6664517 infectious disease

7/31/2019 6664517 Infectious Disease

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Infection in ChildhoodInfection in Childhood

Dr Maysara AbdelazizDr Maysara Abdelaziz

Consultant PaediatricianConsultant Paediatrician




• Cause:Cause:

ViralViral

BacterialBacterial

ParasiticParasitic

FungalFungal




• Presentation:Presentation:

AgeAge

Type of infection Type of infection

System involvedSystem involved

Immune systemImmune system




• Neonate(first 4 wk of life)Neonate(first 4 wk of life)

Inutro (congenital)Inutro (congenital)

During LabourDuring Labour

After birth.After birth.

• Infancy(first 12 months of life)Infancy(first 12 months of life)

• Childhood infectionChildhood infection




Neonate(first 4 wk of life)Inutro (congenital)Neonate(first 4 wk of life)Inutro (congenital)

•BacterialBacterialGp B streptocuccusGp B streptocuccus

Neisseria GonorrhoeoNeisseria GonorrhoeoChlamidiaChlamidia

ListeriaListeria

TreponemiaTreponemia

Pallidum(syphylis)Pallidum(syphylis)TBTB

•ViralViralCMVCMV

Hepatitis B and CHepatitis B and CHIVHIV

Herpes simplexHerpes simplex

RubellaRubella

Varicella (chickenpox)Varicella (chickenpox)

•ParasiticParasiticToxoplasmosisToxoplasmosis



Erythema toxicum picErythema toxicum pic



Erythema ToxicumErythema Toxicum

• Transient blotchy erythema seen in Transient blotchy erythema seen in

infants during first week to ten days of infants during first week to ten days of

lifelife

• Erythematous macules 2-3 cm inErythematous macules 2-3 cm in

diameter with 1-2mm pinpoint vesiclesdiameter with 1-2mm pinpoint vesicles

• Primarily on face but but occurs onPrimarily on face but but occurs ontrunk on trunk and extremitiestrunk on trunk and extremities

• Occur in approximately one-half of Occur in approximately one-half of

neonatesneonates



Neonatal acne picNeonatal acne pic



Neonatal AcneNeonatal Acne

• Defined as acne that occurs in theDefined as acne that occurs in thefirst 30 days after birthfirst 30 days after birth

• Common; has been estimated toCommon; has been estimated to

occur in up to 50% of all newbornsoccur in up to 50% of all newborns

• Rare in immediate neonatal period;Rare in immediate neonatal period;

generally first appears between 2generally first appears between 2

and 4 weeks of ageand 4 weeks of age

• Often has a pustular appearanceOften has a pustular appearance

• Resolves spontaneouslyResolves spontaneously




• Respiratory tract infectionRespiratory tract infection

URTIURTI

Upper airway obstruction(croup,Upper airway obstruction(croup,epiglottitis)epiglottitis)

BronchiolitisBronchiolitis

PneumoniaPneumonia

WCWC



• neonate with severe respiratoryneonate with severe respiratory

distress.avidistress.avi

http://f/neonate%20with%20severe%20respiratory%20distress.avi








• recession mildrecession mild severe.avisevere.avi

http://f/recession%20mild%20severe.avi








• severesevere preterminalpreterminal respiratoryrespiratory

distress.avidistress.avi

http://f/severe%20preterminal%20respiratory%20distress.avi














• respiratoryrespiratory distress.avidistress.avi

http://f/respiratory%20distress.avi









• UTIUTI

AgeAge

0 to 1 year0 to 1 year1year to 5 yrs1year to 5 yrs

Over 5 yearsOver 5 years

OrganismsOrganisms Treatment Treatment

InvestigationInvestigation




• FeverFever




• RashRash



Childhood RashesChildhood Rashes

Change in the skinChange in the skin

• Appearance or texture.Appearance or texture.

• localized to one part of the body, orlocalized to one part of the body, oraffect all the skin.affect all the skin.

