RESPIRATORY

DISORERS
(TODDLERS AND
PRESCHOOLERS)
BY: ALLYSA R. MILLABAS
Breathing is the
greatest pleasure
in life.
– Giovanni Papini
 RESPIRATORY SYSTEM is the
network of organs and tissues that help you
breathe. It includes your airways, lungs,
and blood vessels. The muscles that power
your lungs are also part of the respiratory
system. These parts work together to move
oxygen throughout the body and clean out
waste gases like carbon dioxide.
 RESPIRATORY DISEASES ARE SUPER COMMON
The human respiratory tract is open to the outside world to let air in and
carbon dioxide out, making it an easy point of entry for germs that can
potentially cause illness. Diseases that impact the respiratory system – the nose,
throat and lungs – are very common, especially in children who have not yet
built up immunity to common viruses and bacteria that can cause such
problems.
These seven common childhood respiratory diseases may impact your
child at some point. Know the signs and symptoms, and seek help from your
pediatrician for any symptoms that linger or seem to get worse over time.
 OBJECTIVES:

02

HOW COMMON AND SEVERE ARE DEADLY RESPIRATORY

ARE RESPIRATORY DISEASE BECOMING RARER
DISEASES IN CHILDREN. IN DEVELOPED COUNTRIES.

03 04

PREVENTION AND TREATMENT

COMMON CHILDHOOD
IN RESPIRATORY DISEASES
RESPIRATORY DISEASES
IN CHILDREN
 01
HOW COMMON AND SEVERE ARE
RESPIRATORY DISEASES IN CHILDREN. HOW
COMMON AND SEVERE ARE RESPIRATORY
DISEASES IN CHILDREN.
 How common and severe are respiratory diseases in
children
Respiratory disease is the most common cause of mortality in children in
underdeveloped economies and the commonest cause of morbidity in developed economies.
Respiratory tract symptoms are particularly prevalent in young children and evidence for the
relative contributions of potentially remediable environmental factors is emerging. The state of
children’s respiratory health is determined by the interaction of many factors including potential
stressors from their environment, patterns of exposure, individual vulnerability and genetics.
Identifiable risk factors include infection, air pollution (indoors and outdoors), diet, lifestyle,
social condition, occupation, and provision of medical care. They produce a multi-causal effect
that has both short- and longer-term manifestations with implications for lifelong respiratory
health. This effect varies with gender, developmental age and ethnicity.
 How common and severe are respiratory
diseases in children
Childhood respiratory illness is the commonest cause of morbidity in
industrialized countries and, acute respiratory infections (ARI) are common
causes of death and serious morbidity in young children in underdeveloped and
emerging economies. Serious morbidity is less and the causative infective agents
differ in developed economies such as those in the EU in that bacterial
infections, including tuberculosis, are common in underdeveloped countries
while viral infections explain most ARI in developed economies. In temperate
European countries there is a marked seasonality of ARI with a significant rise in
prevalence in the winter months falling to relatively low levels in the summer.
 How common and severe are respiratory
diseases in children
This pattern is evident for the respiratory syncytial virus (RSV) which is the commonest
cause of the viral pneumonia labelled as “bronchiolitis” and which predominantly affects infants
and very young children. Whereas serious morbidity and mortality from respiratory disease has
fallen to low levels in developed economies, the total burden of respiratory disease remains high
with a shift from life threatening ARI to an increased incidence of asthma and related atopic
disease (rhinitis/high fever and eczema).

The reasons for what has been termed the “asthma and atopy epidemic” are not yet
entirely clear although several environmental risk factors have been proposed including a
reduction in the overall burden of infectious disease the so-called hygiene hypothesis [Strachan,
1989], dietary factors including low anti-oxidant intake [Seaton et al 1994; Fogarty & Britton
2000] and greater intake of processed fats [Helms 2001]. Whereas in the last decade increased
exposure to allergens and particularly those within the internal environment, including the
house dust mite, were considered to be major factors,
 02
ARE DEADLY RESPIRATORY DISEASE
BECOMING RARER IN DEVELOPED
COUNTRIES.
“Temporal changes”
The marked reduction in the prevalence of life threatening
ARI in developed countries in the last 50 years reflects an improved
standard of living, IMMUNIZATION against tuberculosis, pertussis,
diphtheria, measles and Haemophilus influenzae and the
introduction of effective antimicrobial drugs and the relatively low
rate of HIV infection. For those children with life threatening disease
technological advances in managing respiratory failure have also
had their impact clearly identified.
 Targets for further reductions in the burden of illness particularly in the youngest age
groups include the elimination of RSV infection by an effective vaccine and a reduction in
exposure to cigarette smoke in utero and in early childhood. Whereas the hospital work load for
acute respiratory events including asthma may be diminishing the burden in primary care
remains at high levels with the highest workload in the youngest age groups.

Although sudden infant death syndrome (SIDS) is of unknown etiology sufficient is

known of its epidemiology for some practical preventive measures to have been formulated. It
is likely that this recent decline is related to a response to recommendations that infants should
sleep in the supine position, since prone sleeping had been observed to be a risk. The
observation in monitored infants that death or near-death is preceded by a period of severe
bradycardia speaks for such factors being mediated via the autonomic nervous system and its
central connections.
 03
COMMON CHILDHOOD RESPIRATORY
DISEASES
 Need to know about respiratory infections in children:

 They are very common, particularly in children in daycare or

school or in children with siblings.
 Having six respiratory infections per year is normal.
 Some uncomplicated respiratory infections can last up to two
weeks.
 Many respiratory symptoms overlap and make differentiating the
illnesses difficult, especially for parents and teachers.
What are the common symptoms in uncomplicated respiratory illnesses?

