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Anemia in Pediatrics

• Anemia in infants aged three to six months may indicate a hemoglobinopathy.
• Nutritional iron deficiency is an unlikely cause of anemia in term infants before six months.
• In toddlers, children, and adolescents, acquired causes of anemia are more common, especially iron deficiency anemia.
• Screening for iron deficiency anemia is advised for all children at ages nine to twelve months.

Iron Deficiency Anemia

• Iron deficiency anemia typically appears after six months of age.
• Key risk factors include:
  • Maternal iron deficiency, hypertension, and diabetes mellitus.
  • Prematurity and low birth weight.
  • Teenage females.
  • Low socioeconomic status.
  • Obesity.
  • Use of bottle feeding.
  • Introduction of unmodified cow’s milk before 12 months of age.

Diagnosis of Iron Deficiency Anemia

• Clinical features to diagnose include:
  • Microcytic hypochromic anemia observed on blood tests.
  • Increased red cell distribution width (RDW).
  • Possible thrombocytosis (increased platelet count) or thrombocytopenia (decreased platelet count).
  • Low serum ferritin levels indicating depleted iron stores.

Anemia in Pediatrics

• Anemia in infants aged three to six months may indicate a hemoglobinopathy.
• Nutritional iron deficiency is an unlikely cause of anemia in term infants before six months.
• In toddlers, children, and adolescents, acquired causes of anemia are more common, especially iron deficiency anemia.
• Screening for iron deficiency anemia is advised for all children at ages nine to twelve months.

Iron Deficiency Anemia

• Iron deficiency anemia typically appears after six months of age.
• Key risk factors include:
  • Maternal iron deficiency, hypertension, and diabetes mellitus.
  • Prematurity and low birth weight.
  • Teenage females.
  • Low socioeconomic status.
  • Obesity.
  • Use of bottle feeding.
  • Introduction of unmodified cow’s milk before 12 months of age.

Diagnosis of Iron Deficiency Anemia

• Clinical features to diagnose include:
  • Microcytic hypochromic anemia observed on blood tests.
  • Increased red cell distribution width (RDW).
  • Possible thrombocytosis (increased platelet count) or thrombocytopenia (decreased platelet count).
  • Low serum ferritin levels indicating depleted iron stores.

Objectives of Study

• Clinical features indicate potential congenital heart malformations.
• Understanding pediatric heart disease classifications is essential.
• Differentiation between cyanotic and non-cyanotic heart diseases is crucial.
• Anatomy and physiology of prevalent congenital cardiac defects must be comprehended.
• Clinical presentation and management strategies for acyanotic and cyanotic heart diseases should be discussed.

Common Congenital Heart Disease Syndromes

• Left-to-Right Shunts: Presenting with breathlessness.
• Right-to-Left Shunts: Resulting in cyanosis (blue appearance).
• Common Mixing: Causes both breathlessness and cyanosis.
• Outflow Obstruction: Can be asymptomatic in well children but presents with murmurs; sick neonates may exhibit shock.

Antenatal Diagnosis

• Cardiac ultrasound routinely performed between 18 to 20 weeks gestation to check fetal heart anatomy.
• Detailed evaluation by pediatric cardiologist if abnormalities are detected.
• High-risk cases (e.g., suspected Down syndrome) are monitored closely.
• Infants with duct-dependent lesions may require delivery at specialized cardiac centers.

Detection Methods

• Heart murmurs are often the first sign of congenital heart disease, although most children with murmurs may have normal hearts.
• 30% of children can exhibit innocent murmurs which can be identified by soft, systolic sounds.

Clinical Presentation of Heart Failure

• Symptoms: Breathlessness, sweating, poor feeding, recurrent infections.
• Signs: Poor weight gain, tachypnea, tachycardia, heart murmurs, gallop rhythm, and hepatomegaly.
• Causes of heart failure differ by age group (neonates, infants, older children).

Cyanosis

• Peripheral Cyanosis: Manifested as blueness in hands and feet.
• Central Cyanosis: Noted as slate blue coloration of the tongue, indicating reduced blood oxygen levels.
• Measured via pulse oximetry; values should be ≥94%.

