The most frequent infec0ous diseases in childhood

AgnieszkaWegnerMD,PhDDepartmentofPediatricNeurologyMedicalUniversityofWarsaw

Types of infec0ons  Bacterial:◦ MayrequireanDbioDcs◦ Causesomeillnesseslikestrepthroat,someearinfecDons,sinusinfecDonsandmanygastrointesDnalillnesses

 Viral:◦ Causemostcommonrespiratoryillnesses(e.g.,colds,flu,acutebronchiDs)◦ Mustruntheircourse-an#bio#cswillnothelp

 ParasiDc◦ CommonlycausegastrointesDnalillnesseslikeGiardia

High risk groups of pa0ents  New-bornsareat riskbecausetheirprotecDvesystemsarenotyet testedandarenotalwaysmature.

 Infantsareatriskbecausetheytendtoputeverythingintotheirmouthsandrarelycleantheirhands.

 Olderchildrenare lessat riskbecause theirhygiene isbeNerand theyhavebecome immunethroughpriorinfecDonorcarriageofbacteria.

 Theuseofmedicaldevicessuchascathetersandothertubes.

 Immunosupression- medicines such as corDcosteroids (used in asthma and many othercondiDons)andcancerchemotherapycaninterferewithachild’sabilitytofightinfecDon.

Fi;h Disease (Erythema Infec0osum - Parvovirus B19) Occursprimarilyamongschool-agedchildren

 Symptoms: Raised, red, warm rash, first appearing on cheeks (slappedcheekappearance).

 AUer1-4days,alace-likerashspreadstotherestofthebody.

 Rashfadesbutmayrecurfor1–3weeksonexposuretosunlight.

 Flu-likesymptoms(e.g.,runnynose,sorethroat,mildbodyweaknessandjointpain,fever)maybepresentabout7daysbeforeonsetofrash.

Fi;h Disease (Erythema Infec0osum - Parvovirus B19)  •Howisitspread?Direct&indirectcontact,air •Incuba#onperiod:Usually4–20daysfromcontactwithinfectedperson

 •Whenisthepersoncontagious?Usuallyfor7–10daysbeforeonsetofrash.Oncetherashappears,thechildcannolongerpassitontoanyoneelse.

Roseola (Exanthema Subitum)  Itiscausedbytwohumanherpesviruses,humanherpesvirus6(HHV-6)andhumanherpesvirus7(HHV-7),whicharesomeDmesreferredtocollecDvelyasRoseolovirus.

 Mostcommonacuterashillnessofchildren6monthsto2yearsofage

 Symptoms◦  Irritability,runnynose,malaise,highfever◦  Mostkidswillbealertandplayful

 Rashappearance◦  Palerose-pinkflatspotswithawhitehalooverneckandtrunk,extremiDesspared

◦  lastsfor1-2days

Roseola  ThoughttobetransmiNedthroughacontactwithaparent’sorcaregiver’ssaliva◦ Childrenalsothoughttobeareservoir

 IncubaDonperiod:5-15days Communicableperiod:unknown

Hand / Foot / Mouth Disease (Coxsackie virus)  Commonamongyoungchildren

 Symptoms: Sudden onset. Fever, sore throat, small greyish blisters inmouthlasDng4-6days. Rashappearance◦ Oralulcersfirst◦  2dayslater,vesiclesappearonhandsandfeet

 TransmiNedbydirectcontactwithrespiratorysecreDonsorfecesfromaninfectedindividual IncubaDonperiod:4–6days Communicableperiod◦  fromtheonsetoforalulcerstoweeksfollowingresoluDonoftheillness

Chickenpox- varicella- zoster virus Ø TheinfecDousdiseasecausedbythevaricella-zosterviruswhichresultsinablister-likerash,itching,Drednessandfever

Ø Rashappearance-Beginswithredflatlesions(maculopapular)thatrapidlyprogresstovesicles,pustulesandcrusts

Ø IncubaDonperiod:10-21days

Ø highlyinfecDousandspreadsfrompersontopersonbydirectcontactorthroughtheair

Chickenpox- varicella- zoster virus Ø Communicableperiod-2daysbeforeandunDlalllesionshavecrustedover(usually5-7days)

Ø PreventablethroughvaccinaDon

Ø Treatment:Control feverwithacetaminophen. Ibuprofencontraindicated.Baths inasoluDon

ofgenDanviolet,potassiumpermanganate,anDhistaminesmayalsoreduceitching.