 Runny nose
 Sore throat
 Red eyes
 Hoarseness
 Coughing
 Fever
 Swollen lymph nodes
What are the symptoms that may cause you to seek medical advice?

 Breathing fast
 Retractions (seeing a deeper outline of the ribcage or ribs than what is normal)
 Coughing (frequent; vomiting may occur with it)
 Activity (not playing or being usual self)
 Talking (infants and toddlers are quiet, not making normal sounds. Older children are
unable to talk normally, having to catch breaths between words)
 Wheezing (a high-pitched whistling sound heard when breathing out)
 Stridor (a harsh, raspy vibrating sound heard when breathing in. As it progresses, it can
sound like a seal, particularly with coughing)
 Fever (keep track of the number of diapers an infant/toddler is using or when the last time
your potty trained child went to urinate)
9 COMMON CHILDHOOD
RESPIRATORY DISEASES
 The human respiratory tract is open to
the outside world to let air in and carbon dioxide
out, making it an easy point of entry for germs
that can potentially cause illness. Diseases that
impact the respiratory system the nose, throat
and lungs are very common, especially in
children who have not yet built up immunity to
common viruses and bacteria that can cause
such problems.

These seven common childhood

respiratory diseases may impact your child at
some point. Know the signs and symptoms, and
seek help from your pediatrician for any
symptoms that linger or seem to get worse over
time.
What is bronchiolitis?
Bronchiolitis is a common lung infection
in young children and infants. It causes inflammation
and congestion in the small airways (bronchioles)of
the lung. It is almost always caused by a virus. Peak
time is during the winter months.
• It is most common around six months of age and
is rarely seen after age two.
• The main symptom is wheezing. The wheezing
generally lasts about seven days with 14 days of
cough.
• The most common cause is from a respiratory
virus (usually RSV, which is present in the winter
and spring months).
• It is spread by direct contact with respiratory
secretions like a cough or sneeze.
• There is no specific treatment and antibiotics are
not used when illnesses are caused by viruses. A
bulb suction should be used on infants to help
clear nasal passages, especially before feedings.
A vaporizer in the bedroom is helpful. It is key that
your child drink a lots of fluids to avoid
dehydration.
Common complications include ear infections.
Influenza
Also called the flu, “influenza is a virus that typically
causes five to seven days of high fevers, muscle aches,
fatigue, cough and runny nose,” says Dr. Katherine
Williamson, a pediatrician with CHOC Children’s at Mission
Hospital in Orange County, California, and spokesperson for
the American Academy of Pediatrics. “Complications from
influenza are pneumonia and hospitalization from secondary
bacterial infections.”

Influenza can be dangerous, even deadly, especially in young

children. Kids’ fevers tend to be higher than in adults, and
their digestive symptoms are typically worse, too.
 VACCINES are available that can greatly reduce the risk of
contracting the illness or lessen its symptoms if your child does get the
flu. Your child can be vaccinated from age 6 months onward. Vaccines
need to be administered annually, as the formulation changes each
year in anticipation of the strain(s) expected to be prevalent in the next
season. It takes about two weeks for the vaccine to become effective
after it’s been administered.

There’s no medication that will cure a case of the flu outright,

but “there is an antiviral medication called Oseltamivir (Tamiflu) that
may shorten the duration of the illness if started in the first 48 hours of
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the onset of fevers,” Williamson says. You can also “help your body
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fight the infection with appropriate rest and fluids. Acetaminophen and
ibuprofen can help with muscle aches, fevers and general discomfort.”
The common cold

Also caused by viruses, the common cold, aka an upper

respiratory infection, is the primary reason kids stay home sick from
school, the Centers for Disease Control and Prevention reports.
Children’s Hospital of Philadelphia reports that most children will have
six to eight colds per year.

Symptoms typically include:

• Runny nose.
• Sore throat.
• Coughing.
• Sneezing.
• Headache and body aches.
 Common colds are caused by viruses that are “typically less severe than
influenza and have a lower risk of causing a secondary pneumonia,” Williamson
says. The symptoms are very similar in adults and children, but kids may also run
a slight fever, whereas adults usually don’t.

Millions of people get colds each year in the U.S., and most of the time
they aren’t serious and clear up on their own in a few days. Resting and drinking
plenty of fluids can help your child feel better faster. But avoid giving over-the-
counter cold medicines, especially if your child is under 2 years of age.

In 2008, the Food and Drug Administration provided updated guidance

that noted over-the-counter cough and cold products should not be used in infants
and children under age 2 because of potentially dangerous side effects, including
convulsions, increased heart rates, loss of consciousness and even death.
ASTHMA

The CDC reports that more than 6.2 million children in

the United States, or about 8% of all American kids,
have asthma. Asthma is a potentially very serious lung
disease that causes:

 Coughing.
 Chest tightness or pressure.
 Shortness of breath or difficulty breathing.
 Wheezing or whistling when exhaling.
 Symptoms in adults tend to be the same as in
children. However, adults may experience more
persistent symptoms. Kids are also more likely to
have allergies in addition to asthma than adults
are.
Asthma attacks can be triggered by a number of factors, such as
inhaling dust or pollen or exposure to an allergen such as pet dander.
Asthma can put children at higher risk of bronchitis or pneumonia. It’s
also the third-leading cause of hospitalizations among children under the
age of 15, according to the American Lung Association.