• It leads to color change, itch, SkinIt leads to color change, itch, Skin

become warm, bumpy, dry, crackedbecome warm, bumpy, dry, crackedor blistered, swellor blistered, swell

• May be painful.May be painful.



Type Type

• Macule-Flat & ImpalpableMacule-Flat & Impalpable

• Papule-Circumscribed elevated lesionPapule-Circumscribed elevated lesion

• Vesicle-Clear fluid <0.5 cmVesicle-Clear fluid <0.5 cm• Pustule-Elevated lesion containingPustule-Elevated lesion containing

puspus

• Petechaie –Spots that cant bePetechaie –Spots that cant beblanced if > 0.5 cm called purpurablanced if > 0.5 cm called purpura



CausesCauses

• Allergies for example to foods, dyes, medicines,Allergies for example to foods, dyes, medicines,insect stings; such rashes are often called hivesinsect stings; such rashes are often called hivesMetals such as zinc or nickelMetals such as zinc or nickel

• skin contact with an irritantskin contact with an irritant

• Infection, e.g., by the bacteria ,virus and othersInfection, e.g., by the bacteria ,virus and others

• Reaction to vaccinationReaction to vaccination• skin diseases such as eczema or acneskin diseases such as eczema or acne

• Autoimmune disordersAutoimmune disorders

• Cancer or other diseaseCancer or other disease• Exposure to sun (sunburn) or heatExposure to sun (sunburn) or heat

• Irritation such as caused by abrasivesIrritation such as caused by abrasivesimpregnated in clothing rubbing the skinimpregnated in clothing rubbing the skin



Maculopapular rashes of childhoodMaculopapular rashes of childhood

• The rashes associated with The rashes associated withsome of these viralsome of these viralinfections (fifth and sixthinfections (fifth and sixthdiseases) reflect immunediseases) reflect immuneresponses to the virus. Theresponses to the virus. Therash of second disease isrash of second disease iscaused by a bacterialcaused by a bacterialtoxin.toxin.

Exanthemsubitum(roseola

Sixth Disease

Erythemainfectiosum

Fifth Disease

Filatov-DukesFourthDisease

German

measles(rubella)

Third Disease

Scarlet feverSecondDisease

Measles(rubeola)First Disease

http://en.wikipedia.org/wiki/Image:Rash.jpg



MeaslesMeasles



MeaslesMeasles

• Highly contagious, vaccine-preventable viral diseaseHighly contagious, vaccine-preventable viral disease• Characteristic prodrome: fever, gradually increasingCharacteristic prodrome: fever, gradually increasing

cough, runny nose, conjunctivitis with or withoutcough, runny nose, conjunctivitis with or without

photophobiaphotophobia

•Koplik’s spotsKoplik’s spots: silvery-white to erythematous pinpoint: silvery-white to erythematous pinpoint

macules that antedate the rashmacules that antedate the rash

• Exanthem: diffuse macular to maculopapular rash thatExanthem: diffuse macular to maculopapular rash that

begins on scalp and forehead and moves caudad;begins on scalp and forehead and moves caudad;

initially discrete lesions that rapidly coalesce; beginsinitially discrete lesions that rapidly coalesce; begins

to fade on third to fourth dayto fade on third to fourth day

• Complications:Complications:

– secondary bacterial infection; otitis media,secondary bacterial infection; otitis media,

pneumoniapneumonia

– laryngotracheitis, bronchitislaryngotracheitis, bronchitis



RubellaRubella



Rash in an eight month oldRash in an eight month oldunvaccinated child who has hadunvaccinated child who has had

generalized irritability, fever andgeneralized irritability, fever and

“knots” in the back of the head for“knots” in the back of the head forthe past 48 hours.the past 48 hours.



