Critical Thinking and Decision-Making Quiz

Pediatric Cardiology

• Congenital Heart Diseases (CHD) affect 8 per 1000 live births.
• Risk factors include genetic predisposition, exposures during pregnancy (drugs or disease), and chromosomal abnormalities.
• Acyanotic CHD (80% of all CHD) occurs with a left-to-right shunt.
• Common lesions in this category include Ventricular Septal Defect (VSD), Patent Ductus Arteriosus (PDA), and Atrial Septal Defect (ASD).
• Clinical features of a left-to-right shunt depend on the size of the defect and the pressure gradient across it; this may manifest as poor feeding, recurrent chest infections, recurrent heart failure, or growth failure.
• Heart failure is less common in full-term neonates but might occur in infancy.
• Obstructive lesions, such as aortic coarctation, aortic stenosis, or pulmonary stenosis, are another type of Acyanotic CHD.

Acyanotic Congenital Heart Diseases (ACHD)

• ACHD constitutes 80% of all CHD
• The commonest lesions in this category are Ventricular septal defect (VSD), Patent ductus arteriosus (PDA), and Atrial septal defect (ASD)
• General clinical features include degree of left to right shunt; dependent on size of the defect and pressure gradient across the defect.
• Manifestations of high pulmonary blood flow: Poor feeding (sweating and tachypnea) in babies, exercise intolerance and easy fatigability in children, Recurrent chest infections and chest wheezes, Recurrent heart failure, and Growth failure (faltering of growth)
• Heart failure rarely occurs in full-term neonates but may occur in infancy as pulmonary vascular pressure declines
• Obstructive lesions can include Aortic coarctation, Aortic stenosis, and Pulmonary stenosis

Atrial Septal Defect (ASD)

• Defects in the inter-atrial septum
• Increased pulmonary blood flow causes pulmonary congestive symptoms
• Volume overload affects right ventricle ,left atrium and left ventricle

Ventricular Septal Defect (VSD)

• Defects in the interventricular septum
• Blood is shunted from the left ventricle (higher pressure) to the right ventricle (lower pressure).
• Increased pulmonary blood flow.
• Causes pulmonary congestive symptoms; volume overload over right ventricle, left atrium, and left ventricle

Patent Ductus Arteriosus (PDA)

• Persistent fetal duct connecting the aorta and the pulmonary artery.
• Often associated with congenital rubella syndrome and premature infants
• Medical closure in preterm infants is done by IV indomethacin during the first week of life.

Atrioventricular septal defect (AVSD)

• Defect in the atrioventricular septum (Endocardial cushion defect)
• Common association with Down syndrome.
• General manifestations include asymptomatic presentation, symptoms appearing if defect is large ; dyspnea during suckling and recurrent chest infections (sign of pulmonary congestion)
• Physical examination may reveal tachycardia and enlarged tender liver (heart failure)
• Potential complications : Infective endocarditis, higher risk of Eisenmenger syndrome, and heart failure

Cyanotic Congenital Heart Disease (CCHD)

• Fallot tetralogy is a common cyanotic congenital heart disease with decreased pulmonary blood flow
• Characteristics include pulmonary stenosis, right ventricular hypertrophy, ventricular septal defect, and aortic dextroposition.
• Clinical features: Central cyanosis present from birth or within the first year, cyanotic clubbing of fingers and toes, growth retardation, squatting position for relief of dyspnea, and paroxysmal hypercyanotic spells (hypoxic)

Investigations for CHD

• Chest X-ray, electrocardiography (ECG), echocardiography, CBC, and other tests as appropriate.

Heart Failure

• Definition: Heart is unable to pump enough blood to meet body needs.
• Commonest causes in infancy; congenital heart diseases and rheumatic heart diseases (school age)
• Other potential causes: Myocarditis, infective endocarditis, and severe anemia, and nutritional deficiency
• Symptoms in infants include poor feeding, dyspnea during sucking, and profuse sweating. Symptoms in older children include dyspnea on exertion, effort intolerance, and ankle edema.
• Compensatory response to heart failure can include tachycardia, gallop rhythm, and weak pulse, and cold, sweaty skin.
• Systemic congestion symptoms that may occur include an enlarged tender liver (may be absent in early left-sided failure), congested neck veins, generalized edema (which starts in the ankles/ sacrum in bed-ridden adults/ infants and may involve the eyelids), a tender-to-palpate enlarged liver (heart failure)
• Investigations include chest X-ray (cardiomegaly or fluffy perihilar pulmonary markings), echocardiography (confirm ventricular dysfunction), and ECG (detect arrhythmias)

Acute Rheumatic Fever (ARF)

• Immunologic disease affecting mainly the heart and joints, and less frequently central nervous system and skin
• Risk factors include peak onset between (5-15 years) in childhood and (20-30) years in adults ; developing countries
• Pathogenesis occurs after 1–3 weeks of infection by Group A β-hemolytic streptococcal (GAS) pharyngitis.
• Anti-streptococcal antibodies cross-react with host tissues, causing inflammation in the heart (cardiac) and joints (arthritis).
• Clinical features include arthritis, migratory affecting large joints (knees, ankles, wrists, elbows), red, hot, swollen (inflamed) joints, and dramatic response to salicylates within 48 hours, resolving without residuals.
• Carditis is the 2nd common and most serious manifestation of ARF affecting primarily the endocardium, myocardium, and pericardium; commonly leading to mitral valve damage or aortic valve damage

