Childhood Infectious Diseases

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Childhood Infectious Diseases
Dr Elham Bukhari Assistant Professor
Consultant Pediatric Infectious Diseases King
Khalid University Hospital King Saud University,
Riyadh
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Common Viral Infecions

• Measles
• Mumps
• Rubella
• Chicken pox
• Erythema infectiousum (Fifth Disease)
• Roseola infantum(Sixth Disease)

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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.

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• Vesicular
• Raised hemispherical lesions,lt0.5 cm
  diameter,contain clear fluid.ex chicken pox
• Pustular/bullous
• Raised hemispherical lesions,gt0.5cm
  diameter,contain clear or purulent fluid.
• ex Imptigo

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Cont

• Desquamation
• Dry and flaky loss of surface epidermis, often
  peripheries. ex Kawasaki disease.

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Measles

• RNA Virus
• Incubation Period 6 12 days
• Clinical Features.fever,rash,coryza
• Complications
• Respiratory pneumonia,om
• Neurologicalfebrile conv.encephalitis,SSPE
• Othersdiarrhoea,hepatitis
• Treatmentsymptomatic
• Isolation Infectivity 2 days before till 6
  days after rash

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CLINICAL MANIFESTATIONS
yy

• 1.Incubation period is approximately
  618days,10days is the most common.
• (3-4weeks)
• 2 .predromal phase
• 34 days.
• 1. Fever.
• 2. Catarrhal inflammation of URT.
• 3. Kopliks spots.
• 4. Transient prodromal rashes.

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• 3. Eruption stage
• 1. Time the 35 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.
• course10-14 days

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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.

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Measles (cont.)
Kopliks spots
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Measles (Cont.)
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Measles vs. Scarlet fever
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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

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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
• seasonwinter and spring
• age6 months to 5 years old

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DIFFERENTIAL DIAGNOSIS

• 1 .Rubella (German measles)
• 2. scarlet fever.
• 3 .Roseola infantum (infant subitum,exanthem
  subitum)
• 4. Drug rashes.

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Mumps

• RNA Virus
• Incubation Period 14 21 days
• Clinical Featuresfever,sweeling
• Complications
• Glandular
• Non glandular
• Isolation Infectivity 9 days after onset of
  parotid swelling

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Clinical manifestation of mumps are

• Parotid inflammation (or parotitis) in 6070 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

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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

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Rubella

• RNA Virus
• Incubation Period 14 21 days
• Clinical Featuresfever ,rash.
• Complications
• Acquired arthritis,encephalitis,
• Congenitalfetal damage.
• Isolation Infectivity 7 days from onset of
  rash
• Congenital Rubella until 1 year of age

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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.

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Rubella (Cont.)
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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.

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Congenital Rubella Syndrome
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Chicken Pox (Varicella)

• DNA Virus(VZV).
• Incubation Period 10 21 days
• Clinical FeaturesPapules-vesicles-pusules-crusts.
  
• Complications
• 2nd bacterial infectionstaph.strep
• Neurological cerebellitis, encephalitis
• Reye syndrome
• Disseminatedimmunocompromised
• Treatment (Acyclovir).ZIG.
• Isolation Infectivity 2 days before rash till
  all skin lesions have crusted (6th day of rash)

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Cont. Chicken Pox
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Cont. Chicken Pox
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Rubella, Smallpox, Chickenpox
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Poliovirus

• Incubation Period 7 21 days
• Clinical Features lt1 classical paralytic polio
• Complications aseptic meningitis.
• Treatment
• Isolation Infectivity several weeks

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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.

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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.

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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.

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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.

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Polio Vaccines
IPV

• OPV

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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

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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

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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.

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Croup

• Parainfluenza
• Incubation Period 2 6 days
• Clinical Features
• Complications
• Treatment
• Isolation Infectivity contact precaution in
  hospital, infective up to 3 weeks

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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

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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

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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.

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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

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steeple sign.
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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

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Bronchiolitis

• Respiratory Syncytial Virus
• Incubation Period 2 8 days
• Clinical Features
• Complications
• Treatment
• Isolation Infectivity 3 8 days (up to 4
  weeks in infants)

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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.

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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).

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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.