If your child seems to be coughing a lot, coughing when exercising or

has shortness of breath, visit the pediatrician. Wheezing or whistling
breaths or repeated episodes of bronchitis should also send you to the
doctor for an evaluation.
Sinusitis
Also called a sinus infection, sinusitis is an
inflammation or swelling of the tissue that lines the
sinuses. Fluid can build up in these normally air-filled
sacs behind the nose and eye and lead to an
infection. It often accompanies a cold or the flu or may
be triggered by allergies.

Sinusitis can lead to:

• Pain and pressure in the face, particularly behind

the eyes and nose.
• Feeling very stuffed up or congested.
• Coughing and a runny nose.
• Post-nasal drip that may cause a sore throat, bad
breath and nausea or vomiting.
In children, symptoms may linger longer than in adults. Using a
neti pot to irrigate the sinuses or taking an over-the-counter
decongestant may help bring down the inflammation and reduce
symptoms. If a bacterial infection is present, your pediatrician
may prescribe an antibiotic. In children with persistent sinusitis,
surgery to clear the congested areas may be recommended.
Bronchitis
Bronchitis is inflammation of the bronchi, or
the large breathing tubes in the lungs. It’s usually
caused by a virus and may develop after having had a
cold or the flu. The constant cough is a classic
symptom that can linger for three to four weeks after
the virus has cleared the system. In addition to a
chesty cough, symptoms may include:

• Runny nose.
• Chest pain and congestion.
• Fever and chills.
• Overall feeling of malaise or tiredness.
• Wheezing.
• Sore throat.
 Symptoms are largely the same
among adults and children with bronchitis,
but kids with bronchitis may be more likely to
swallow mucus rather than cough it up.

Children with asthma or allergies or

those who have chronic sinusitis are at
higher risk of developing bronchitis.
Sometimes asthma can be mistaken for
bronchitis or vice versa, so when in doubt,
check with your pediatrician. Treatment
usually focuses on easing symptoms.
Croup
Croup, also called laryngotracheobronchitis,is
usually caused by a virus that causes swelling in the
trachea (windpipe) and larynx (voice box). The
swelling prevents free flow of air into the lungs and
creates a sort of squeaking or high-pitched wheezing
sound when taking a deep breath in. You child’s voice
may sound huskier than normal, too.

“Croup tends to affect younger children under 4 years

of age and is characterized by a harsh, barky cough
and respiratory distress,” Williamson says. Though it’s
much more common among kids, adults can also
develop croup.
 Because it’s usually caused by a virus, croup is
typically treated with rest, fluids and over-the-counter anti-
inflammatories and painkillers such as ibuprofen or
acetaminophen.

Breathing in humidified air may also help ease

breathing, especially at night. For severe cases, your
child may need steroids to bring down inflammation to
make breathing easier.
STREP THROAT
Dr. Rajsree Nambudripad, an integrative medicine
specialist with St. Jude Medical Center in Fullerton,
California, says strep throat is quite common in children.
“Up to 3 in 10 children with a sore throat will have strep
throat,” she notes. By comparison, only about 1 in 10
adults with a sore throat will have strep, she says.

Because it’s caused by a bacterial infection, strep

throat is typically treated with antibiotics. “The most
commonly used antibiotic is penicillin or amoxicillin for 10
days,” Nambudripad says. The medicine is typically given
as a liquid suspension to be drunk rather than a pill to be
swallowed, as taking a pill may be difficult for younger
children to manage. The dose will be adjusted according
to your child’s body weight.
 Strep should be taken seriously and treated as
soon as possible in both children and adults. Left
untreated, it can lead to serious health complications
including rheumatic fever, which is a serious inflammatory
condition that impacts the heart, joints, nervous system
and skin. It can also lead to rheumatic heart disease and
kidney disease.

“In children, there is a possible relationship

between group A strep infection and a neurological
condition called pediatric autoimmune neuropsychiatric
disorder associated with group A streptococci (PANDAS),”
Nambudripad says. This condition causes neurologic
symptoms, including obsessive compulsive disorder, tics
and other mental health problems.
Pneumonia
Pneumonia is caused by an infection of the lungs
and can become a dangerous condition. Symptoms
include:

• Rapid breathing.
• High fever and chills.
• Coughing.
• Fatigue.
• Pain in the chest, especially when breathing.

