Pediatrics L6

DODO AGLADZE
Infections Characterized by Fever and Rash

Measles (Rubeola)

Single stranded RNA paramyxovirus which has airborne route

1 million death annually is caused by measles

Clinical manifestation: Measles infection is divided into four phases:

 incubation
 Prodromal (catarrhal)
 rash
 recovery
 Measles (rubeola)

 Diagnostics - PCR, Serology, Inspection

 Treatment – hydration and antipyretics, High-dose of vitamin A

 Complication – pneumonia, otitis, encephalitis, conjunctivitis

 Prevention - vaccination
 Rubella

 German measles or 3 day measles is a single stranded RNA virus

 Occurs mostly in spring, epidemics has cycles of every 6-9y.

 25-5-% of rubella cases are subclinical

 Erythematous, maculopapular, discrete rash

Rubella

 Diagnostics – WBC count, thrombocytopenia, serology test

 Treatment – hydration and antipyretics

 Complications – very rare

 Prevention – vaccination
Roseola Infantum

 Etiology – human herpesvirus type 6 and 7, DNA virus

 Epidemiology – trans placental antibodies protect infants till 6m. Incidence of infection
increases as maternally derived antibody levels decline

 Clinical manifestation – high fever, maculopapular, rose-colored

rash. 1/3 of the patients will develop febrile seizures
Roseola Infantum

 Diagnostics– serology test or PCR

 Treatment – Hydration and antipyretics

 Prognosis – is good. In rare cases could develop encephalitis

Erythema Infectiosum

 Etiology – Human parvovirus B19

 Seroprevalence 2-9% in children younger than 5y, 15-25% in children 5-18y

 Clinical manifestation - rash, low grade or no fever, and occasionally pharyngitis and mild
conjunctivitis
Erythema Infectiosum

 Diagnostics – Serology and PCR

 Clinical manifestation - hematologic abnormalities, mild anemia,

thrombocytopenia, lymphopenia, and neutropenia.

 Treatment – symptomatic

 Prognosis – mostly positive

Varicella Zoster Virus

 Chickenpox and Zoster

 Transmission is by direct contact, droplet, and air.

 Clinical manifestation:
Ataxia
Alopecia
Vesicles and Bullae
Fever and Rash
Petechiae/Purpura
Varicella Zoster Virus

 Diagnostics – PCR or serology test

 Treatment - Symptomatic therapy which includes non aspirin antipyretics, cool baths, and
careful hygiene

 Prognosis – pneumonia, staphylococci and streptococci, toxic shock, myocarditis,

pericarditis, hepatitis, ulcerative gastritis, glomerulonephritis, and arthritis

 Prevention – vaccination which is in 85% effective

Cutaneous Infections

 Impetigo

 Cellulitis

 Folliculitis

 Perianal Dermatitis
Superficial viral infections

 Herpes simplex virus

 Human papillomaviruses

 Molluscum contagiosum
Pharyngitis

 Etiology - Many infectious agents and viruses can cause pharyngitis

 Epidemiology - Sore throat is the primary symptom in approximately one third of upper
respiratory tract illnesses.
 Clinical manifestation - Pharyngeal inflammation causes cough, sore throat, dysphagia,
and fever.
 Headache, nausea, vomiting, and abdominal pain are frequent
Pharyngitis

 Diagnosis - rapid streptococcal antigen test and a throat culture

 Treatment – antimicrobial therapy

 Complication and prognosis - pharyngeal abscess, infections of the deep fascial spaces of
the neck, acute rheumatic fever and acute post infectious glomerulonephritis
Sinusitis

 Etiology - Sinusitis is an infection of the paranasal sinuses and is often complication of

the common cold and allergic rhinitis.
 In 90% of children with acute sinusitis, the bacterial causes are Streptococcus pneumonia
and Haemophilus influenza

 Epidemiology – true incidence is unknown, common cold is major factor

 Clinical manifestation – persistent rhinorrhea, nasal stuffiness, and cough especially at

night
Sinusitis

 Lab and imaging - Sinus culture is the most accurate diagnostic method but is not
practical.
 Plain x-ray and CT may reveal sinus clouding, mucosal thickening

 Treatment – Antibacterial treatment for 10 to 14 days is recommended as first-line therapy

of sinusitis in children

 Prognosis - orbital cellulitis, epidural or subdural empyema, brain abscess, sinus

thrombosis
Otitis media

 Etiology - Otitis media (OM) is an infection of the middle ear cavity. Both bacteria and viruses
can cause OM.

 Epidemiology - Diseases of the middle ear account for approximately one third of office visits
to pediatricians.