Diff i l Di iDiff ti l Di i



Differential DiagnosisDifferential Diagnosis

1. Rubella1. Rubella

2. Measles2. Measles

3. Kawasaki’s Syndrome3. Kawasaki’s Syndrome



RubellaRubella

• Vaccine-preventable acute exanthematousVaccine-preventable acute exanthematous

viral diseaseviral disease

• Incubation period: 14 - 21 daysIncubation period: 14 - 21 days

• Mild prodrome often antedates the fever andMild prodrome often antedates the fever and

rashrash

• Rash begins on face and moves cephaladRash begins on face and moves cephalad

over 48 - 72 hours; usually macular but mayover 48 - 72 hours; usually macular but may

be maculopapularbe maculopapular• Adenopathy is an invariable concomitant;Adenopathy is an invariable concomitant;

suboccipital lymph nodes are almost alwayssuboccipital lymph nodes are almost always

enlargedenlarged

• Resolves over 3-5 daysResolves over 3-5 days



Erythema infectiosum-Parvo B19Erythema infectiosum-Parvo B19



Erythema infectiosumErythema infectiosum

•When theWhen the

rashrashappears,appears,the child isthe child is

no longerno longerinfectious.infectious.



Vesicular RashesVesicular Rashes

Coxsackie A16 Infection



Coxsackie A16 Infection(Hand-Foot-Mouth Disease)

• Peak incidence in summer and fall

• No gender predilection• Full age spectrum

• Highly contagious (clinical disease in 52 % of family

contacts)

• Incubation Period: 3- 6 days

• Prodrome: 1-2 days

– low grade fever

– anorexia

– malaise

• Enanthem (90% of cases): – buccal mucosa - 61%

– tongue - 44%

– palate, uvula - 36%

• Exanthem: rapid progression from macule to vesicle to ulcer

• Resolves in 1- 6 days



Scarlet fever-MaculopapularScarlet fever-Maculopapular

• Exotoxin-mediatedExotoxin-mediated

disease arisingdisease arising

from group A beta-from group A beta-

hemolytichemolytic

streptococcalstreptococcal

infectioninfection

• Exotoxin-mediatedExotoxin-mediatedstreptococcalstreptococcalinfections rangeinfections range

from localized skinfrom localized skindisorders (eg,disorders (eg,bullous impetigo)bullous impetigo)to the systemicto the systemic

rash of scarletrash of scarletfever to thefever to theuncommon butuncommon buthighly lethalhighly lethal

streptococcal toxicstreptococcal toxic



14Equinox.mpg14Equinox.mpg

http://f/14Equinox.mpg





• Features which predict poorFeatures which predict poorprognosis at the time of presentationprognosis at the time of presentationincludeinclude

• Presence of shockPresence of shock• Absence of meningismAbsence of meningism

• Rapidly progressive purpuric rashRapidly progressive purpuric rash

• Low peripheral white blood cell countLow peripheral white blood cell count• Thrombocytopenia Thrombocytopenia

• Markedly deranged coagulationMarkedly deranged coagulation

• Depressed conscious levelDepressed conscious level

Meningococcal Disease



Respiratory Failure

Metabolic derangementCVS Dysfunction

Renal failure

Coagulopathy

CNS Dysfunction

Meningococcal Disease



Respiratory failureRespiratory failure

((arterial POarterial PO22

<10kPa in air or PCO<10kPa in air or PCO22

>6)>6)

In shock. Capillary leak into lungIn shock. Capillary leak into lung

parenchyma acute pulmonary oedema.parenchyma acute pulmonary oedema.

Clinically: tachypnoea, chest wall retraction,Clinically: tachypnoea, chest wall retraction,hypoxia.hypoxia.



• Metabolic derangementMetabolic derangement

Septicaemia causes profound acidosis andSepticaemia causes profound acidosis and

derangements in metabolism, which may affectderangements in metabolism, which may affect

myocardial function and need correcting.myocardial function and need correcting.Hypoglycaemia is common. Hypokalaemia,Hypoglycaemia is common. Hypokalaemia,

hypocalcaemia, hypomagnesaemia andhypocalcaemia, hypomagnesaemia and

hypophosphataemia all occurhypophosphataemia all occur



CoagulopathyCoagulopathy

(purpuric rash)(purpuric rash) Coagulopathy occurs early inCoagulopathy occurs early in

patients with septicaemia. Thepatients with septicaemia. The

laboratory findings of disseminated intravascularlaboratory findings of disseminated intravascular(DIC) are common in such patients.(DIC) are common in such patients.