Symptoms may be less obvious in children than

adults, meaning that it might be harder to diagnose. The
World Health Organization reports that pneumonia
accounts for 15% of all deaths of children under 5 years.
Viruses, bacteria or fungi can be the culprit, and pneumonia may develop after
your child has had a cold, the flu or strep throat. Bacterial pneumonia can be
treated with antibiotics. There’s no specific medicine that can cure viral
pneumonia, but your doctor may prescribe an antiviral medication that will
shorten the duration of the disease. Rest and plenty of fluids can also help your
child feel a little better. VACCINES against pneumococcus, measles and
whopping cough can reduce the risk that your child will develop pneumonia.
 REGARDING ASPIRIN

A WORD OF CAUTION: You should never

use aspirin or any medication that
contains aspirin to treat viral illnesses
such as the flu, a cold or the chickenpox
in children. Use of aspirin in treating viral
infections has been associated with Reye
syndrome, a potentially deadly condition
that causes brain and liver damage in
children. Fevers are generally a sign of a
viral infection, so if your child has a fever,
do not give aspirin. If in doubt, talk to your
health care provider for guidance.
 04
PREVENTION AND TREATMENT IN
RESPIRATORY DISEASES IN CHILDREN
Environmental factors play an important role in altering host resistance
to respiratory diseases in childhood. It is likely that the accession of a number of
former Soviet Union countries to the European Community will be accompanied by
changes in the patterns of disease among children in those countries. These are likely
to include increases in asthma and allergic conditions and decreases in serious and life
threatening infections. It is recommended that prospective research be targeted at
such changes in order to establish likely causative factors and methods of
intervention.

The factors most likely to be associated with benefits to children's respiratory health
are those with other general benefits, namely good housing and nutrition, avoidance
of exposure to cigarette smoke, active encouragement of physical exercise in a clean
air environment and avoidance of obesity, and good health care
including immunization programs. It is recommended that steps be taken to
encourage physical activity and a good balanced diet in children, with adequate
amounts of fresh fruit and vegetables, to discourage parental smoking and to
provide maintain clean air both in the internal (home) and external environment.
Many environmental factors thought to influence
children's respiratory health remain unclear and sometimes
controversial. This is especially the case with respect
to asthma and allergies. Since it is likely that these conditions will
increase in a number of European countries over the next decade, it is
important to target research towards this area. Hence the
recommendations to investigate the influence of the environmental
and potentially modifiable factors while recognizing that the risk
factors may differ between the respiratory diseases and symptoms of
childhood. Once these issues have been clarified, it is recommended
that Community-wide intervention trials be carried out.
It is highly unlikely that there is any single measure that will
reverse the rise in asthma and allergies in prosperous countries,
since these diseases have multiple interacting causes. There is
therefore a need to address all the identifiable risk factors and
to establish the evidence base for whole population
interventions by systematic reviews of existing evidence and by
further research in the areas of uncertainty including the
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medium to long term outcomes of exposures in early life.
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STAYING HEALTHY

“The most important approach to respiratory illnesses is prevention,”

Williamson says. Follow these simple tips to reduce transmission of these common
diseases:

• Cover your cough or sneeze. Because these conditions are typically transmitted
via coughs and sneezes, it’s important to cover your cough or sneeze, preferably
with your elbow or a tissue rather than a bare hand.
• Wash your hands frequently. “Respiratory illnesses are transmitted through saliva
and nasal secretions either through direct contact such as shaking hands,
touching shared surfaces like doorknobs and countertops or coughing in a nearby
area,” Williamson says. Be sure to wash for at least 20 seconds with warm water
and soap to kill off any viruses or bacteria that may be lingering on your skin.
• Avoid touching your eyes, nose and mouth. These areas are
common entry points for many viruses to enter the body.

• Limit contact with sick people. As much as possible, avoid

contact with other people who are sick. This also means
keeping a sick child home from school.

• Get vaccinated against the flu. “The most effective prevention

for influenza is the flu vaccine, which significantly reduces the
risk of contracting pneumonia or being hospitalized if you are
exposed to someone with influenza,” Williamson says.
 COMMON
INFECTIOUS
DISEASE
(TODDLERS AND PRESCHOOLERS)
Prepared By: Allysa R. Millabas
 INFECTIOUS DISEASE are disorders caused by
organisms such as bacteria, viruses, fungi or parasites.
Many organisms live in and on our bodies. they’re
normally harmless or even helpful. But under certain
conditions, some organisms may cause disease. Some
infectious disease can be passed from person to person.
The common infectious diseases of children include a broad spectrum of both
viral and bacterial infections. The clinical severity ranges from asymptomatic to
severe and life-threatening. There is considerable overlap in the clinical features
of these conditions, with fever and rash being common to many. The differential
diagnosis includes drug-induced exanthems. It is useful to categorize the more
common conditions as follows:
● Viral exanthems
● Non-viral exanthems
● Other common childhood infectious diseases without exanthems
 VIRAL EXANTHEMS
Viral exanthema is an eruptive skin rash that is often related to a viral
infection. Immunizations have decreased the number of cases of measles,
mumps, rubella and chickenpox, but all viral skin infections require clinical
care by a physician or other healthcare professional.
 MEASLES
Etiology: The incubation period runs
from seven to 14 days.
Prodrome: three to seven days. Fever,
cough, coryza, Koplik spots (exanthem) may
be present from two days before to two days
after onset of the exanthema.
Clinical features: fever, generalized
maculopapular rash starting from behind the
ears, forehead and neck and spreading down
the body and conjunctivitis
 MEASLES
Diagnosis: clinical, serology (IgM), PCR
on blood or urine.
Treatment: vitamin A, symptomatic n
Complications: pneumonia, otitis media,
laryngotracheobronchitis, gastro-enteritis, eye
involvement, encephalitis.
Period of communicability: from four
days before the rash appears until four days
after onset of rash (immunocompromised
patients may be contagious for duration of
illness)
Prevention: VACCINATION all children should receive at least two doses of
measles vaccination. Measles vaccine (monocomponent) is usually
administered at nine and 18 months of age but may be given from six
months of age. If the first dose is given before nine months of age, two
further doses are required. The measles, mumps and rubella (MMR)
combination vaccine is recommended at 15-18 months of age (may be used
in place of the second dose of measles monocomponent vaccine) and
repeated at 4-6 years of age but may be given any time 4-6 weeks after the
first dose. It is not registered for use over the age of 12 years
Hospitalized cases should ideally be isolated with airborne
transmission precautions.
RUBELLA
Etiology: rubella virus n Incubation period:
14-21 days
Prodrome: zero to two days, mild
nonspecific symptoms
Clinical features: low-grade fever, mild to
moderate maculopapular rash, lymphadenopathy
(usually post auricular or occipital)
Diagnosis: clinical, serology (IgM), PCR on
urine or throat/nasopharyngeal swab
Treatment: symptomatic
 Complications: uncommon; arthritis, encephalitis,
thrombocytopaenia, congenital rubella syndrome in pregnancy

