Hepatitis C wikipedia , lookup
Schistosomiasis wikipedia , lookup
Hepatitis B wikipedia , lookup
Eradication of infectious diseases wikipedia , lookup
Marburg virus disease wikipedia , lookup
Rocky Mountain spotted fever wikipedia , lookup
Lymphocytic choriomeningitis wikipedia , lookup
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 RNA Virus Incubation Period: 6 – 12 days Clinical Features.fever,rash,coryza Complications: 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 1.Incubation period is approximately 6~18days,10days is the most common. (3-4weeks) 2 .predromal phase 3~4 days. 1. Fever. 2. Catarrhal inflammation of URT. 3. Koplik’s spots. 4. Transient prodromal rashes. 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 . 4 . Convalescent stage brown staining. fine desquamation. course:10-14 days COMPLICATIONS : 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. 1 .Epidemiologic data. 2 .Clinical manifestations. 3. Laboratory findings: . . . 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 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 1 .Rubella (German measles) 2. scarlet fever. 3 .Roseola infantum (infant subitum,exanthem subitum) 4. Drug rashes. Mumps RNA Virus Incubation Period: 14 – 21 days Clinical Features:fever,sweeling Complications: Glandular Non glandular Isolation & Infectivity: 9 days after onset of parotid swelling Clinical manifestation of mumps are: 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: 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 RNA Virus Incubation Period: 14 – 21 days Clinical Features:fever ,rash. Complications: Acquired ;arthritis,encephalitis, Congenital:fetal damage. Isolation & Infectivity: 7 days from onset of rash 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 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) 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 Incubation Period: 7 – 21 days Clinical Features: <1% classical paralytic polio Complications: aseptic meningitis. Treatment Isolation & Infectivity: several weeks What is Poliomyelitis? 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? 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? 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? 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 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) 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 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 Parainfluenza Incubation Period: 2 – 6 days Clinical Features Complications Treatment Isolation & Infectivity: contact precaution in hospital, infective up to 3 weeks Croup (or laryngotracheobronchitis) 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 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 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 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: 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 Respiratory Syncytial Virus Incubation Period: 2 – 8 days Clinical Features Complications Treatment Isolation & Infectivity: 3 – 8 days (up to 4 weeks in infants) Bronchiolitis 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 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 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) 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 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) HHV-6 Incubation Period: 9 – 10 days Clinical Features:fever followed by macular rash as fever wanes. Complications;associate e febrile convulsion Treatment Roseola 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 Epstein-Barr Virus Incubation Period: 30 – 50 days Clinical Features:fever ,tonsillopharngitis.cx lymphadenopathy,rash. Complications: Hepatitis Hemolytic Anemia GBS Splenic rapture Myocarditis Malignacy Treatment COMMON BACTERIAL INFECTIONS Staphyloccoacl and Group A streptoccocal infections. By direct effect –abscess,celluitis ,imptigo,orbital celluitis. Toxin mediated:toxic shock syndrome Toxic epidermial necrolysis. Continue…. 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) 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) Bordetella Pertusis Incubation Period: 7 – 14 days Clinical Features Complications: Pneumonia & Bronchiectasis Haemorrhage Hernia Hypoxia Treatment Isolation & Infectivity: up to 6 weeks, but with treatment => 5 days after starting therapy Vaccine Diagnosis 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 Spread through direct contact of respiratory secretions. Most contagious during first few stages of infection Resides in upper airway pathways, mostly the trachea and bronchi. Very contagious Progession of Whooping Cough Incubation period 4-21 days 3 Stages 1st Stage- Catarrhal Stage 1-2 weeks 2nd Stage- Paroxysmal Stage 1-6 weeks 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 gradual recovery starts Complications Adults Pneumonia Rib Fracture Weight Loss Children Hernias Hypoxia Urinary Incontinence Apnea Pneumonia Seizures Treatment 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 Corynebacterium diphtheriae Incubation Period: 2 – 7 days Clinical Features Complications: Thrombocytopenia Myocarditis Vocal cord paralyses Treatment Isolation & Infectivity: up to 6 weeks, but with treatment communicable for fewer than 4 days Vaccine 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 Clostridium tetani Incubation Period: 2 days to months, most within 14 days Clinical Features Complications: 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 Candida Albicans Clinical Features Complications Treatment Kawasaki disease 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 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