Infective Endocarditis

• Definition: Infection of the valvular & mural endocardium
• Risk factors include prosthetic cardiac valve, previous infective endocarditis, congenital heart disease (except ASD), and permanently damaged valves due to Rheumatic heart disease.
• Commonest causative organisms include Streptococcus viridans (50%),Staphylococcus aureus and epidermidis, and Group D enterococci; fungal infections are more frequent in immunodeficient individuals
• Pathogenesis involves implantation of the organism in the diseased endocardium forming friable vegetations containing platelets, fibrin, inflammatory cells, and organisms
• Clinical features might include fever, poor appetite, weight loss, malaise, palpable spleen, and pale clubbing. Heart murmurs and embolic manifestations (neurologic, pulmonary, renal, or skin) may also occur

Anemia

• Definition: Reduction of hemoglobin and/or RBCs count below the average for age and sex, interfering with oxygen carrying capacity of blood.
• General Features: Fatigue, headaches, faintness, palpitations, breathlessness, and angina/ intermittent claudication
• Signs: Pallor, tachycardia, and hemich murmurs (functional, systolic)
• Heart failure may be evident in severe anemia with hemoglobin below 4 gm/dL
• Classification: Morphologic (microcytic, normocytic, macrocytic) and Etiologic (decrease/production, increased destruction)
• Decreased production: Pure red cell anemia, aplastic anemia, anemia of chronic inflammation, chronic infection, and chronic renal failure.
• Specific factor deficiency: Iron deficiency, copper deficiency, folic acid deficiency, and protein deficiency
• Increased destruction: Hereditary spherocytosis, hereditary elliptocytosis, immunologic hemolytic anemia (is immune hemolytic anemia, passively acquired antibodies such as in the hemolytic disease of the newborn ), autoimmune hemolytic anemia, non-immunologic hemolytic anemia (e.g., microangiopathic hemolytic anemia (MAHA), thrombotic thrombocytopenic purpura, sepsis, malaria, drug-induced hemolysis, march hemoglobinuria, paroxysmal nocturnal hemoglobinuria) , and hypersplenism
• Other causes include thalassemia
• Iron Deficiency Anemia (IDA) can be due to decreased intake, decreased absorption, decreased stores, and increased loss.
• Mild anemia is often asymptomatic; however, systemic manifestations may appear with severe iron deficiency.

Megaloblastic Anemia

• Definition: Anemia with megaloblasts in bone marrow and macrocytes in peripheral blood.
• Etiology: Vitamin B12 (cobalamin) deficiency or folic acid deficiency
• Clinical picture: Hematologic signs and symptoms (anemia, anorexia, pallor, tiredness, and slight jaundice), and other signs and symptoms such as altered gut function (atrophic glossitis/beefy red glazed tongue, atrophic gastritis, dyspepsia, vomiting, abdominal pain or diarrhea).

Thalassemia

• Definition: Autosomal recessive disorders due to defective globin chain production
• Types include ∝ thalassemia (one or more gene deletion for ∝globin genes on chromosome 16-One gene missing o Silent carrier (Asymptomatic), two gene missing o ∝ thalassemia trait, three genes missing o Hemoglobin H disease, four gene missing Fetal hydropes, and β-thalassemia (mutation of 1 or more β-globin genes on chromosome 11- One gene mutation o B thalassemia trait and Two genes mutation B thalassemia major ))
• Clinical pictures differ based on the type and severity of the condition; mild to moderate microcytic hemolytic anemia at birth with chronic hemolysis in some cases and evidence of severe intrauterine anemia and heart failure in others.

Sickle Cell Disease

• Etiology: Autosomal recessive disorder; single amino acid substitution in the 6th position of the β-chains (valine for glutamic acid) resulting in abnormal hemoglobin (HbS).
• Clinical features include anemia, chronic hemolysis, and renal disease (proteinuria, nephrotic syndrome, chronic renal failure).
• Crisis types include aplastic, hemolytic, megaloblastic, hyperhemolytic, and vaso-occlusive (painful) crisis.
• Investigations for sickle cell disease include low Hb% and Ht, blood film to detect sickle cells.

Hemophilia A

• Definition: Sex-linked recessive coagulation defect due to deficiency of factor VIII; 20% of cases are new mutations and 80% are cases of hemophilia A
• Clinical features include unusual bleeding episodes, from the circumcision site or umbilical stump in neonates and frequent external bleeding (epistaxis, dental/mouth bleeding, gastrointestinal bleeding, hematuria), easy bruising, ecchymotic patches, and hematomas; internal bleeding such as muscle hematomas, intracraniai bleeding, retroperitoneal bleeding, and hemothorax can occur.
• Investigations for hemophilia A include prolonged clotting time, prolonged partial thromboplastin time (PTT), normal prothrombin time (PT), and normal bleeding time, direct FVIII-C gene mutation analysis and blood sampling for immunoradiometric assay of FVIII-C antigen.