Heart Defects Classification

• Ventricular Septal Defects (VSD):
  • Classified by size: small, large, and can lead to significant pulmonary hypertension.
  • Larger VSDs often present with symptoms like breathlessness and require drug therapy with diuretics.

Specific Heart Defect Types and Management

• Atrial Septal Defects:
  • Two types: primum/AVSD and secundum ASD.
  • Management may involve catheterization for occlusion devices or surgical correction by age 3-5 to avert long-term complications.

Key Management Considerations

• Maintenance of good dental hygiene to prevent bacterial endocarditis.
• Surgical interventions often required for significant congenital heart abnormalities.
• Prostaglandin infusion is critical for managing certain heart defects in neonates, particularly in cyanotic cases.

Classification of Respiratory Infections

• Respiratory infections are categorized based on the affected respiratory tract level:
  • Upper respiratory tract infection
  • Laryngeal/tracheal infection
  • Bronchitis
  • Bronchiolitis
  • Pneumonia

Croup

• Characterized by mucosal inflammation, increased secretions, and subglottic area edema.
• Viral etiology accounts for over 95% of cases, notably parainfluenza viruses and RSV.
• Peak incidence occurs in children aged 6 months to 6 years, particularly during the 2nd year of life and common in autumn.

Clinical Features of Croup

• Symptoms include:
  • Low-grade fever
  • Cough (barking)
  • Harsh stridor
  • Hoarseness
• Physical examination may reveal:
  • Tachycardia, tachypnea, and low oxygen saturation
  • Use of accessory muscles, respiratory distress, and cyanosis in severe cases.

Diagnosis of Croup

• Clinical diagnosis; diagnostic tests rarely necessary.
• Neck X-ray may show the "steeple sign."

Differential Diagnosis (DDx) of Croup

• Consider other upper respiratory conditions and infections.

Management of Croup

• Prioritize minimizing agitation in symptomatic children and positioning for evaluation.
• Steroid treatment:
  • Dexamethasone (0.15-0.6 mg/kg) recommended for faster symptom resolution.
  • Can also use prednisolone for 5 days.
• Nebulized budesonide (2 mg) for mild-to-moderate or moderate-to-severe croup.
• Nebulized racemic epinephrine provides symptomatic relief through vasoconstriction.

Pneumonia

• Occurs when defensive mechanisms in the lower respiratory tract are compromised, leading to pathogen invasion.
• Causes include:
  • Mycoplasma pneumoniae
  • Chlamydia pneumoniae
  • Streptococcus pneumoniae
  • Staphylococcus aureus (MRSA)
• Mycobacterium tuberculosis should be considered at all ages.

Pathophysiology of Pneumonia

• Infection leads to immune response with fluid, white blood cells, and debris accumulation in alveoli, impairing ventilation and causing clinical symptoms.

Clinical Features of Pneumonia

• Symptoms include:
  • Fever, difficulty breathing, cough
  • Irritability, poor feeding, localized chest pain
  • Abnormal breath sounds such as crackles and wheezing

Diagnosis of Pneumonia

• Chest X-ray is essential; can show white spots or round pneumonia indications.
• Blood tests can reveal elevated white blood cell counts, ESR, CRP, and hyponatremia.

Management of Pneumonia

• Distinguish between outpatient and inpatient treatment based on severity and risk factors.
• Supportive care is vital; aim for re-evaluation within 48 to 72 hours after starting antibiotics.

Indications for Admission

• Consider age, respiratory distress, dehydration, toxic appearance, and underlying health conditions.

Anti-Microbial Therapy

• Outpatient Treatment:
  • Children may receive clindamycin, vancomycin, or macrolides/amoxicillin (duration varying).
  • Antivirals (e.g., Tamiflu) for viral pneumonia, particularly influenza.
• Inpatient Treatment:
  • Broader spectrum antibiotics for newborns.

Prognosis

• Most healthy children with community-acquired pneumonia recover without long-term complications.

General Principles of Immunization

• Passive Immunization: Administration of preformed antibodies for immediate but short-term protection.

• Natural Passive Immunization: Maternal antibodies transfer through the placenta.

• Artificial Passive Immunization: Immunoglobulin preparations derived from human plasma or antitoxins.

• Active Immunization: Stimulates an immune response by introducing antigens; provides longer-lasting immunity.