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Erythema Infectiosum(Fifth Disease)

• Parvovirus B19
• Incubation Period 4 21 days
• Clinical Featuresfever,,slapped cheek rash.
• Complicationsaplastic crises
• Treatment
• Isolation Infectivity droplet precautions for
  7 days

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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.

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Fifth disease
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Roseola (Sixth Disease)

• HHV-6
• Incubation Period 9 10 days
• Clinical Featuresfever followed by macular rash
  as fever wanes.
• Complicationsassociate e febrile convulsion
• Treatment

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Roseola

• Typically the disease affects a child between six
  months and two years of age, and begins with a
  sudden high fever (3940 C 102.2-104 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

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Infectious Mononucleosis

• Epstein-Barr Virus
• Incubation Period 30 50 days
• Clinical Featuresfever ,tonsillopharngitis.cx
  lymphadenopathy,rash.
• Complications
• Hepatitis
• Hemolytic Anemia
• GBS
• Splenic rapture
• Myocarditis
• Malignacy
• Treatment

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COMMON BACTERIAL INFECTIONS

• Staphyloccoacl and Group A streptoccocal
  infections.
• By direct effect abscess,celluitis
  ,imptigo,orbital celluitis.
• Toxin mediatedtoxic shock syndrome
• Toxic epidermial necrolysis.

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Continue.

• Group A streptococcus
• Direct effect.tonsillitis ,osteomyelitis,om,cellui
  tis
• Toxin mediatedtoxic shock like syndrom,scarlet
  fever
• Post infectious.rheumatic fever,glomerulonephritis
  .

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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)
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Hib (Cont.)
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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 gt 5 days after starting therapy
• Vaccine

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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

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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

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Progession of Whooping Cough

• Incubation period 4-21 days
• 3 Stages
• 1st Stage- Catarrhal Stage 1-2 weeks
• runny nose, sneezing, low fever, and a mild cough
  (common mistaken for cold)
• 2nd Stage- Paroxysmal Stage 1-6 weeks
• 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

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Complications
Adults Pneumonia Rib Fracture Weight
Loss Hernias Urinary Incontinence
Children Hypoxia Apnea Pneumonia Seizures
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Treatment

• Antibiotic Therapy
• Erythromycin
• Azithromycin
• Clarithromycin

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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.
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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

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Diphtheria is an upper respiratory tract illness
caused by Corynebacterium diphtheriae, a
facultative anaerobic, Gram-positive bacterium.
It is characterized by sore throat, low fever,
and an adherent membrane (a pseudomembrane) on
the tonsils, pharynx, and/or nasal cavity.
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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-confirme
d or epidemiologically linked to a
laboratory-confirmed case Empirical treatment
should generally be started in a patient in whom
suspicion of diphtheria is high.
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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 lt10 kg and 600,000 U/d for
those weighing gt10 kg). - Patients with allergies
to penicillin G or erythromycin can use rifampin
or clindamycin.
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Diphtheria (Cont.)
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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

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• 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

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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.
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Guide to Tetanus Prophylaxis in Routine Wound
Management
History of Adsorbed Tetanus Toxoid (Doses) Clean, Minor Wound Clean, Minor Wound All Other Wounds All Other Wounds
History of Adsorbed Tetanus Toxoid (Doses) Td TIG Td TIG
Unknown or lt3 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
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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
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Thrush

• Candida Albicans
• Clinical Features
• Complications
• Treatment

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Kawasaki disease

• Affect infant and young children
• Clinical criteria
• Fever gt5days
• Conjunctival injection
• Red mucous membrane
• Cervical lymphadenopathy
• Rash
• Oedema of palms soles with peeling

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Further Reading

• RED BOOK by Report of the committee on Infectious
  Diseases.

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Viral Hepatitis
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Feature Hepatitis A Hepatitis B Hepatitis C Hepatitis D Hepatitis E
Virus HAV HBV HCV HDV HEV
Genome RNA DNA RNA RNA RNA
Incubation 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
Sequelae Fulminant liver failure Carrier Chronic hepatitis Rare No No Uncommon Yes Yes Uncommon Yes Yes Yes Yes Yes Yes No No
Mortality 0.1-0.2 0.5-2 1-2 2-20 1-2