Period of communicability: from approximately a

week before onset of rash until five to seven days after onset
of rash

Prevention: vaccination (vaccine not included in

current national immunisation schedule); hospitalised cases
should ideally be isolated with droplet transmission
precautions
ROSEOLA INFANTUM (EXANTHEM SUBITUM)

Etiology: human herpes virus 6 n Incubation period:

approximately 10 days
Prodrome: high fever, irritability
Clinical features: fever for three to seven days which
subsides after start of erythematous rash on trunk and face
Diagnosis: clinical (presumptive), serology or PCR
Treatment: symptomatic
Complications: uncommon; febrile convulsions n Period of
communicability: uncertain
Prevention: no vaccine available
ERYTHEMA INFECTIOSUM

Etiology: parvovirus B19 n Incubation period: four to 21 days n

Prodrome: fever, malaise, myalgia, headache seven to 10 days prior
to onset of rash
Clinical features: “slapped-cheek” appearance sparing peri-oral
region,eyelids and chin; fine rash on trunk and limbs.
Diagnosis: clinical (presumptive), serology or PCR
Treatment: symptomatic; blood transfusion may be required for
aplastic crises; intravenous immunoglobulin for chronic infection
 Complications: may cause aplastic crisis in patients with
haemolytic anaemia; chronic infection in immunocompromised
patients; hydrops foetalis with in utero infections, polyarthritis

Period of communicability: from approximately a week before

onset of rash until appearance of the rash

Prevention: No vaccine available

HAND-FOOT-MOUTH DISEASE

Etiology: coxsackie A16 and enterovirus 71

Incubation period: usually three to six days
Prodrome: may be absent or mild fever,
anorexia, malaise and painful mouth for one to two
days before skin lesions appear.
Clinical features: vesicular lesions on an
erythematous base which appear on palms, soles
and mouth (buccal mucosa and tongue); may be
painful or pruritic, usually resolve within seven
days; may have maculopapular rash over buttocks
and genitalia
● Diagnosis: clinical (presumptive) n Treatment: symptomatic
n
● Complications: uncommon
● Period of communicability: uncertain
● Prevention: Hospitalized cases require contact precautions
(fecal-oral transmission).
 ENTEROVIRAL INFECTIONS
● Etiology: Numerous different enteroviruses may cause exanthems,
notably coxsackie A and B viruses and echoviruses.
● Incubation period: variable
● Prodrome: variable
● Clinical features: fever and wide array of different exanthems. Various
organ systems may also be involved.
● Diagnosis: PCR may be available
● Treatment: symptomatic and supportive
● Complications: aseptic meningitis, encephalitis, paralysis,
respiratory, gastro-intestinal, myocardial, eye and muscle involvement
● Period of communicability: variable
● Prevention: Hospitalized cases require contact precautions.
CYTOMEGALOVIRUS INFECTION

● Etiology: cytomegalovirus (human herpes virus 5)

● Incubation period: unknown
● Prodrome: may be absent or influenzalike symptoms
● Clinical features: may be asymptomatic, infectious
mononucleosis-like syndrome including prolonged fever
and mild hepatitis. Congenital or early postnatal
acquisition of infection may result in neurodevelopmental
problems and sensorineural hearing loss.
● Diagnosis: serology, PCR
CYTOMEGALOVIRUS INFECTION

● Treatment: Specific antimicrobial therapy is

not usually required in immunocompetent
patients with mild disease.
Immunosuppressed patients and neonates
may require treatment with ganciclovir.
● Complications: Immunocompromised
patients may have disseminated disease with
severe end-organ manifestations
(pneumonitis, retinitis, colitis).
● Period of communicability: uncertain n
Prevention: no vaccine available
HERPES SIMPLEX INFECTIONS
● Etiology: herpes simplex virus (1 and 2) n Incubation period:
two days to two weeks
● Prodrome: fever, irritability
● Clinical features: primary infection during early childhood:
asymptomatic or gingivostomatitis (painful oral ulcers, drooling
of saliva, perioral vesicles) Genital herpes in adolescents:
vesicular or ulcerative lesions of male or female genitalia or
perineum. Herpetic whitlow (clusters of vesicles on distal parts
of fingers) and conjunctivitis/keratitis also occur. Eczema
herpeticum: vesicular lesions in areas of eczematous skin in
patients with atopic dermatitis. Reactivation of latent infection:
herpes labialis (“cold sores” or “fever blisters”). Disseminated
disease may occur in newborn infants and encephalitis at any
age may occur following primary or recurrent herpes simplex
infection
HERPES SIMPLEX INFECTIONS