• Natural Active Immunization: Acquired through previous infections.

• Artificial Active Immunization: Activation through vaccines, either whole or parts of microorganisms.

Types of Vaccines

• Live Attenuated Vaccines: Mimic natural infections, capable of replication, generally require fewer doses; e.g., measles, mumps, rubella.
• Inactivated (Killed) Vaccines: Produced by inactivating microorganisms; cannot replicate, often require multiple doses; e.g., polio (IPV), hepatitis A.
• Fractional Vaccines: Include subunit and toxoid vaccines, enhancing immunogenicity; e.g., Hepatitis B, diphtheria, and tetanus toxoids.

Vaccine Administration

• Routes: Most vaccines administered via intramuscular (IM) injection; live vaccines may be given orally or intradermally.
• IM Sites: Anterolateral thigh preferred for infants; deltoid muscle used for older children.

Vaccination Schedule

• Common Vaccines: Include BCG, DTaP, IPV, and Hep B.
• DCov: DTaP is recommended for children under 7, Tdap for those over 7 (less severe side effects).
• Pneumococcal Vaccines: PCV13 for infants, PCV23 for older children with special health conditions.

Less Common Vaccines

• Meningococcal Vaccine: Important for high-risk travelers and those with complement deficiencies.
• Rota Vaccine: Live oral vaccine for preventing rotavirus gastroenteritis in children.
• RSV Immunoglobulin: For infants at risk of severe RSV infections.
• Influenza Vaccine: Annually recommended for those aged 6 months and older.
• Rabies Vaccine: For high-risk individuals, like veterinarians.

Immunization Considerations

• Timing & Spacing: Most vaccines can be administered simultaneously; live vaccines require a minimum interval of 4 weeks.
• Contraindications: Permanent contraindications include severe allergic reactions and severe immunodeficiency. Temporary include recent illness or immunoglobulin administration.
• Catch-Up Immunization: Necessary for those who fall behind vaccination schedules.

Side Effects and Reactions

• Common side effects include local irritation, low-grade fever, and mild allergic reactions. Severe side effects may involve neurological symptoms post-vaccination.

Recommended Schedule by Health Organizations

• Adherence to vaccination schedules set forth by the Ministry of Health and WHO is crucial for disease prevention.

Special Considerations

• Post-Exposure Prophylaxis: Vaccination recommended after exposure to infectious diseases, especially in high-risk scenarios.
• Individual Assessment: Consider benefits vs risks for vaccinations based on medical history and current health status.

Comparison of Human Milk and Colostrum

• Human breast milk has higher fat and glucose levels than colostrum.
• Human colostrum contains more protein and immunoglobulins compared to breast milk.

Nutritional Composition of Milk and Formula

• Calories per 100 ml:
  • Breast milk: 67 kcal
  • Standard formula: 67 kcal
  • Premature formula: 67-81 kcal
  • Soy formula: 67 kcal
• Protein Type:
  • Breast milk protein is primarily whey and casein, while soy formula contains soy protein with added methionine for infants over 6 months.

Types of Infant Formula

• Ready to Feed: Most expensive, no water needed.
• Concentrate: Requires mixing with water in equal parts.
• Powder: Requires mixing with water.

Breastfeeding Insights

• Initial days: Not receiving breast milk in the first 2 days is normal, feeding typically begins around day 3-4.
• Nutritional focus: Infants primarily use fat as their main energy source (important for brain development), while carbohydrates become the main source (45%-65%) for children aged 1 year and older.

Key Figures

• 100 ml of breast milk provides approximately 67 kcal.

Benefits of Breastfeeding

• Contains major protective and anti-inflammatory factors such as:
  • Immunoglobulins (A, M, G)
  • Lactoferrin
  • Lysozyme
  • Prostaglandins
  • Lymphocytes

Nasal Discharge and Bacterial Infections

• Listeria is a less common cause of bacterial meningitis.
• In bacterial meningitis, cerebrospinal fluid (CSF) appears turbid, resembling "milk," with high protein levels and low glucose content.
• Kering's sign may be present in patients with bacterial meningitis, indicating potential meningeal irritation.
• Severe cases of bacterial meningitis can lead to death.