Coagulopathy is generally associated with theCoagulopathy is generally associated with the

presence of a purpuric rash, but significantpresence of a purpuric rash, but significant

coagulopathy may infrequently occur in thecoagulopathy may infrequently occur in the

absence of purpura.absence of purpura.

http://f/Whole%20cd/APLS_INSTCD_0120%20(D)/APLS/Lectures/recession%20mild%20severe.avi





Neurological dysfunctionNeurological dysfunction

In septicaemia, patients may be alert until late inIn septicaemia, patients may be alert until late in

the illness. Falling conscious level results fromthe illness. Falling conscious level results from

impaired cerebral blood flow and disturbed brainimpaired cerebral blood flow and disturbed brainmetabolism due to hypotension, hypoxia andmetabolism due to hypotension, hypoxia and

acidosis.acidosis.



Myocardial failureMyocardial failure

Depressed myocardial function is multifactorial,Depressed myocardial function is multifactorial,

including endotoxin, cytokines, multipleincluding endotoxin, cytokines, multiple

metabolic derangements, hypoxia, andmetabolic derangements, hypoxia, andhypovolaemia.hypovolaemia. Clinically: tachycardia, gallopClinically: tachycardia, gallop

rhythm, cool peripheries and eventuallyrhythm, cool peripheries and eventually

hypotension.hypotension.



Renal failureRenal failure

Little or no urine output (<1ml/kg/hour) is a veryLittle or no urine output (<1ml/kg/hour) is a very

early sign in septic shock, initially due toearly sign in septic shock, initially due to

hypovolaemia. If shock persists then renal failurehypovolaemia. If shock persists then renal failuremay occur. Serum creatinine 2 times uppermay occur. Serum creatinine 2 times upper

limit of normal for age or 2-fold increase inlimit of normal for age or 2-fold increase in

baseline creatinine indicates renal dysfunction.baseline creatinine indicates renal dysfunction.



• capillarycapillary refill.avirefill.avi

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• intraosseousintraosseous needleneedle insert.aviinsert.avi

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• 14Equinox.mpg14Equinox.mpg






Diff i l Di i




1. Suppurative thyroiditis

2. Infected thyroglossal duct cyst

3. Superficial abscess

4 Infected branchial cleft cyst

THYROGLOSSAL DUCT THYROGLOSSAL DUCTC S SCYSTS



CYSTSCYSTS

• Thyroglossal duct is a remnant of the Thyroglossal duct is a remnant of theconnection between the Foramen Cecum andconnection between the Foramen Cecum and

the thyroidthe thyroid

• Cysts/infections are most common in theCysts/infections are most common in the

youngyoung

• 63% and 25% of cysts occur in the infrahyoid63% and 25% of cysts occur in the infrahyoid

and suprahyoid regions, respectively; areand suprahyoid regions, respectively; are

almost always midlinealmost always midline

• Infections are polymicrobial;aerobic andInfections are polymicrobial;aerobic and

anaerobic mouth organisms are most commonanaerobic mouth organisms are most common

• Treatment consists of antimicrobials Treatment consists of antimicrobials andand

surgery;during the operative procedure, it issurgery;during the operative procedure, it is



ImpetigoImpetigo



p g

• Superficial infection of skin caused bySuperficial infection of skin caused by

strains of strains of Staphylococcus aureusStaphylococcus aureus andandGroup A streptococciGroup A streptococci

• Three clinical forms: Three clinical forms:

– papulovesicular with honey-coloredpapulovesicular with honey-coloredcrusted lesionscrusted lesions