● Complications: uncommon, secondary infection,

recurrent infection (e.g., herpes labialis or genital
herpes), disseminated herpes infection
● Period of communicability: variable
● Prevention: contact precautions with active
mucocutaneous lesions
VARICELLA ZOSTER INFECTIONS

● Aetiology: varicella zoster virus n Incubation period:

14-21 days
● Prodrome: zero to two days
● Clinical features: primary infection (chickenpox):
fever, vesicular rash on trunk followed by peripheries
Reactivation of latent infection months to years after
primary infection (herpes zoster/shingles): vesicular
rash in sensory nerve distribution (dermatome), local
pain or pruritis.
● Diagnosis: clinical, serology, PCR, history of
previous chickenpox for shingles
● Treatment: acyclovir for severe infections or
immunocompromised patients, analgesia
○ Complications: primary infection: secondary bacterial infection of skin lesions,
pneumonia, encephalitis. Reactivation disease: recurrent episodes,
disseminated disease in immunocompromised, post-herpetic neuralgia
(uncommon in children)
○ Period of communicability: primary infection: from one to two days before rash
until all lesions are crusted (usually five to seven days after onset of rash).
Reactivation disease: from onset of rash until all lesions have crusted.
○ Prevention: vaccination (not included in current national immunization
schedule). A vaccine, indicated for adults aged 50 years and older, is now
available. A single subcutaneous dose is recommended for those who have
previously had chickenpox, even if they have already had an attack of shingles.
Hospitalized chickenpox cases should be isolated with airborne transmission
precautions, post-exposure prophylaxis for vulnerable contacts.
 ● NONVIRAL EXANTHEMS
The nonviral exanthems include various noninfective skin eruptions,
drug-induced exanthems, and fungal, bacterial and parasitic infections. This
section will focus on common infectious bacterial conditions and Kawasaki
syndrome.
MENINGOCOCCAL DISEASE

● Etiology: Neisseria meningitidis

● Incubation period: hours-days
● Prodrome: unusual
● Clinical features: fever, variable distribution
of petechiae or purpura, but may have
maculopapular rash in early phase
● Diagnosis: clinical, blood culture
● Treatment: intravenous antibiotics (penicillin
G or cephalosporin), intravenous fluids ±
inotropic support n Complications: shock,
meningitis
 MENINGOCOCCAL DISEASE

● Period of communicability: until two days after start of

antibiotic treatment n
● Prevention: vaccination (not included in current national
immunization schedule). Hospitalized cases require isolation
and droplet transmission precautions for the first 48 hours of
antibiotic treatment. Post-exposure prophylaxis is required for
vulnerable contacts.
 SCARLET FEVER
● Aetiology: group A beta-haemolytic Streptococcus
● Incubation period: hours to days
● Prodrome: fever, sore throat n Clinical features:
intense erythematous rash on face and trunk strawberry
tongue, circumoral
● Diagnosis: clinical; evidence of streptococcal infection:
elevated anti-streptolysin O titre or anti-DNAse B titre,
culture of throat swab
● Treatment: penicillin n Complications: rheumatic fever,
myocarditis, acute glomerulonephritis, arthritis
● Period of communicability: until rash fades and
desquamation starts
● Prevention: no vaccine available, antibiotic treatment
of pharyngitis
IMPETIGO
● Aetiology: Streptococcus and Staphylococcus species
● Incubation period: hours to days n Prodrome: unusual
n Clinical features: vesicular/pustular rash on face or
peripheries
● Diagnosis: clinical, culture of pus from lesions
● Treatment: antibiotics against Staphylococcus and
Streptococcus, antiseptic soap washes
● Complications: cellulitis, systemic infection, acute
glomerulonephritis
● Period of communicability: until lesions have healed
● Prevention: personal hygiene and hand-washing
 TOXIC SHOCK SYNDROME

● Aetiology: Staphylococcus aureus or Streptococcus species

● Incubation period: hours to days
● Prodrome: unusual
● Clinical features: sudden onset of high fever, vomiting, diarrhea, headache,
pharyngitis, myalgia, severe hypotension. Diffuse macular or scarlet iniform
erythema (erythroderma), accentuated in flexures, initially affecting trunk
spreading to limbs with edema of hands and feet. Desquamation of peripheries
occurs one to two weeks later. Conjunctival hyperemia and strawberry tongue may
occur.
TOXIC SHOCK SYNDROME
● Diagnosis: clinical, may or may not culture
Staphylococcus or Streptococcus on blood
culture (toxinmediated disease)
● Treatment: intravenous cloxacillin; may
require aggressive cardiovascular,
respiratory and metabolic supportive
management
● Complications: multi-organ failure
● Period of communicability: not applicable
● Prevention: not available
SCALDED SKIN SYNDROME
● Etiology: Staphylococcus aureus
● Incubation period: hours to days
● Prodrome: unusual
● Clinical features: more common during infancy and
children under five years of age; primary focus of
infection may be nasopharynx, conjunctiva, umbilicus
and blood. Spectrum includes bullous impetigo,
scarlatiniform rash without blistering and generalized
blistering form (Ritter’s disease). Sudden onset of fever
and irritability, cutaneous erythema and flaccid blisters
and erosions emerge within 24-48 hours of onset.
Conjunctival hyperemia and peri-oral or lip crusting are
common.
SCALDED SKIN SYNDROME