Osteomyelitis

• Osteomyelitis typically presents with fever and localized pain at the infection site.
• Commonly affects long bones and is frequently caused by Staphylococcus aureus.
• In sickle cell disease patients, Staphylococcus aureus and Salmonella are potential pathogens of concern.
• Diagnosis may involve CBC, differential counts, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), blood cultures (c/s), and synovial fluid analysis.
• Imaging techniques include plain X-rays and MRI scans to assess bone involvement and extent of infection.

Treatment and Symptoms

• Empiric treatment for osteomyelitis should include coverage for both Staphylococcus aureus and Salmonella.
• Symptoms of uncomplicated cellulitis include edema, warmth, erythema, and tenderness of the skin.
• Antimicrobial therapy is effective for treating uncomplicated cellulitis.
• Patients may show reluctance to use the affected extremity due to pain and discomfort associated with the infection.

GH1 Gene Mutations and Growth Hormone Deficiency

• GH1 gene mutations can lead to growth hormone insensitivity and pituitary hypoplasia, often associated with CNS anomalies like anencephaly and midfacial defects.
• Acquired causes of pituitary hypoplasia include radiotherapy, trauma, infiltrative lesions like craniopharyngioma, vascular infarction, and surgery.
• Suspicion of pituitary problems arises with midline defects due to the central positioning of the pituitary gland.

Clinical Manifestations of Growth Hormone Deficiency

• Congenital hypopituitarism typically presents with normal size at birth, followed by growth rates below the 25th percentile.
• Symptoms may include neonatal emergencies (apnea, cyanosis, hypoglycemia), microphallus in boys, prolonged jaundice, and delayed sexual maturation.
• Physical characteristics include a round head, short broad face, underdeveloped chin, small nose, high-pitched voice, and well-proportioned extremities.
• Intelligence is generally normal, but cases of symptomatic hypoglycemia occur in 10-15% of children with panhypopituitarism.

Laboratory Investigation and Hormone Levels

• GH plasma level <10 micrograms/L after stimulation suggests GH deficiency.
• IGF-1 plasma levels typically range from 0.3 to 1.4 U/ml, relevant for growth evaluation.

Tanner Stages of Puberty Development

• Tanner stages classify breast development in females and genitalia maturation in males, indicating progression from prepubertal to mature stages.
• Key differences include early development of breasts in females and testicular enlargement in males during puberty.

Abnormalities of Growth: Short and Tall Stature

• Short stature is defined as being 2 standard deviations below the mean height for age/gender.
• Common causes of tall stature include familial predisposition, obesity, and various syndromes like Marfan or Klinefelter.
• Endocrine disorders (hyperthyroidism, excess GH) can also contribute to tall stature.

Abnormal Head Growth Overview

• Monitoring head circumference during infancy is essential, with microcephaly defined as being 2 standard deviations below the mean and macrocephaly as above.
• Causes of macrocephaly include hydrocephalus and brain enlargement; microcephaly may be genetic or environmental.

Growth Patterns and Influences Throughout Life

• Infancy sees rapid linear growth influenced mainly by nutrition; hormonal influences become significant during childhood.
• Puberty is driven by sex hormones, with girls typically starting growth spurts about two years earlier than boys.

Conditions Associated with Short Stature

• Turner syndrome presents with short stature; careful investigation is warranted even if there are no obvious dysmorphic features.
• Small for Gestational Age (SGA) is indicated by birth weight/length <2 SDs below the mean and may benefit from recombinant human GH therapy.

Genetic and Hormonal Factors in Growth Hormone Deficiency

• Isolated GH deficiency (IGHD) is associated with GHRH receptor gene mutations.
• Multiple pituitary hormone deficiencies (MPHD) can result from genetic causes and hormonal imbalances.

Developmental Assessment

• Assessment covers Gross motor, Fine motor-adaptive, Psychosocial, and Language skills.
• Conduct developmental assessments until the child reaches 6 years of age.
• Development occurs in a cephalocaudal direction: head control, sitting, standing.
• Skill acquisition requires loss of primitive reflexes.
• For premature infants, adjust for chronological age during the first 2-3 years.

Health and Developmental Concerns of Screen/Media Use

• Major concerns include obesity and sleep disturbances.
• Potential development issues: cognitive, language, and social/emotional delays.
• Risks of exposure to unsuitable content and privacy breaches.

