Immunization 2,4

1
Immunization(2,4)
2
Vaccines
CD4gt15
3
Upper airway obstruction (7)

• Difficulty swallowing? drooling

H. influenzae
Thumb-print sign
Retropharyngeal abscess
acute epiglottitis
4
Retropharyngeal abscess (7)

• The retropharyngeal space located between the
  anterior border of the cervical vertebrae and the
  posterior wall of the esophagus.
• two potential ways that the space may become
  infected.
• 1. upper respiratory tract infection
• 2. penetrating trauma
• Mostlt 6 years

5
Retropharyngeal abscess (7)

• Group A streptococcus, anaerobic , and
  Staphylococcus aureus.
• fever, dysphagia, trismus, neck stiffness,
• Clindamycin (30 mg/kg/d)

6
Epiglottitis (7)

• High fever, irritability, throat pain, airway
  obstruction
• Tripod position (ie, a sitting
• position with their jaws thrust forward)
• Difficult to swallow saliva drooling
• a hot potato muffled voice
• Ceftriaxone,100 mg/kg/d
• Cefotaxime, 200 mg/kg/d in

7
Viral Croup laryngotracheobronchitis

• Most common cause of airway obstruction in
  children
• 6 months - 2 years
• URI for 2-3 day then
• Barking cough
• Inspiratory stridor
• No clinical of difficulty swallowing
• Pencil sign
• Treatment Adrenaline NB
• Dexamethasone

8
Antibiotics in AOM / sinusitis (12)

• 1st line Amoxicillin
• 2nd line Amoxicillin/clavulanate
• Cefprozil, Cefuroxime axetil
• Clarithromycin, Azithromycin
• 3rd line Ceftriaxone
• Cefixime, Ceftibuten, Cefdinir
• Fluoroquinolone
• consider surgical drainage (ENT consulation)

9
Management of children with uncomplicated
AOM/Sinusitis
Risk factor for resistant to amoxicillin 1.
Attendance at day care 2. Recent receipt (lt90
day) of ATB 3. Age lt 2 years
Are symptoms mild to moderate?
Yes
No
Are there allergies to penicillin?

• Cep 2nd , 3rd
• Macrolides
• TMP/SMX Clinda
• Quinolone 3rd, 4th

Yes
No
Amoxicillin
No

• Ceftriaxone
• Clinda Cephal 3rd

Is patient cured in 3 days
Pediatrics 2001 CID 2005
10
Pharyngitis (26, 91)
White patches on the tonsils and back of the
throat
Lymphadenopathy, hepatospleenomegaly
11
Diphtheria
Gram ve, bacilli
adherent membrane (pseudomembrane)
Diphtheria bull neck
12
Gram-positive cocci in chain
13
Tbc in children (15)

• Closed contact pulm Tbc
• Evaluate signs and symptoms of Tbc
• Work-up CXR, PPD test
• Clinical suspected Tbc morning gastric content
  for AFB, c/s x 3 days

14
Tbc in children (37)

• Closed contact pulm Tbc
• Evaluate signs and symptoms of Tbc
• Work-up CXR, PPD test if negative
• Agelt 5 year-old treat as latent infection with
  INH 9 month
• Age gt 5 year-old treat as primary prevention,
  repeat PPD test if lt 10mm stop anti-tbc

15
Bacterial Meningitis (17, 24)

• S. pneumoniae, H. influenzae most common lt
  2year-old
• Salmonela (rare, agelt1 year)
• N. meningitidis Rapidly progress, shock,
• Adrenal hemorrhage hypoglycemia, adrenal insuf
  (hyponatremea, hyperkalemia, metabolic acidosis),
  
• Hydrocortisone 10 CPR

16
????????????????????????(animal bite) (19)

• 1. ???????????????????????
• - ?????????????????????????????? ?????
  ?????????????????
• ????????????????????????? ??????????????????
• - ???????????????????????? ?????? povidone
  iodine, hibitane in water)
• - ????????????? ?????????????????????????
  ??????????????????????? ?????????????????

17
Antibiotic, dog and cat

• Aerobe 50-60 Pastaurella spp 10-20
  Strep. , straph
• Anaerobe ?????????
• Penicillin ? Amoxicillin ???????????? 3-5 ???
• ? Amoxicillin/clavulanic acid
• Cephalosporins, cloxacillin ????????????????
  Pastaurella spp.

18
Tetanus (19)
19
????????????? Rabies

• Pre-exposure prophylaxis

• Post-exposure prophylaxis

Active immunization Rabies vaccine
Passive immunization Anti-rabies
immunoglobulin (RIG)
20
Rabies post-exposure prophylaxis(19)
21
Negri body
3 ??./ ??.
Neuromuscular junction
48-72 hrs.
22
1.????????????????????????
??????????????????????????????????
????????????????????????????????????????????????
? ?????

??????????????????? ???????????????????????????
?????????????????????????? 3 ?????
?????????????????? (???????? 1)???????? 1
??????????????????????????????????????????????????
??????????????????? ?????????????