● Diagnosis: clinical, blisters are typically sterile,

skin biopsy
● Treatment: antibiotics against Staphylococcus
aureus, management of fluid and electrolyte
balance, skin lesions usually heal without
scarring
● Complications: secondary infection, fluid and
electrolyte imbalance
● Period of communicability: not applicable
● Prevention: skin care and hand-washing
KAWASAKI SYNDROME

● Etiology: unknown n Incubation period: unknown

● Prodrome: fever lasting five days or more but without
symptoms; typical of viral prodrome
● Clinical features and diagnosis: The majority of cases
occur before the age of five years.
● Diagnosis is based on the presence of specific clinical
features:
■ - Fever persisting for at least five days (mandatory)
plus four of the following five features:
■ - Changes in peripheral extremities (erythema
and/or oedema of palms and soles, desquamation
during the later stages) or perineal area
■ - Polymorphous exanthem
 KAWASAKI SYNDROME
■ Bilateral conjunctival hyperaemia
■ - Changes in lips and oral cavity (red fissured lips, strawberry tongue,
hyperaemia of oral and pharyngeal mucosa)
■ - Cervical lymphadenopathy
● In the presence of coronary artery involvement and fever, fewer than four of the
remaining five criteria are sufficient
● Treatment: IVIG (2 g/kg administered over 10-12 hours) during first 10 days of illness
significantly reduces risk of aneurysms. Administer aspirin (30-50 mg per kg/day in four
divided doses) for the first two weeks, then low-dose aspirin (3-5 mg/kg/day) for a
further six to eight weeks. Follow-up echocardiography at six to eight weeks and
ongoing cardiology review if aneurysms persist.
● Complications: Approximately 20% of untreated patients develop coronary artery
aneurysms.
● Period of communicability: not applicable
● Prevention: unknown
OTHER COMMON CHILDHOOD INFECTIOUS
DISEASES WITHOUT EXANTHEMS
VIRAL GASTRO-ENTERITIS
● Etiology: rotavirus (differential diagnosis of acute
gastro-enteritis includes various other viral, bacterial
and parasitic infections)
● Incubation period: one to three days
● Prodromal period: fever, vomiting
● Clinical features: loose or watery stools, vomiting,
may have low-grade fever, abdominal cramps
● Diagnosis: enzyme immuno-assay, electron
microscopy, PCR. Diagnosis is frequently presumptive
and not confirmed by laboratory testing.
● Treatment: usually a self-limiting condition that
resolves within three to seven days. Oral or parenteral
rehydration, management of fluid and electrolyte
imbalances.
VIRAL GASTRO-ENTERITIS

● Complications: dehydration, hypovolaemic

shock, acidosis
● Period of communicability: Rotavirus is
present in stools for several days before and
several days after onset of clinical disease.
● Prevention: vaccination, contact precautions –
particularly hand-washing to prevent faecal-oral
spread
HEPATITIS A
● Etiology: hepatitis A virus
● Incubation period: 15-50 days n Prodromal period:
two to five days. Anorexia, malaise, nausea and
vomiting, diarrhoea, fever and flu-like symptoms
● Clinical features: frequently asymptomatic in young
children. Jaundice, dark urine, tender palpable liver
● Diagnosis: hepatitis serology (IgM).
● Treatment: supportive, hydration, avoidance of
hepatotoxic medication, high energy/low protein diet.
● Complications: Fulminant hepatitis and acute liver
failure are rare. Danger signs which require
admission to hospital and further investigation and
management include: protracted vomiting,
dehydration, persistent fever, hypoglycaemia,
confusion, intercurrent infections and abnormal
bleeding. Chronic infection does not occur
HEPATITIS A
● Period of communicability: The most infectious period is from
one to two weeks before onset of jaundice until one week after
onset of jaundice.
● Prevention: vaccination (not included in current national
immunization schedule), improved sanitation and personal
hygiene – particularly handwashing to prevent fecal-oral
spread. Hospitalized cases require contact transmission
precautions. Hepatitis A vaccine (inactivated hepatitis A virus)
is licensed for children over one year of age. Recommended
dose schedule is two doses six to 12 months apart. Vaccination
is recommended for children with chronic liver disease,
hemophilia, institutionalized children, and travelers to endemic
areas. Post exposure (within 72 hours and up to 14 days after
contact) or pre-exposure prophylaxis may be provided by a
single intramuscular dose of pooled human immunoglobulin
(0.02-0.04 ml/kg) or hepatitis vaccine (unlicensed for use as
post-exposure prophylaxis).
INFLUENZA
● Etiology: influenza virus (A, B & C)
● Incubation period: one to four days
● Prodromal period: nonspecific symptoms and signs including
cough, fever, sore throat, malaise and headache
● Clinical features: asymptomatic or range from uncomplicated
upper respiratory tract disease to severe complicated illness
including viral pneumonia, exacerbation of underlying
diseases and multi-organ failure. Nausea, vomiting, diarrhoea
and otitis media may occur in young children. Uncomplicated
influenza usually resolves in three to seven days but cough
and malaise may persist for two weeks or more.
 INFLUENZA
● Diagnosis: Patients who meet criteria for severe or complicated
illness or patients who are at risk for developing severe or
complicated illness should be tested for influenza infection using
PCR-based testing on a nasopharyngeal or throat swab. Close
liaison with the laboratory and experience in collecting samples are
required. Rapid point-of-care tests are not very sensitive and a
negative test result does not exclude influenza infection. The
differential diagnosis of influenza includes numerous other
pathogens and laboratory testing of uncomplicated influenza-like
illness is not recommended.
 INFLUENZA