Screen Time AAP Recommendations

• Limit entertainment screen time to under 1-2 hours daily.
• Avoid screen media for children under 2 years.
• Keep screens out of children's bedrooms.
• Monitor media accessed by children and co-view content when possible.
• Establish family media use plans and set clear rules for technology usage.

Primitive Reflexes

• Primitive reflexes are present at specific development stages and should disappear over time.
• Persistence or absence of these reflexes may indicate CNS dysfunction.

Sexual Maturation and Tanner Stages

• Tanner stages help assess sexual maturity through a sequence of physiological changes.

Pubertal Changes in Females

• Thelarche (breast growth) marks the first sign of puberty.
• Other changes include adrenarche (pubic hair growth) and menarche (first menstruation).
• Height spurt typically occurs around age 11.5, with normal maturation range from 8-13 years.

Pubertal Changes in Males

• Initial changes include testicular enlargement and penile growth.
• Average growth spurts occur around 13.5, with maturation range from 9-14 years.

Developmental Milestones

• Development is a continuous process encompassing learned skills.
• Delayed milestone development often results from lack of exposure.
• Delay categorization: Gross motor delay when one domain is affected; Global developmental delay if multiple domains are involved.

Developmental Surveillance

• Routine monitoring occurs during every pediatric office visit.
• Approximately 15-18% of children in the U.S. experience developmental or behavioral problems.

Age-Specific Developmental Milestones

• Under 2 Weeks: Basic head movement, alerts to sound.
• 2 Months: Lifts shoulders while prone, responsive smiling.
• 4 Months: Head control, visually tracks objects, laughter.
• 6 Months: Sits with support, transfers objects, basic babbling.
• 9 Months: Pulls to stand, begins use of pincer grasp, shows separation anxiety.
• 12 Months: Walks, uses a mature pincer grasp, words like "Mama" and "Dada."
• 18 Months: Runs, stacks blocks, uses a spoon, says at least six words.
• 24 Months: Walks up/down stairs, can copy a line, starts to combine two words.
• 36 Months: Alternates feet on stairs, contributes to dressing, uses three-word sentences.
• 48 Months: Hops, goes to the toilet independently, narrates a story.
• 60 Months: Skips, follows more complex instructions, knows colors and personal information.

Age Ranges for Abnormalities

• Developmental milestones with specific age ranges indicating concern:
  • Less than 7 months: +/- 2 months
  • 7 months to 2 years: +/- 3 months
  • More than 2 years: +/- 6 months

Separation Anxiety

• Continues until about 18 months of age; generally resolved by age 3.

Developmental Milestones

• Development is a continuous process involving the acquisition of learned skills.
• Delayed milestones often stem from lack of exposure, not just a singular delay.
• Gross motor delays refer to deficits in physical skills; psychosocial delays affect emotional or social development.
• Global developmental delay includes multiple domains affected, indicating possible pathology.

Importance of Monitoring Development

• Pediatric developmental and behavioral problems are the second most common issues after infections, affecting 15% to 18% of children in the U.S.
• Developmental surveillance should occur at every office visit, assessing gross motor, fine motor, psychosocial, and language skills.

Guidelines for Developmental Assessment

• Assessments should be conducted until the child is 6 years old.
• Development follows a cephalocaudal pattern: head control develops before sitting, which precedes standing.
• Acquisition of new skills requires the loss of primitive reflexes.
• For premature infants, chronological age should be corrected for up to 2–3 years.

Screen and Media Use Concerns

• Excessive screen time is linked to obesity, sleep disturbances, and cognitive, language, and social-emotional delays.
• Guidelines suggest limiting total entertainment screen time to under 1 to 2 hours daily.
• Children under 2 should have minimal screen media exposure, and devices should be kept out of bedrooms.

Primitive Reflexes

• Primitive reflexes emerge and fade at specific developmental stages.
• Persistence beyond expected times may indicate CNS dysfunction.

Tanner Stages of Sexual Maturation

• Tanner stages represent the sequence of somatic and physiological changes during puberty.
• In females, initial signs include breast growth (thelarche) and pubic hair development (adrenarche), typically beginning between ages 8-13.
• In males, changes start with testicular enlargement and pubic hair growth, averaging around 9-14 years.

