paediatrics-infectious disease

neonatal (<28 days)- 4% of deaths, infants (28days-1yr) 15% of deaths, 1-14yrs 2% of deaths

flat and impalpable

circumscribed, elevated

circumscribed, elevated, fluid filled, <0.5cm

elevated and putulent exudate

vzv, hsv, h-f-m, impetigo, molluscum, dermatitis herpetiformis, sjs

10-21 days infections

48 hrs prior to onset of rash, until lesions crust

predominantly truncal, lesions at different stages, present in hair line

posterior cervival adenopathy, fever at onset of illness

bacterial superinfection (strep and staph), others are uncommon in children (cerebellitis, encephalitis, pneumonitis, hepatitis, arthritis)

crops of vesicles (At different stages) in a dermatomal distribution

children rarely get post herpetic neuralgia

ramsay hunt syndrome

contact allergies

any age, even in infancy (mother had chickenpox in preg)

vzig

1. during first 5mo preg may be followed by congenital varicella syndrome in fetus 2. during 2nd and 3rd may lead to appearance of zoster in a healthy child 3. 48hrs before-5days after delivery may cause severe neonatal disease, give vzig

skin scars (80%), eye defects (60%) limb abnormalities (70%) also prematurity/lbw (50%), cortical atrophy/low IQ (46%), poor sphincter control (32%), early death (29%)

spreads to liver and lungs, mortality as high as 15% cf 0.1-0.4% in healthy, rapidly progressive

atypical (immunocomp), disting b/w hsv and herpes zoster, to determine immune status in high risk ppl or familes (pregnant, immunocompl), infection control issues

usually clinical, ag detection, culture, genome, serology

requires high doses of antiviral cf hsv to inhibit replication, infection in neonate, immunocomp or complicated chickenpox requires high dose iv, antivirals aciclovir, val, fam

live attenuated

good against severe (>95%), ok for mild (70-90), crap against mild (10-30%), overall 80-85%

1-30% of children are seropositie, peak 9mo-3yrs, clinical: febrile (38-40), irritable, cervial/submandibular adenopathy refusal to eat

immunocompetent 14-21days, severe if immunocompromised, recurrence in 20%, avoid surgical drainage

skin , eye, mouth lesions, encephalitis, disseminated, pneumonitis

4/100000 births

iv aciclovir

25%

85% due to passage through infected birth canal

viral isolation, direct ag detection, pcr (esp of csf), type specific ab

confirm infection (pbs for genital, correct diagnosis-atypical, severe, therapy, prognosis, complications), hsv encephalitis (also neuroimaging and eeg)

enteroviruses, most commonly coxsackie virus type 16, occurs in epidemics, also ev71 assoc with neurological demyelination syndromes

papular vesicular eruption of the mouth hands feet and sometimes buttocks

hsv (involves gingiva too, more anterior). Entero (gums not involved, posterior, more acute)

red macule that becomes vesicular, vesicles burst to leave a honey coloured crust

staph and strep

measles, rubella, scarlet fever, kawasaki, erythema infectiosum/fifth disease/parvo, roseola infantum (hhv 6/7), other viral (entero and adeno)

acute catarrhal illness, fever, koplik spots on membranes, followed by rash

neuro and resp

after 3-4 months due to maternal antibodies

virus isolation during prodrome and until day 2 of rash, pcr, measle igm from 3 days after onset of rash

maculopapular, blotchy, red or pink, raised in places, starts behind the ears and on the face, spreading downwards, lesions become confluent on upper body, skin becmoes brown and rash fades after 2-3 days, desquamation occurs but not on hands and feet as in kawasaki's disease

first symptom, pink fine macular rash which starts on face then trunk then limbs, lesions normally discrete, LN enlargement (post cervical), rash develops quickly and disappears earlier than measles, desquamation not classic

group a strep

rash dark red and punctiform, prominent on neck and major skin folds, cicumoral pallor as a rsesult of rash sparing around mouth, desquamation on face then trunk and limbs, inflammation of tongue (what and red), if no inflam its called scarlatina

acute rhematic fever, acute glomerulonephritis therefor prolonged (10 days) of antibiotics

1-8yrs

fever for 5 or more days, plus 4/5 of 1. bilateral conjuntival injection, rash, oral changes (red mouth/pharynx/tongue and cracked lips) 4 swelling of hands and feet then desquamation of the hands and feet 5 cervical ln increase (at least one >1.5cm)

discrete red maculopapules are seen on feet, around knees, and in the axillary and inguinal skin creases

scarlet fever, staph

may get coronary artery aneurysms

mild febrile illness or first sign is rash (slapped cheecks, lacy maculopapular rash 1-2 wks later- mainly on arms and legs, may fluctuate, worse with bath)

jt aches bilateral, symmetrical, transient

pregnant (hydrops, fetal death), haemotalogical malignancy, hiv infected, hb'opathies-chronic anaemia

pcr on blood, parvovirus igm

high fever for 3-4 days which with onset of rash and child looks well (cf measles)

widespread maculopapular rash mainly on trunk, lesions tend to be discrete (cf measles)

febrile convulsions during prodrome, cns infections

may have early maculopapular rash on trunk, then characteristic petechial or purpuric rash anywhere, non blanching (bacterial may be in rash)

menigitis (fever, vomitin, headache and neck stiffness) or septicaemia (more deaths)

arthritis, pericarditis and pleural effusions may occur as autoimmune phenomena 5-10 days afer acute infection

clincal, gram stain culture from blood, petichial leasons or csf, mening dna (pcr) in blood and csf, serology, blood count (neutrophil count may be high or very low in severe disease, poor prognosis, dic with thrombocytopenia)

prompt antibiotics (im pen, hospital acquired- 3rd gen ceph +/- resus)

rifampicin (not in preg) or ceftriaxone or ciproflox

not major subtype

extra pulm more common in children, cns tb in <4yrs, usually from exposure to sputum from pos adult, tx similar but higher doses/kg (need to get cns), less likely to develop resistance

quantiferon test (ifn-gamma), tst-mantoux, culture/pcr of specimens

fever,lethargy, anorexia, apnea

blood cultures, csf and urine, emperical iv abs

preg (transplacental, ascending), delivery, postnatal (mother, carer, breast milk)

grp b strep, ecoli and then others (gnr, listeria, strep pneu, enterococci, n. meningitidis, s. aureus)

early onset ns usually presents as fulminant multi system disease with pneumonia (<72hrs), late onset ns usually presents as slowly progressive focal infection, most commonly meningitis

rapid (wcc unreliable, neutrophil abnormal in 2/3s, platelets low-severe bact/fungal/congenital), microbio (blood culture, csf, urine, tracheal aspirates, skin lesion swabs) gastrics asps, ag test unhelpful

neonatal urticaria/erythema toxicum, staph, vesicular (hsv, vzv), congenital (cmv), fungal (candida)

usually skin, 20% complicated (abscess, bacteremia, sepsis like syndrome, endocarditis, bone/jt, pneumonia, meningitis), toxin mediated

cmv (1 in 200)

only 10% symptomatic, microceph/iugr, jaundice, petechial rash, chorioretinitis, hepatosplenomegaly, cns sequlae long term, 10% of asymmptomatic may have hearing loss

cataracts, cardiac, cns (deaf, microcephalic)

late onset iddm, 70% asymptomatic in newborn but some have petechial rash, shed rubella for many years

n. gonorrheae, c. trachomatis, staph aureus, pseudomonas