● Treatment: Early treatment initiation is important and should not be delayed until the result of
laboratory testing for influenza is available. Children with uncomplicated illness due to confirmed or
strongly suspected influenza infection do not generally require antiviral therapy. Children with
uncomplicated illness who are at risk of severe or complicated influenza infection, including all infants
and young children under two years of age, and children with severe, complicated or progressive
illness do require treatment with antiviral therapy, usually oseltamivir, as soon as possible. Treatment
initiation within 48 hours of onset of symptoms is optimal but later initiation may still provide benefit.
The usual duration of therapy is five days. Refer to detailed guidelines [see reference 5] or package
insert for dosing instructions. Chemoprophylaxis is not currently routinely recommended by the World
Health Organization but post-exposure presumptive treatment may be beneficial in a high-risk setting,
such as patients with severe immunosuppression.
INFLUENZA

● Complications: Infants and children under two years of age

as well as children with chronic diseases (pulmonary, cardiac,
renal, metabolic, hepatic, neurological, hematological, and
immunosuppressive conditions) are at risk of severe or
complicated influenza. Persistent vomiting, high fever,
progressive dyspnea or any rapid deterioration may indicate
progression to severe disease.
● Period of communicability: from a few days before
symptoms begin until five to seven days after onset of
symptoms. Very young children and individuals with severe
disease (e.g., viral pneumonia) may be infectious for >10
days after onset of symptoms and severely
immunocompromised individuals may shed virus for weeks to
months.
INFLUENZA
● Prevention: VACCINATION
● Recommendations for influenza vaccination are
published in the South African Medical Journal
during the late summer period annually.
Hospitalised cases with confirmed suspected
influenza ideally require droplet transmission
precautions for a minimum of seven days after onset
of symptoms or until 24 hours after resolution of
fever.
PERTUSSIS
● Etiology: Bordetella pertussis
● Incubation period: usually seven to 10 days (range of five to 21
days)
● Prodromal period: variable duration, usually mild upper
respiratory tract symptoms.
● Clinical features: progression from upper respiratory tract
symptoms (catarrhal stage) to cough and paroxysmal cough
(paroxysmal stage) characterised by inspiratory whoop and
frequently followed by vomiting. Fever is usually absent or
minimal. Symptoms decrease over weeks to months
(convalescent stage). Immunised children may have milder
cough manifestations. In young infants (less than six months
of age), disease may be different and more severe with a short
catarrhal stage, bradycardia or apnoea as early
manifestations, absence of a whooping cough, and prolonged
convalescent stage.
PERTUSSIS
● Diagnosis: PCR testing on nasopharyngeal aspirate or swab.
Culture is less sensitive.
● Treatment: Antimicrobial therapy during the catarrhal stage may
reduce severity of the disease. Initiation of antimicrobial therapy
after the cough is established may not affect the course of the
illness but can reduce transmission to others. Treatment with
azithromycin, erythromycin or clarithromycin is required.
Azithromycin is recommended for infants younger than one month
of age as an association between oral erythromycin and
hypertrophic pyloric stenosis has been reported.
● Complications: In infants, pneumonia, seizures, encephalopathy,
hernias, sub conjunctival and subdural-bleeding, and sudden death
may occur.
PERTUSSIS
● Period of communicability: Patients are most infectious
during the catarrhal stage and for the first two weeks after
onset of cough. Other factors influencing communicability
include age, immunization status, and appropriate
antimicrobial therapy.
● Prevention: vaccination. Hospitalized cases ideally
require droplet transmission precautions until five days
after initiation of effective therapy or if appropriate therapy
is not given, until three weeks after onset of cough. Post
exposure chemoprophylaxis is indicated for vulnerable
contacts.
 MUMPS

● Etiology: mumps virus

● Incubation period: 14-21 days
● Prodrome: zero to one day
● Clinical features: fever, parotitis
● Diagnosis: clinical, serology (IgM),
PCR
● Treatment: symptomatic
MUMPS

● Complications: aseptic meningitis,

orchitis (uncommon in childhood),
arthritis, myocarditis, pancreatitis,
hearing loss
● Period of communicability: until
parotid swelling subsides.
● Prevention: vaccination (vaccine not
included in current national
immunisation schedule)
● In conclusion, infectious disease are caused by micro
organisms that can hijack the nutrients and cellular
machinery in our bodies. Fortunately, our immune system
and current therapies can keep us healthy. In fact,
according to WHO, infectious, maternal neonatal, and
nutritional related diseases combined caused about 23%
deaths around the world in 2000. however the recent
Ebola virus have shown us that infectious diseases are
still a major threat. This is especially important with an
increasing amount of global travel and a lack of new
drugs.
● We can do our part by taking sick leave or avoiding travel
when ill, taking antimicrobial drugs properly, getting the
appropriate vaccinations to protect those vulnerable in the
population (thru herd immunity), and asking scientists and
politicians to make infectious diseases a priority.
THANKYOU!!!