Key Developmental Milestones by Age

• 2 Weeks: Moves head to the side, regards face, alerts to sound.
• 2 Months: Lifts shoulders while prone, tracks objects, smiles responsively.
• 4 Months: Achieves head control, reaches for objects, and laughs.
• 6 Months: Sits briefly, rolls over, crawls, babbles.
• 9 Months: Pulls to stand, develops pincer grasp, shows separation anxiety.
• 12 Months: Walks, uses mature pincer grasp, and can say specific words.
• 18 Months: Runs, scribbles, and has a vocabulary of at least six words.
• 2 Years (24 months): Walks up and down stairs, copies lines, uses two-word sentences.
• 3 Years (36 months): Alternates feet while going upstairs, copies shapes, and forms three-word sentences.
• 4 Years (48 months): Hops on one foot, tells simple stories, and can use the toilet independently.
• 5 Years (60 months): Skips, copies more complex shapes, and can name colors and personal information.

Recognizing Abnormalities in Development

• Milestone acquisition should be assessed within specific age ranges; regarding delays:
  • Less than 7 months: +/- 2 months
  • 7 months to 2 years: +/- 3 months
  • Over 2 years: +/- 6 months
• After 1 year, focus shifts toward fine motor and language skills development.
• Separation anxiety gradually decreases, typically easing by age 3.

Shingles (Herpes Zoster)

• Caused by reactivation of latent varicella zoster virus.
• Typically presents with macular rash evolving from clear, fluid-filled teardrop-shaped vesicles to cloudy and umbilicated lesions, then crusting over.
• Rash appears throughout the body and is usually pruritic.
• Common symptoms include burning, throbbing pain, itching, fever, and fatigue.
• Antiviral treatment recommended within 72 hours of rash onset; supportive care if rash appears later.

Epstein-Barr Virus (EBV)

• Transmitted through bodily fluids.
• Symptoms include malaise, fatigue, fever, headache, sore throat, nausea, abdominal pain, myalgias, and generalized lymphadenopathy.
• Physical activity should be avoided due to risk of splenic rupture.
• Common condition associated with this virus: mononucleosis.

Congenital Cytomegalovirus (CMV) Infection

• Transmitted via bodily fluids including breast milk, saliva, urine, blood, and tears.
• Symptoms may include blueberry muffin lesions and potentially lead to hearing loss, eye issues, and seizures.
• Infection risk is highest in the first and second trimesters of pregnancy.

Measles Virus

• Incubation period is approximately two weeks.
• Transmitted through direct contact or airborne droplets.
• Symptoms include fever, cough, coryza, conjunctivitis, and a characteristic maculopapular rash with Koplik spots.
• High fever often reaches above 40°C.
• Prevention via MMR (Measles, Mumps, Rubella) vaccine.

Rubella Virus

• Incubation period of 2-3 weeks.
• Transmitted through respiratory droplets or transplacentally.
• Presents with a less bright maculopapular rash and tender cranial lymphadenopathy that appears approximately 24 hours before the rash.
• Erythematous papular eruption resembling sandpaper.
• Symptomatic treatment provided.

Otitis Media

• Most common bacterial pathogens include Streptococcus pneumoniae, Nontypeable Haemophilus influenzae, and Moraxella catarrhalis.
• Incubation period of approximately 21 days.
• Symptoms include ear pain, fever, lethargy, and irritability.
• Management includes oral analgesia, ibuprofen, and acetaminophen.

Acute Rheumatic Fever

• Diagnosis based on Jones criteria; requires satisfaction of either two major criteria or one major plus two minor criteria.
• Major criteria include polyarthritis, carditis, subcutaneous nodules, erythema marginatum, and Sydenham chorea.
• Commonly caused by Streptococcus.

Impetigo

• Primarily caused by Staphylococcus aureus or Group A Streptococcus (GAS).
• Incubation period is around 10 days.
• Treatment involves wound cleaning and antibacterial wash.

Urinary Tract Infection (UTI)

• Mainly caused by E. coli (70-90%), Klebsiella, Proteus, Enterococcus, and Enterobacter.
• Treatment can be oral or parenteral and is equally effective.