Rubella (German Measles)  Mildfebrileviralillness.Childrenusuallypresentfewornoclinicalsymptoms Rashappearance◦  Pinkmaculopapularrash◦  Startsonfacethenspreadsdownwardandperipherally◦  lasts2-5days(3-daymeasles)

 TransmiNedviacontactwithinfectednasopharyngealsecreDons IncubaDonperiod:16-18days

Rubella (German Measles)  Communicableperiod:5daysbeforeto5-7daysaUerrashonset

 InfecDoncanbedetrimentaltoadevelopingfetus.RubellainfecDonduringpregnancycancauseseverebirthdefects,miscarriage,orsDllbirth.

 85%of foetuseswhoare infectedwithrubella inthefirst10weeksofpregnancywilldevelopCongenitalRubellaSyndrome(CRS).

 CRSmayincludedeafness,eyeproblems,heartdefects,liver,spleen,andbraindamage.

Mumps  Causedbythemumpsvirus. Signsandsymptoms:◦  Fever◦  Headache◦  Swollenandpainfulsalivaryglands(foundinfrontofandbelowtheearorunderthejaw)

 Complica#onsofmumpsdiseaseinclude:◦  MeningiDsin20%ofpeopleinfected◦  OrchiDsin20-30%ofpost-pubertalmales◦  OophoriDsin5%ofpost-pubertalfemales◦  DeafnessandinferDlityoccuroccasionally

 Incuba#on period:Usually 16 – 18 days from contact with aninfectedpersonbutcanrangefrom14–25days

Mumps Methodofspread:

 ThroughdirectorindirectcontactwithnoseandthroatsecreDonsofaninfectedperson◦  Breathingaircontaminatedwiththeviruswhenaninfectedpersonhascoughedorsneezed◦  TouchingthenoseandthroatsecreDonsofaninfectedperson◦  Kissing◦  Sharinganythingthatisputinthemouth(e.g.,cups,toys)

CommunicablePeriod:From7daysbeforeto9daysaUertheonsetofswelling◦  Childismostcontagious2daysbeforeto4daysaUertheonsetofillness.

Measles “red measles” (Rubeola virus)  Symptoms:Fever,inflamedeyes,drycough,runnynose,duskyredblotchyrash3-7dayslaterspreadingdownwardsfromface,whitespotsinmouth.

 Koplik's spots: LiNle spots inside the mouth that are highlycharacterisDc of the early phase ofmeasles (Rubeola). The spotslooklikeaDnygrainsofwhitesand,eachsurroundedbyaredring.They are found especially on the inside of the cheek (the buccalmucosa)oppositethe1stand2nduppermolars.

 Methodof Spread: Spreadby sneezing or coughing, or by directcontactwithnoseandthroatsecreDons.Highlycontagious.

Measles  Incuba#on:7-18daysfromexposuretoonsetoffever,usually14daysunDlrashappears.

 CommunicablePeriod:Fromjustbeforethesymptomsstartto4daysaUertherashappears.

 Preven#on:2dosesofmeaslesvaccine

Herpes simplex  Symptoms:Superficialclearvesicles(blisters)withredbase,usuallyonfaceorlips,whichcrustandhealwithindays.

 Method of Spread: Direct contact with secreDons from throatandmouthofinfectedpeople.

 Incuba#onperiod:2-12daysfromdateofcontact.

 Communicableperiod:Upto7weeksaUeronset.

 Control Avoid direct contact with secreDons or infecDousmaterials.

 Preven#on EducaDon to minimize transmission of infecDousmaterial, avoiding contact with children with eczema or burnsandtheimmunocompromised.

HSV - figures  •MostareasymptomaDc

 •GingivostomaDDs–mayneedintravenousfluidsandaciclovir

 •SkinmanifestaDons–mucocutaneousjuncDons,e.g.lipsanddamagedskin

 •EczemaherpeDcum–mayresultinsecondarybacterialinfecDonandsepDcaemia

 •HerpeDcwhitlows–painfulpustulesonthefingers •Eyedisease–blephariDs,conjuncDviDs,cornealulceraDonandscarring •CNS–asepDcmeningiDs,encephaliDs

 •PneumoniaanddisseminatedinfecDonintheimmunocompromised.

Impe0go  Symptoms: A skin infecDonwithmoist, purulent, yellow crusted soressurroundedbyredness.Spreadsformingnewsores.Usuallyfoundontheface.

 MethodofSpread:DirectcontactwithsecreDons fromopensoresandnose.Canalsobespreadperson-to-personviahands.

 Incuba#on: Staphylococcal: 4 - 10 days from date of contact.Streptococcal:1-3daysfromdateofcontact.

 CommunicablePeriod: Ifuntreated,as longassoresarepresent,or24hoursaUeranDbioDctherapyhasbeenstarted.

