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Infections (Paediatrics)

Infections (Paediatrics). Public Health: Notifiable Diseases. Malaria Measles Meningococcal septicaemia Mumps Plague Rabies Rubella Severe Acute Respiratory Syndrome (SARS) Scarlet fever Smallpox Tetanus Tuberculosis Typhus Viral haemorrhagic fever (VHF) Whooping cough

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Infections (Paediatrics)

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  1. Infections (Paediatrics)

  2. Public Health: Notifiable Diseases • Malaria • Measles • Meningococcal septicaemia • Mumps • Plague • Rabies • Rubella • Severe Acute Respiratory Syndrome (SARS) • Scarlet fever • Smallpox • Tetanus • Tuberculosis • Typhus • Viral haemorrhagic fever (VHF) • Whooping cough • Yellow fever • Acute encephalitis • Acute infectious hepatitis • Acute meningitis • Acute poliomyelitis • Anthrax • Botulism • Brucellosis • Cholera • Diphtheria • Enteric fever (typhoid or paratyphoid fever) • Food poisoning • Haemolytic uraemic syndrome (HUS) • Infectious bloody diarrhoea • Invasive group A streptococcal disease • Legionnaires’ disease • Leprosy

  3. Pathogens

  4. Pathogens

  5. Prokaryote vs Eukaryote • Prokaryote • No membrane bound organelles • Eukaryote • Membrane bound organelles • (e.g. Nucleus)

  6. Viruses • Need a host cell to reproduce in • No cell wall • Smaller than bacteria • REplicate faster than bacteria • E.g Rotavirus, HIV

  7. Bacteria • Prokaryotes • Self-reproducing • Organelles • More complex • Spheres, rods and spirals

  8. Parasites • Organism lives on / in a host • Disease causing

  9. Fungi • Overgrowth can lead to symptoms • E.g Thrush (Candida)

  10. Protazoa • Unicellular eukaryotic organisms • Sub Kingdom of protista • Get food from surrounding environment • E.g. Malaria

  11. Prion • Type of protein • Triggers normal proteins to fold abnormally • Can spread through infected meat products • Prion diseases are a group of neurodegenerative conditions • E.g. CJD (Creutzfeldt-Jakob Disease)

  12. UK Immunisation Schedule

  13. UK Immunisation Schedule *Changed from 5-in-1 to 6-in-1 (+ Hep B) 6-in-1 • Diphtheria • Tetanus • Pertussis (Whooping cough) • Polio • Hib (Haemophilus influenzae type b) • Hepatitis B Give at 8w, 12w, 16w

  14. Physiology

  15. Fetus / Childhood • Infective agent → mounts an immune response (normally) • Born with immature immune complexes • Circulating immunoglobulins from mother (transplacental) • Decrease during first few months of life • Susceptible to infections • (risk of congenital / acquired immunodeficiency) • HIV • Chromosomal syndromes • Maternal infection • Bloodborne • Infection during pregnancy

  16. Paediatric Infections

  17. Viral Infections

  18. NOTIFY PUBLIC HEALTH ENGLAND! Measles

  19. Measles • UK Vaccine programme • MMR (measles, mumps, rubella) • Autism / IBD scares surrounding vaccine- Andrew Wakefield • Cause: measles virus • Droplet spread • Incubation period 10-14 days • Fever • Rash • Koplik’s spots • Conjunctivitis / coryza • Cough

  20. Measles - Clinical Features • Rash • Spreads downwards from behind the ears • Whole body • Maculopapular rash • Fever • Koplik’s spots • White spots on buccal mucosa • Conjunctivitis • Coryza • Cough

  21. Measles - Treatment • No curative treatment • Symptomatic • Isolation (especially if admitted to hospital) • Immunocompromised patients: • Ribavirin • Vitamin A given in developing countries to modulate immune response

  22. Complications • Respiratory • Pneumonia • Secondary bacterial infection and otitis media • Tracheitis • Neurological • Febrile convulsions • EEG abnormalities • Encephalitis • 1/5000 - 8 days post onset of symptoms, 15% mortality • Subacute sclerosing panencephalitis • 1/18,000 - loss of neurological function → dementia → death • Measles antibody in blood, CSF and EEG abnromalities • Other • Diarrhoea • Hepatitis • Appendicitis • Corneal Ulceration • Myocarditis

  23. Mumps

  24. Mumps • Part of MMR vaccine • Cause: Mumps Virus (family: paramyxovirdae (same as measles) • Respiratory droplet spread • Single stranded RNA • Most common in winter and spring • First gland affected - Parotid glands • Incubation period 15-24 days