Human Herpesvirus 6 (HHV-6)

• Incubation period of 9-10 days.
• Transmitted through contact and presents with mild rhinorrhea, mild pharyngeal erythema, and conjunctival symptoms.
• High fever often exceeds 40°C before rash appears; treatment involves fluids and acetaminophen.

Mumps Virus

• Incubation period of 16-18 days and spread through droplet and contact transmission.
• Symptoms include fever, malaise, and parotitis (swelling of salivary glands).
• Self-limiting disease, managed symptomatically.

Parvovirus B19 (5th Disease)

• Incubation period of 7-14 days with transmission via aerosol, blood, and transplacentally.
• Characterized by "slapped-cheek" rash that spreads to a diffuse maculopapular rash.
• Often worsens with fever; treatment with NSAIDs or prednisone may be needed for aplastic crises.

Coxsackie A Virus (Hand, Foot, and Mouth Disease)

• Incubation period of 1-5 days, transmitted through airborne droplets and fecal-oral routes.
• Symptoms include inflamed oropharynx with vesicular lesions and potential maculopapular or pustular lesions on extremities.

Scarlet Fever

• Caused by Group A Streptococcus with symptoms including ear pain, fever, lethargy, and irritability.
• Characterized by a red/swollen tongue ("strawberry tongue").

Objectives for Common Pediatric Infections

• Recognize incubation period, mode of transmission, clinical presentation, and management for viral pathogens like measles, mumps, rubella, and various herpes viruses.
• Identify etiology and clinical presentation of common pediatric infections including pharyngitis, sinusitis, otitis media, skin infections, and UTIs.
• Provide management guidelines and prevention strategies for these infections.

General Information

• Asymptomatic Transmission: Incubation period ranges from 1 to 4 days for many infections.
• Modes of Transmission (MoT): Includes droplet, airborne, and fecal-oral routes.

Clinical Presentations of Viral Infections

• Gingivostomatitis & Herpetic Whitlow: Characterized by painful pustules on fingers; can cause flu-like symptoms.
• CNS Involvement: Can lead to conditions like encephalitis and myositis.
• Eye Diseases: Associated with viral infections, potentially leading to conjunctivitis.

Specific Viral Infections

• HSV-1 & HSV-2:

  • HSV-1 linked to oral lesions; HSV-2 primarily associated with genital lesions.
  • Neonates and immunocompromised patients require acyclovir treatment.

• Varicella (Herpes Zoster):

  • Characterized by a vesicular rash starting on the head and trunk, moving to extremities.
  • Incubation period of 8-12 days, with a range of 7 to 21 days.
  • Reactivation leads to shingles, can cause Ramsey-Hunt syndrome.

• Measles:

  • Symptoms include fever, lymphadenopathy, Koplik spots, and a maculopapular rash.
  • Complications include pneumonia, diarrhea, and acute encephalitis.
  • Prevention includes vaccination and vitamin A for immune modulation.

• Mumps:

  • Symptoms include fever, malaise, parotitis, and complications like pancreatitis and orchitis.

• EBV (Epstein-Barr Virus):

  • Infectious mononucleosis presents with exudative pharyngitis and atypical lymphocytes.
  • Associated with Burkitt lymphoma and nasopharyngeal carcinoma in immunocompromised patients.

Management and Treatment

• Supportive Care: Recommended for most viral infections, including those causing influenza symptoms.
• Oseltamivir: Administered regardless of timing for patients with severe symptoms or comorbidities.
• Acyclovir Infusion: Essential for immunocompromised patients and neonates for HSV infections.
• VZV Vaccine: Provides prevention against varicella and subsequent complications.

Complications of Viral Infections

• Skin & Secondary Infections: Eczema herpeticum may lead to bacterial infections like necrotizing fasciitis.
• Pneumonia: Can be a significant cause of mortality in measles cases.
• Neurological Effects: Include acute flaccid paralysis and transverse myelitis.

Statstical Data

• Clinical Presentation of Enteroviruses: May present with gastrointestinal symptoms, often in cases of hand, foot, and mouth disease.
• Incubation Periods: Varicella (Herpes 3) is typically 8-12 days, while measles is around 16-18 days.