Rotaviral infec0on  Rotavirus is the most common cause of severe diarrhoea among young children. It usuallyaffectschildrenbetweentheagesof6monthsand2years.

 Signsandsymptoms:◦  Fever(maybeashighas40°C),VomiDng◦  About12–24hourslater,childstartstopasslargeamountsofwaterydiarrhoea◦  Abdominalpain

 Theillnessusuallylasts3–7days. Mostchildrenrecovercompletelywithouttreatment.Somechildrenneedtobehospitalizedforre-hydraDon(replacementoffluidslost)duetodiarrhoea.

Rotaviral infec0on ModeofSpread:Throughdirectcontact:◦  changinganinfectedchild’sdiaperorassisDngachildwithtoileDng

 Throughindirectcontact:◦  touchinganobjectthatwascontaminatedwithrotavirus.Thevirusisabletosurviveforlongperiodsonhardsurfaces,incontaminatedwater,andonhands.

 Incuba#onperiod:Usually1–3days

 Contamina#onperiod:DuringtheacutestageofillnessandunDldiarrhoeastops

 Preven#on-vaccinaDon(HumanrotavirusRIX4414)

Hepa00s A HepaDDsAisaninfecDonofthelivercausedbytheHepaDDsAvirus.Itisusuallymildandrarelycausespermanentliverdamage.HepaDDsAisusuallymoreseriousinadultsthanchildren.

Signsandsymptoms:◦  Fever◦  FaDgue◦  LossofappeDte,nausea,andvomiDng◦  Abdominalpain◦  Jaundice(yellowingoftheskinandeyes)

Incuba#onperiod:Usually25–30days(rangeis15–50days)

Hepa00s A  Methodofspread:◦  Directcontactwiththestool,handsofaninfectedperson◦  Directcontactwithanobjectcontaminatedwiththevirus◦  Drinkingcontaminatedwater

 Communicableperiod:Fromabout14daysbeforeonsetofsymptomsunDlabout7daysaUeronset of jaundice. Infants and childrenmay conDnue to shed virus in their stool for up to 6months.

 Preven#on:vaccinaDon2doses

Mononucleosis Mononucleosis is caused by the Epstein-Barr virus (EBV). It is mostcommoninolderchildrenandadolescents.

 Signsandsymptoms:◦  Fever◦  Sorethroat◦  Swollenlymphglands◦  Lethargy(exhausDon)◦  Enlargedliverandspleen◦  Jaundice(yellowingoftheskinandeyes)occursoccasionally

 Incuba#onperiod:4–6weeks

Mononucleosis Methodofspread:

 ThroughdirectandindirectcontactwiththenoseandthroatsecreDonsofaninfectedchild:◦  Kissing◦  Sharinganythingthatchildrenputintheirmouths(e.g.,toys,Sippycups,food,drinks,soothers)◦  Touchingsomethingcontaminatedwithaninfectedperson’ssaliva

 Diagnosisissupportedby:

 •atypicallymphocytes(numerouslargeTcellsseenonbloodfilm)

 •aposiDveMonospottest(thepresenceofheterophileanDbodies–thistestisoUennegaDveinyoungchildrenwiththedisease)

 •seroconversionwithproducDonofIgMandIgGtoEpstein–BarrvirusanDgens.

Pertussis (Whooping cough)  CausedbythebacteriaBordetellapertussis. Infantsunderoneyearofageareathighestrisk.

 Ifapregnantwomanhaspertussis2-3weeksbeforelabour,theinfantisathighriskofpertussisdisease.

 Signsandsymptoms:◦  Runnynose,lowgradefever,andmildcough◦  AUer1–2weeks,thecoughworsens◦  Childwill coughviolentlyandrapidly,overandover,unDlnoair is leU intheirlungs.ChildwilltheninhalewithcharacterisDc“whooping”sound

◦  ChildwillsomeDmesvomitaUercoughing◦  Coughingwilllastforseveralweeks

Pertussis Methodofspread:

 ThroughdirectcontactwiththerespiratorysecreDonsofaninfectedperson◦  Breathinginaircontaminatedwithpertussiswhenaninfectedpersonhascoughedorsneezed◦  Sharinganythingthatisputinthemouth(e.g.,cup,toys)◦  Infectedadultsoradolescentswithmildillnessornosymptomsmayinfectinfants.

 Incuba#onperiod:Usually7–10days(rangeis5–21days)

Communicableperiod:UsuallyfromtheDmewhenfirstsymptomsdevelop(1–2weeksbeforeseverecoughingstarts)unDlabout3weeksaUercoughstarts◦  AchildwhoisstartedonanDbioDcsisnotinfecDousaUer5daysofanDbioDctherapy.