– bullous with thin-roofed bullae withbullous with thin-roofed bullae with

opalescent fluidopalescent fluid

– mixedmixed

• Epidemiology has changed from primarilyEpidemiology has changed from primarily

streptococcal to staphylococcal; mixedstreptococcal to staphylococcal; mixed

forms commonforms common




1. Scarlet Fever1. Scarlet Fever

2. Stevens Johnson Syndrome2. Stevens Johnson Syndrome

3. Staphylococcal Scalded Skin3. Staphylococcal Scalded Skin

SyndromeSyndrome

Staphylococcal ScaldedStaphylococcal Scalded



Skin SyndromeSkin Syndrome

• Acute generalized exanthem caused by toxin-Acute generalized exanthem caused by toxin-producing strains of producing strains of Staphylococcus aureusStaphylococcus aureus

• Acute onset; diffuse bright red exanthemAcute onset; diffuse bright red exanthem

associated with high fever; skin is tenderassociated with high fever; skin is tender

• Mucopurulent conjunctivitis and/or rhinitis areMucopurulent conjunctivitis and/or rhinitis arealmost always present and generally antedatealmost always present and generally antedate

the exanthemthe exanthem

• May have fragile thin- roofed bullae that easilyMay have fragile thin- roofed bullae that easily

rupture; Nikolsky’s sign is presentrupture; Nikolsky’s sign is present

• Follows characteristic course; exfoliation of Follows characteristic course; exfoliation of

skin on second to third day of illnessskin on second to third day of illness

• Rarely, if ever, have positive blood culturesRarely, if ever, have positive blood cultures



Infantile ScabiesInfantile Scabies



Infantile Scabiesa e Scab es

• Generalized skin involvement is commonGeneralized skin involvement is common• Face and scalp are often involvedFace and scalp are often involved

• Large incidence of involvement of palms andLarge incidence of involvement of palms and

solessoles

• Burrows are infrequentBurrows are infrequent

• Vesicular lesions are commonVesicular lesions are common

• Marked pruritis and secondary excoriationMarked pruritis and secondary excoriation• Large incidence of eczematization andLarge incidence of eczematization and

secondary infectionsecondary infection

• Nodular lesions are more common than inNodular lesions are more common than in

adultsadults



Thrush Thrush



• Superficial infection of mucous membranesSuperficial infection of mucous membranescaused by strains of caused by strains of Candida albicansCandida albicans

• CandidaCandida is considered as normal flora inis considered as normal flora in

newborns; present in oropharyngx of 80%newborns; present in oropharyngx of 80%

of infants at 3 monthsof infants at 3 months

• Superficial pseudomembrane consisting of Superficial pseudomembrane consisting of

white , curdish-appearing material that iswhite , curdish-appearing material that is

adherent to mucous membraneadherent to mucous membrane• Generally occurs in neonatal period butGenerally occurs in neonatal period but

can be transmitted from nipples duringcan be transmitted from nipples during

breast or bottle feedingbreast or bottle feeding



Primary Irritant Diaper DermPrimary Irritant Diaper Derm



Primary Irritant Diaper DermPrimary Irritant Diaper Derm

picpic



Molluscum ContagiosumMolluscum Contagiosum



• Benign viral infection of skin and,Benign viral infection of skin and,

sometimes, mucous membranessometimes, mucous membranes

• Lesions are:Lesions are:

– discretediscrete

– umbilicated papulesumbilicated papules– pearly graypearly gray

– 1-5 mm1-5 mm

• Trunk, face and genitalia are most Trunk, face and genitalia are mostcommon sitescommon sites

