2
COMMON PEDIATRIC CONDITIONS
STREPTOCOCCAL INFECTION Tonsillop Tonsillopharyng haryng Grp A Streptococcus in school age itis and teenagers Streptococci cause otitis media, mastoiditis, sinusitis, pneumonia and empyema Scarlet fe fever “strawberry to tongue” culture for culture Diagnosis? -throat for pharyngitis -↑ ASO titer in titer in Rheumatic fever -↑ titers to D!se and hyaluronidase -!ntiDase best serology for pyoderma "omp "ompli lica cati tion ons? s? -Rhe -Rheum umat atic ic feve fever, r, -glomerulonephritis -#ematogenous, -#ematogenous, local, lymphatic e$tension of infection Treatment? Treatment? -%enicillin, -%enicillin, %enicillin %enicillin & for for strep pharyngitis for '( days -)en*athin %enicillin, +rythromycin PNEUMOCOCCAL INFECTION Streptococcus -maor cause of lower respiratory pneumoniae tract infection, bacteremia, and meningitis %atho athoge gene nesi sis? s? .T .T-hem -hemat atog ogen enou ous s or dire direct ct e$tension into neighboring organs S/S$? )ronchopneumonia -fever, cough and nasal discharge, productive copious purulent and rusty colored sputum. -"hest pain, di0culty of breathing "1R -di2use or focal pattern with o segmental or lobar involvement o !cute lethargy, poor activity and irritability followed by vomiting, bacterial sei*ures, nec3 rigidity meningitis o "S4 -cloudy 5uid -6 '((( cells/mm 7 -predominance of pmn -↑ protein -↓low sugar Diagnosis -isolation from the lungs, csf , trachea or middle ear aspirates, blood and other body 5uids Treatment Treatment - %en 8 or %en %en &9, +rythromycin, +rythromycin, 'st generation cephalosporin, cephalosporin, chloramphenicol MENINGOCOCCAL MENINGOCOCCA L INFECTION "ausative -Neisseria meningitidis-gram meningitidis -gram !gent? negative, biscuit-shaped diplococcus %rev %reval alen ence ce? ? occu occurs rs most most fre: fre:ue uent ntly ly in chil childr dren en from ;-< years S/S$ -=%> '-'(days -pper respiratory infection Acute meningococcemia-initially meningococcemia-initially as 5u-li3e illness with fever, malaise, chills arthralgia, headache, 8= complaints@ -%etechial, purpuric or maculopapular lesions within hours with hypotension, D=", oliguria, coma Meningiti-sei*ures, fever -Acute Meningiti-sei*ures, Diagnosis -)lood cu culture, "S "S4, s3 s3in pe petechiae, gram stain of petechiae -Aeu3ocytosis -thrombocytopenia -increased +SR and "R% Di2erential -Dengue
Diagnosis
2
"omplications
Treatment
COMMON PEDIATRIC CONDITIONS -Septicemia due to other gram negative or gram positive organism -#ypo-ischemic organ inury -myocardial failure -shoc3 -%enicillin 8, "efota$ime, "eftria$one, "hloramphenicol -vaccine - Rifampicin
%revention "hemoprophyl a$is !EMOP!ILUS INFLUEN"A INFECTION Type ) -more invasive in neonates and infants Type 4 -also cause invasive infection !ge -most common in children 3 mos3yrs eningitis - single most common cause of bacterial meningitis in children # mo-#$r !cute - in older children, pea3 age 2-4yrs epiglottitis Diagnosis -"ulture of "S4, blood, synovial 5uid, lung aspirate -!ntigen detection -+A=S! Treatment 4or invasive disease Bmeningitis, epiglottitisC -high dose iv antibiotics for '(-' days "hloramphenicol o !mpicillin o "eftria$one o o "efota$ime o De$amethasone o 4or non-invasive disease Botitis media, etc@C oral amo$icillin, coo amo$iclav, oral cephalosporin, macrolide C!OLERA +tiology? &ibrio cholerae group ('E biotypesclassic +l Tor, gram negative bacilli =%> several hours to < days "linical -!brupt onset of diarrhea with anifestations profuse watery stools, becoming rice watery-li3e with 5ec3s of mucus, odorless or Fshy odor@ -. tenesmus Diagnosis Typical clinical features -=dentiFcation of &ibrio cholerae in stools and vomitus -Serology -=mmuno5uorescence Treatment -4luid and electrolyte therapy -Tetracycline -"o-trimo$a*ole MEASLES .ther ames Rubeola, Morbilli +tiology measles virus, R! virus 'serotype, orbillivirus =ncubation %eriod> G-'; days ode of direct contact with infectious Transmission droplet, airborne %-2&a$ before the onset of %eriod of "ommunicabilit symptoms up to '-(&a$ u y appearance of rash "linical -4ever anifestations -Cory*a, Cough, Conunctivitis -rash> cephalocaudal, maculopapular
2
COMMON PEDIATRIC CONDITIONS
-Koplik’s spot - B-C measles =g antibody -=solation of measles virus from urine, blood or nasopharyngeal secretions "omplications -.titis media -Aaryngotracheo-bronchitis -Pneumonia-common complication -Ence)*aliti-more common in measles -Severe conunctivitis may lead to corneal ulcerations and blindness Treatment Supportive measures> -antipyretics, ade:uate nutrition and 5uid inta3e -+itamin A supplementation -!ntibiotics for complications li3e pneumonia and otitis media -=solation> -< days from the onset of the rash in a healthy child and for the duration of illness in immune compromised patients "ontrol !ctive immuni*ation-live measles measures> vaccine is given to infants ,- mont* -;nd dose at %2-%(mont* as R DENGUE !EMORR!AGIC FE+ER ode of day biting female mos:uitoes Transmission B Aedes aegypti) Diagnosis
ACUTE GASTROENTERITIS " cause &irus BRotavirusC " bacterial +@ coli cause ; primary '@ Damage to the villous brush mechanisms border of the intestine, causing responsible for malabsorption of intestinal contents acute and leading to osmotic diarrhea gastroenteritis are as follows> ;@ Release of to$ins that bind to speciFc enterocyte receptors and cause the release of chlorideions into the intestinal lumen, leading to secretory diarrhea Signs and Diarrhea symptoms &omiting or ↓in urinary fre:uency !bdominal pain %resence of fever, chills, myalgias, rash, rhinorrhea, sore throat, cough "hanges in appearance and behavior - weight loss, malaise, lethargy - irritability, -changes in feeding -childHs level of thirst Diagnosis )aseline electrolytes )icarbonate urea/creatinine ")" and blood cultures 4ecal leu3ocytes and stool culture Stool analysis for ova and parasites anagement .RS Iinc - To treat diarrhea **WHO recommends supplementation or all
zinc c!ildren
2 "ommon "auses eonates
!dolescent sE summerfall epidemics !dolescent =nfants
osocomial pneumonia &iral "linical anifestation
&iral pneumonia )acterial pneumonia
TR+!T+T
COMMON PEDIATRIC CONDITIONS younger t!an gastroenteritis@
"
years
#it!
acute
PNEUMONIA Streptococcus pneumoniae 8roup ) strep Mycoplasma pneumoniae
$!lamydia pneumoniae $!lamydia trac!omatis 8ram-negative enteric RS& )ronchiolitis Tachypnea crac3les and whee*ing nasal 5aring, and use of accessory muscles is common J)" count not higher than ;(,(((/mm '<,(((-(,(((/m
amo$icillin