 The peak incidence of acute OM is between 6 and 15 months of life

 Clinical manifestation - Ear Pain, Strabismus, Abnormal Eye Movement, Diarrhea, Hearing
Loss, Fever
Otitis media

 Diagnostics - Tympanometry provides objective acoustic measurements

 Treatment - The recommended first-line therapy for most children with a certain diagnosis
of acute OM or those with an uncertain diagnosis but who are younger than 2 years of age
or have fever greater than 39° C or otalgia is Amoxicillin
Otitis media

 Prognosis - The complications of OM are hearing loss and acute pain, loss of appetite

 Prevention - Parents should be encouraged to continue exclusive breastfeeding as long as

possible
 Parents should be warned about the risks of bottle feeding
Otitis Externa

 Etiology - Otitis externa, also known as swimmer’s ear, is defined by inflammation in the
external auditory canal.
 Most common bacterial pathogens are Pseudomonas aeruginosa, especially in association
with swimming in pools or lakes

 Epidemiology - Otitis externa cases peak in summer

 Clinical manifestation - Pain, tenderness, and aural discharge

Otitis Externa

 Diagnosis is based on clinical symptoms and physical examination findings

 Treatment - Topical antimicrobial/corticosteroid preparations are sufficient in most cases

of otitis externa

 Prognosis - Acute otitis externa usually resolves promptly without complications within 1
to 2 days after treatment.
 Complications of otitis externa include invasion of the bones which may cause cranial
nerve palsies
Croup (Laryngotracheobronchitis)

 Etiology
1. Most common infection of the middle respiratory tract
2. Most common causes of croup are parainfluenza viruses and respiratory syncytial virus
3. Croup is most common in children 6 months to 3 years of age, with a peak in fall and
early winter

 Clinical manifestation - The manifestations of croup are a harsh cough described as

barking, inspiratory stridor, low-grade fever, and respiratory distress
Croup (Laryngotracheobronchitis)

 Treatment - Oral or intramuscular dexamethasone for children with mild, moderate, or

severe croup reduces symptoms, the need for hospitalization, and shortens hospital stays

 Prognosis - most common complication of croup is viral pneumonia, which occurs in 1%

to 2% of children.
Pertussis

 Etiology - Classic pertussis (whooping cough) is caused by B. pertussis

 Epidemiology - incubation period is 7 to 10 days.

 Worldwide there are an estimated 30 to 50 million cases of pertussis and 300,000 deaths
annually

 Clinical manifestation - progression of the disease is divided into catarrhal, paroxysmal,

and convalescent stages
Pertussis

 Treatment - Azithromycin, clarithromycin, or erythromycin are recommended for children

under 1 month of age,
 Trimethoprim-sulfamethoxazole is an alternative therapy among children older than 2
months

 Prognosis - hypoxia, apnea, pneumonia, seizures, encephalopathy, malnutrition, and death

 Prevention - vaccination
Bronchiolitis

 Bronchiolitis is a disease of small bronchioles with increased mucus production and occasional
bronchospasm, most commonly caused by a viral lower respiratory tract infection

 Epidemiology - Bronchiolitis is a leading cause of hospitalization of infants.

 Bronchiolitis occurs almost exclusively during the first 2 years of life, with a peak age at 2 to 6 months

 Clinical manifestation – Wheezing, Apnea

 Treatment - Bronchiolitis treatment consists of supportive therapy, including respiratory monitoring,
control of fever, hydration, upper airway suctioning, oxygen administration
Bronchiolitis

 Prognosis - Most hospitalized children show marked improvement in 2 to 5 days with

supportive treatment alone.

 There is a 1% to 2% mortality rate

 Prevention – Seasonal Vaccination

Pneumonia

 Etiology - Pneumonia is an infection of the lower respiratory tract that involves the
airways and parenchyma with consolidation of the alveolar spaces.
1. Lobar pneumonia describes pneumonia localized to one or more lobes of the lungs
2. Atypical pneumonia describes patterns typically more diffuse or interstitial than lobar
pneumonia
3. Bronchopneumonia refers to inflammation of the lung that is centered in the
bronchioles
4. Interstitial pneumonitis refers to inflammation which is composed of the walls of the
alveoli
Pneumonia

 Epidemiology - An estimated 2 million deaths in developing countries are due to acute

respiratory tract infections annually

 Clinical manifestation – Cough, Wheezing, Chest Pain, Abdominal Pain, Failure to Thrive

 Diagnostics – CBC, PCR, bronchoscopy, chest X-ray, CT

Pneumonia

 Diff diagnosis - allergic pneumonitis, asthma, and cystic fibrosis, cardiac diseases, such as
pulmonary edema caused by heart failure and autoimmune diseases

 Treatment - Therapy for pneumonia includes supportive and specific treatment and
depends on the degree of illness.
 Because viruses cause most community-acquired pneumonias in young children, not all
children require antibiotic treatment for pneumonia
End of part 6