• ???????????????
• ?????????????????? ??????? ?????????
  ??????????????????????????
• ??????? ??????????????????????????
  ??????????????????????????
• ?????????????????????????? ?????????????
  ??????????????? ?
• ???????????????????????????? (Abrasion)
  ????????????? ?
• ?????????????????????????????????????????????????
  ?????????????
• ?????? ?????????????????????????????
  (Laceration)
• ??????? ?????????????????????????
• ??????? ????????????????????????? ??? ????
• ??????????????? ?????????????????????????????????
  ???????????
• ??????????????????????????????????????????????????
  ??????????????????
• ????????????????????????????????
  ???????????????????

• ??????????
• ????????????????
• ????????????????
• ???????????????
• ??? rabies vaccine
• ???????????????
• ??? rabies vaccine ??? RIG ?????????????

??????????????? ???????? 1 ????????????????????
? ???????? 2 ????????????????????????? ???????
? 3 ????????????????????????????
??????????????????????? (????????????????)
????????????????????????????????????????? 10
??? ???????????????????????????????? ????? ??
??? ?????????? ?????????? ????????????
????????????????? ????????????????????????????????
?? ??? ?????????? ???????
????????????????????????????????????????????
(?????????????????????? 7 ??? ????????????????????
???????????? ????????????????????????????
???????????????????????????????????????? ? ??
23

???????????????????????????????? 2
????????????????????????????????????????????
??????????????????
???????????????????????
??????????????????
??????????????????

• ???????????????????????????????????????????????
  ???????????????? ?????????????????????????????????
  ??????? 2 ????? ?????????????????????? 1 ??
• ??????????????????????????????????????
  ??????????????? ???????????????????????????????
• ????? ?????????????????????????????????
  ?????????????????????????? ??????????????????????
  ??????????????????????? 10 ??? (????????????????
  1-6 ???)

???????????????????????? ???? ???????????????????
???? ???????????????????????????????
??????????????????????? ?????????????????????????
???????????? ????????? ?????????????????
?????????????????????? 10 ??? ???????????????????
???????????? ??????? ???????????????????????????
??????? ?????????? ???????? ??????????
???????????????????????????????????????????????? ?
??????????????? ??????????? ?????? 10 ???
??????????

• ?????????????????????????????????????????????????
  ???????????????????????????????
• ????????????????????????????????????????????????
  ?????
• ????????????????????????????????????????????????
  ??????????????????????????????????????????????????
  ??????????????????????????????????

24
???????????????????????
??????????????????
??????????????????

• ????? ???????????????????????????????????????????
  ???? ???????????? ???????????????????????????????
  ???? ?????????? ???????????????????
  ?????????????????? ???????????????????????????????
  ?????
• ????? ??? ??????? ?????????? ????????????????????
  ?????? ????????????????????????????????
• ??????????????? ? ???????????????????????????
  ???? ?????? ????? ??? ???

• ????? ???????????????????????????????????
• ?????????????????????????????
• ??????????????????

????????????????????????????????????????????
?????????? (??????????? Post exposure)
25
?????????????????????????????????????????
????????????????????
Tetanus immunization
??????????
Antibiotic treatment
26
??????????? Post-exposure
gt3
lt3 ????
?????????? RIG
???????????
?????????????????? 3
?????????????????? 2
????????????6 ????????????
RIG
?????????? RIG
????? 6 ????????????????????????????????????????
? 1 ????
???? 6 ????? ???????????????????????????????????
2 ????? ???????? 0 ??? 3
????????? 1 ml.???????????????????? ??????
0,3,7,14 ??? 30 ????????????? 0.1 ml.2
?????????????????????? ?????? 0,3,7 ??? 1 ???
?????? 30 ??? 90 ???????????????????????????
8-0-4-0-1-1
????????????????? ??????????????????
10 ???
27

• 2. ????????????????????????? (Post exposure
  immunization)
• ?. ??????????????????????????
  (Intramuscular, IM)
• ????????? HDCV PCEC PDEV 1 ml. ???? PVRV 0.5 ml.
  ???????????????????? (deltoid)
  ??????????????????? ??????????????????????????????
  (anterolateral site of the thigh)
• ?????????????????????????? ???????????????????????
  ????
• ???????????????? 1 dose ???????? 0, 3, 7, 14 ???
  30

?????? 0 3 7
14 30
RIG
28

• ?????????????????????????????????????????????????
  ????? (?????????????)

???????????????????????????????????????
???????????????????????????????????????
?????????????? 6 ????? ???????????????? 6
???????????
???????????? ????????????
?????????? ?????? 2 ????? ???????? 0 ??? 3
??????????????????????????????????????????
??????????????????????????????????????????????
???????????????????????????????
29
???????????????? ?????????????????????
???????? 2 doses 1.0 ml. (IM) Day 0 ??? 3
30
??????????????????????? ???? ????????????
- ???????????????????? ???????????
????????????????? ???????????????? ???????????
?????????????????
- ?????????????? ??????????????????
???????????????????????????????
??????????????????????? 10 ???
??????????? ?????????????????? ??????????????
- ????????????????? ????????????????????????????
31
Recurrent pneumonia (21)

• Growth and Development
• delay dev pharyngeal incorporation
• Regurgitation GERD
• Serious infection, failure to thrive immune
  deficiency

32
Abcess (27)

• S. aureus
• DOC cloxacillin