  25. Mumps - Clinical Features • Initially • Fever • Malaise • Parotitis • Children may complain of earache, pain on eating and drinking • Usually mild, self-limiting illness • Hearing loss may result - usually unilateral and transient • Complications: • Viral meningitis • Viral encephalitis • Orchitis

  26. Rubella

  27. Rubella (German Measles) • Generally mild • Winter / spring • Can severely damage a fetus • Incubation period: 15-20days • Cause: Rubella Virus • Rash starts of face and spreads to body • May be itchy in children, less likely • Lymphadenopathy • Suboccipital • Postauricular • Complications (rare): • Arthritis • Encephalitis • Thrombocytopenia • Myocarditis • Serological diagnosis • No effective treatment - prevention is key

  28. Human Herpesviruses (VZV, CMV, EBV, HSV)

  29. Chicken Pox(Varicella Virus - Herpesvirus)

  30. Chicken Pox • Cause: Varicella Zoster Virus (A human herpesvirus) • Vesicular rash, itchy • Mode of spread: respiratory (highly contagious) • Progresses through blood and lymphatics - cause vesicular lesions in skin • Complications: • Secondary bacterial infection with staph/strep leading to TSS / necrotising fasciitis (consider if new fever after first few days) • Encephalitis • Purpura fulminans • Consequence of vasculitis • Strokes • Very rare - incidence increased due to vasculitis / protein S deficiency

  31. VZV - Prevention • ZIG - Human varicella zoster immunoglobulin • Recommended for high risk immunocompromised individuals with T-lymphocytes function • Neonates • Bone marrow transplant recipients • Congenital / acquired immune deficiency

  32. NOTE - Shingles • Same virus • Reactivation of VZV • Dermatomal distribution • Most commonly occurs in Immunocompromised people • Most commonly thoracic

  33. Epstein-Barr Virus

  34. Epstein-Barr Virus • Major cause of Glandular fever (infectious mononucleosis) • Syndrome • Causes → Burkitt’s lymphoma, lymphoproliferative disease, nasopharyngeal carcinoma • B-lymphocyte and epithelial cells of pharynx

  35. Glandular Fever • Symptoms 1-3 months • Fever • Malaise • Tonsillopharyngitis • (reducing intake of food and fluids) • Lymphadenopathy • Splenomegaly (50%) • Hepatomegaly (10%) • Jaundice • Rash / petechiae on soft palate

  36. Glandular Fever • Diangosis: • Atypical lymphocytes on blood film • Positive monospot test - presence of heterophil antibodies • Seroconversion with production of IgM and IgG antigens to EBV • Treatment: • Symptomatic • Corticosteroids if airway compromised • If Group A Strep grown from tonsils - give Penicillin • Note: Ampicillin / Amoxicillin may lead to florid maculopapular rash in children with EBV - avoid!

  37. CMV - Cytomegalovirus • Usually transmitted via saliva, genital secretions, breast milk (rarely blood / placental) • May result in mononuclear syndrome • If immunocompromised can cause range of infections • Treatment: • Ganciclovir or Foscarnet - both have bad SE

  38. Slapped Cheek

  39. Slapped Cheek • Parvovirus B19 • Red rash on cheeks (may spread to top of arms) • Pallor surrounding mouth / eyes • Fever - low grade • Lethargy • Headache

  40. Bacterial Infections

  41. Scalded Skin Syndrome

  42. Scalded Skin Syndrome • Cause: Staph Aureus • Toxin causes syndrome • Treatment: • Admission • IV antibiotics • Flucloxacillin • AKA Ritter’s Disease • Widespread blisters • Epidermolytic exotoxins cause detachement of epidermal layer

  43. Tropical Infections

  44. NOTIFY PUBLIC HEALTH ENGLAND! Diphtheria

  45. Diphtheria • Potentially fatal bacterial infection • Severe damage to kidneys, nervous system, heart • Cause: Corynebacterium Diphtheriae • May be mild or severe • Incubation period: 2-5days • Symptoms: • Sore throat • Fever • (Grey / white patch may develop in throat if severe - can block airway) • Lymphadenopathy

  46. Diphtheria • Complications • Myocarditis • Abnormal heart rate • Inflammation of nerves • Paralysis • Reduced platelets • Renal problems • Diagnosis • Swab throat - culture • Treatment • Diphtheria antitoxin - prevent damage • Antibiotics: penicillin / erythromycin • Fatal in 10% of cases (even with treatment)

  47. Malaria

  48. Malaria • Tropical disease • Spread by female anopheles mosquitoes • Parasites come from saliva into human blood → liver → reproduce • Cause: Plasmodium (falciparum); ovale, malariae, vivax (milder) • Incubation period: 10-15 days • Symptoms: • Fever • Fatigue • Coma • Death • Seizures • Treatment: Hydroxychloroquine

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