• Generally asymptomaticGenerally asymptomatic

• Resolve without therapy within 6 mo’sResolve without therapy within 6 mo’s



Case History 80Case History 80

Ten year old who had diagnosis of Ten year old who had diagnosis of

impetigo of external auditory canalimpetigo of external auditory canal

two days ago. Has had increasingtwo days ago. Has had increasing

pain of ear and awoke this morningpain of ear and awoke this morning

and couldn’t close one of her eyesand couldn’t close one of her eyes




1. Ramsay-Hunt Syndrome1. Ramsay-Hunt Syndrome

2. Brain stem glioma2. Brain stem glioma

3. Idiopathic Bell’s palsy3. Idiopathic Bell’s palsy

4.4. CNS Herpes SimplexCNS Herpes Simplex

Differential Diagnosis




1. Ramsay-Hunt Syndrome

2. Brain stem glioma

3. Idiopathic Bell’s palsy

4. CNS Herpes Simplex

Ramsay-Hunt SyndromeRamsay-Hunt Syndrome



y yy y

• Old term for Herpes Zoster involvementOld term for Herpes Zoster involvementof external auditory canal and/orof external auditory canal and/or

tympanic membrane and concomitanttympanic membrane and concomitant

Bell’s palsyBell’s palsy

• Involvement of facial and auditoryInvolvement of facial and auditory

nervesnerves

• May have associated tinnitus, vertigo,May have associated tinnitus, vertigo,

hyperacusis and deafnesshyperacusis and deafness

• Cutaneous or tympanic lesions may beCutaneous or tympanic lesions may be

sublimesublime

Herpes ZosterHerpes Zoster



• Clinical syndrome that occurs withClinical syndrome that occurs with

reactivation of Varicella-zoster virusreactivation of Varicella-zoster virus

• Grouped vesicles in specific dermatomeGrouped vesicles in specific dermatome

patternpattern

• Generally, do not cross the midline inGenerally, do not cross the midline in

uncomplicated diseaseuncomplicated disease

• Rarely, if ever, painful in childrenRarely, if ever, painful in children << 1010years of ageyears of age

• Can disseminate and cause generalizedCan disseminate and cause generalized

disease in immunocom romised atientsdisease in immunocompromised patients



Herpes GingivostomatitisHerpes Gingivostomatitis



• Infection of oral mucosa caused by HerpesInfection of oral mucosa caused by Herpes

simplex virussimplex virus

• Almost always Type I strainsAlmost always Type I strains

• Occurs at younger age in infants of lowOccurs at younger age in infants of low

socioeconomic status; in higher socioeconomicsocioeconomic status; in higher socioeconomic

groups, approximately 50% of infections occurgroups, approximately 50% of infections occur

in older childrenin older children

• Characterized by vesicles, ulcers on theCharacterized by vesicles, ulcers on the

gingiva and oral mucous membranes; friablegingiva and oral mucous membranes; friable

interdenticular pegsinterdenticular pegs

•




1. Juvenile Rheumatoid Arthritis1. Juvenile Rheumatoid Arthritis

2. Serum Sickness2. Serum Sickness

3. Scarlet Fever3. Scarlet Fever

4. Kawasaki’s Syndrome4. Kawasaki’s Syndrome





1. Juvenile Rheumatoid Arthritis

2. Serum Sickness

3. Scarlet Fever

4. Kawasaki’s Syndrome

Kawasaki’s SyndromeKawasaki’s Syndrome



• Acute febrile multisystem illness of unknown etiology thatAcute febrile multisystem illness of unknown etiology that

primarily affects children who areprimarily affects children who are << 6 years of age6 years of age

• Prolonged fever unresponsive to antimicrobial therapyProlonged fever unresponsive to antimicrobial therapy

• Enanthem:Enanthem:

– strawberry tongue; conjunctival injectionstrawberry tongue; conjunctival injection

– red, cracked lipsred, cracked lips– diffuse intraoral erythemadiffuse intraoral erythema

• Exanthem:Exanthem:

– Polymorphic rashPolymorphic rash

– Desquamation of tips of fingers and toesDesquamation of tips of fingers and toes

– Induration and erythema of palms and solesInduration and erythema of palms and soles

6664517 infectious disease

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