Scabies  Signsandsymptomsofscabiesmayinclude:◦  Intenseitching,especiallyatnight◦  Apimple–likerashmaybepresent◦  Itchingandrashmaybealloverthebodybutthemostcommonsitesarebetweenthefingers,wrists,elbows,armpits,groinarea,nipples,waist,buNocks,andshoulderblades.

◦  Tinyburrowsthat look likegreyish-whiteorskin-coloured linesontheskinmaybeseen.

 Modeoftransmission:Bothdirect&indirect

 IncubaDon period: Usually 2 – 6weeks in peoplewho have not had scabiesbefore

 ContaminaDonPeriod:UnDlmitesandeggsaredestroyedbytreatment

Streptococcal Infec0ons: Scarlet Fever and Strep Throat Signsandsymptomsofscarletfever:◦  Red rash that looks like sunburn and feels likeroughsandpaper

◦  Rash most oUen begins on chest and stomachandthenspreadstorestofbody

◦  Rashusuallylasts2–7days◦  When rash fades, skin on hands and feet maystarttopeel

◦  Fever◦  NauseaandvomiDng◦  Sorethroat◦  Red,swollenlips,strawberry–liketongue◦  Flushed cheeks and pale area around mouth(Filatowtriangle)

Signsandsymptomsofstrepthroat:◦  Fever◦  Verysorethroat◦  Swollenlymphglands◦  Swollentonsils◦  LossofappeDte

Scarlet Fever  Modeofspread:bothdirect&indirect

 Incuba#on period: Usually 1 – 3 days from contact with aninfectedperson

 Contamina#on period: In untreated cases, 10 – 21 days.Untreatedcasesofstrepthroatmaycarrytheorganismforweeksormonths.

Tuberculosis  •TBaffectsmillionsofchildrenworldwide;lowbutincreasingincidenceinmanydevelopedcountries

 •Clinicalfeaturesfollowasequence–primaryinfecDon,thendormancy,whichmaybefollowedbyreacDvaDontopost-primaryTB

 •DiagnosisisoUendifficult,sodecisiontotreatisusuallybasedoncontacthistory,Mantouxtest,interferon-gammareleaseassays(IGRA),chestX-rayandclinicalfeatures.Youngchildrenswallowtheirsputum,sogastricwashingsarerequired

Tuberculosis  •Tripletherapy(rifampicin,isoniazid,pyrazinamide)istherecommendediniDalcombinaDon-2months.Thisisdecreasedtothetwodrugsrifampicinandisoniazid–4months

 •Contacttracingisimportant

 •TBismoredifficulttodiagnoseandmorelikelytodisseminateintheimmunosuppressed.

 ChemoprevenDon-AsymptomaDcchildrenwhoareMantoux-posiDveandthereforelatentlyinfectedshouldbetreated(e.g.withisoniazidfor3months)

HIV infec0on Affects>2millionchildrenworldwide

 ThemajorrouteofHIVinfecDoninchildrenismother-to-childtransmission(MTCT):

Ø duringpregnancy(intrauterine)Ø atdelivery(intrapartum)

Ø throughbreast-feeding(postpartum)

TreatmentincludescombinaDonanDretroviraltherapyandprophylaxisagainstPneumocys4sjirovecipneumonia(PCP)

ThemajorityofperinatallyinfectedchildrenaresurvivingintoadulthoodifARTtreatmentisavailable

HIV infec0on  Inchildrenover18monthsold,HIVinfecDonisdiagnosedbydetecDnganDbodiestothevirus.

 Childrenlessthan18monthsofagewhoareborntoinfectedmotherswillhavetransplacentalmaternalIgGHIVanDbodies,andatthisage,aposiDvetestconfirmsHIVexposurebutnotHIVinfecDon.

 Before18monthsofage-HIVDNAPCR.

 AllinfantsborntoHIV-infectedmothersshouldbetestedforHIVinfecDon,whetherornottheyaresymptomaDc.

 TwonegaDveHIVDNAPCRswithinthefirst3monthsoflife(atleast2weeksaUercompleDonofpostnatalanDretroviraltherapy)->theinfantisnotinfected

 ConfirmaDonisthelossoftransplacentalmaternalHIVanDbodiesfromtheinfant’scirculaDonaUer18monthsofage.

Refferences and sources  NelsontextbookofPediatrics,19thEdiDon,Kliegman,Behrman,Schor,Stanton,St.Geme

 Pediatria,Kawalec,Grenda,PZWL,Warszawa2013

 IllutratedtextbookofPediatrics,4thEdiDon JohnsHopkinsUniversitySchoolofMedicine:Dermatlas2001-2002

 Google.com

 Slideshare.net