Acute Pharyngitis

• Causes: Viral and bacterial; group A β-hemolytic streptococci is most common.
• Complaint: Fever, anorexia, malaise, sore throat, and dysphagia.
• Features: Red, congested throat, inflamed tonsils with white or yellow exudates, and enlarged tender lymph nodes.

Acute Otitis Media (AOM)

• Risk factors: Eustachian tube obstruction, impaired immune defenses, bottle feeding, and genetic susceptibility.
• Causes: Viral but complications of bronchiolitis and bacterial infections (H. influenzae, pneumococci, moraxella catarrhalis are most common)
• Clinical features include high fever, earache (irritability, rubbing the ears in infants), otoscopic findings of a congested, bulging eardrum, and middle ear effusion with or without perforation and discharge.
• Complications: Mastoiditis, chronic ear infection.
• Treatment: Symptomatic treatment for pain and fever (ibuprofen or acetaminophen) and specific antibiotics (e.g., amoxicillin-clavulanate or ceftriaxone) for 10 to 14 days, depending on culture and sensitivity, and surgery (tympanocentesis and drainage, and tympanostomy tubes).

Acute Sinusitis

• Major Risk Factors: Upper respiratory tract infections, and immunodeficiency
• Causes: As in otitis media; mixed infections.
• Clinical features: Fever, headache, purulent or mucopurulent nasal discharge, postnasal discharge, and cough
• Other features: Nasal obstruction, halitosis (fetid breath odor), decreased smell, and periorbital edema.
• Investigations include culture and sensitivity of sinus aspirates, plain x-ray skull, and CT skull.
• Treatment: Symptomatic treatment for pain and fever, specific antibiotics for 10 days, saline nasal washes/nasal sprays, and surgical procedures for chronic cases.

Acute Infectious Stridor (Laryngeotracheobronchitis)

• Cause: Viral, such as parainfluenza types 1 and 3, respiratory syncytial virus (RSV), influenza, adenovirus, and corona virus
• Presentation: Mild upper respiratory catarrh with rhinitis, low grade fever, croupy cough and hoarseness with toxic appearance
• Management: Most cases respond to home treatment; indications for hospitalization include progressive stridor and severe stridor at rest.
• Treatment: Oxygen, nebulized epinephrine (adrenaline), oral corticosteroids, and supportive care

Acute Epiglottitis

• Infection of the epiglottis; most common causative organism is Hemophilus influenzae
• Clinical features: High fever, drooling and dysphagia, toxic appearance; with a hyperextended neck and preferred upright posture for ease of breathing.
• Management: Medical emergency requiring intubation followed by parenteral antibiotics (ceftriaxone or cefotaxime) pending culture results(antibiotic therapy for 2-4 weeks)

Pneumonia

• Etiology: Bacterial (gram-positive or gram-negative) or viral; some cases are due to atypical organisms or opportunistic infections.
• Anatomic classification: Lobar, bronchopneumonia, and interstitial pneumonia.
• Symptoms: Fever, malaise, toxemia (worst in bronchopneumonia), cough (dry, then productive), and dyspnea with grunting. Signs: respiratory distress, tachypnea, nasal flaring, retractions and grunting, cyanosis.
• Investigations: Chest X-ray, ultrasonography, contrast CT scan (complicated cases), WBC count, and acute phase reactants (ESR, and C-reactive protein), and isolation of an organism.
• Complications: Pleural effusion, empyema, lung abscess, pneumothorax, unresolved pneumonia, meningitis, septic shock, and distant infections.
• Treatment: Supportive care (bed rest, oxygen, fluids, symptomatic relief), and specific antibiotics if bacterial cause is suspected.

Tuberculosis (TB)

• Definition: Chronic, infectious disease caused by mycobacteria (bacterial infection)
• Risk factors: Exposure to high-risk adults, low socioeconomic status, immunosuppressive therapies, malnutrition, and HIV.
• Clinical picture: Can be asymptomatic in early stages, common symptoms include fatigue, poor appetite, nonproductive cough, and mild dyspnea. Potentially affected organs include lungs (pulmonary TB), Cervical lymph nodes, Mediastinal nodes, Mesenteric nodes, Lung, Kidneys, Liver, Spleen, bone marrow, Meninges (TB meningitis), intestinal TB and peritonitis.
• Diagnosis: Tuberculin skin test (TST), chest radiography, blood cultures or PCR (Polymerase Chain Reaction).
• Treatment includes a combination of rifampicin, isoniazid, pyrazinamide, and ethambutol for 6–9 months.

Acute Bronchiolitis

• Etiology: Respiratory syncytial virus (RSV), and other viruses such as adenovirus, para-influenza, and Mycoplasma
• Incidence: Affects primarily the first 2 years of life, peaking around 6 months. Seasonal association with winter and spring
• Clinical picture: Mild upper respiratory catarrh, fever, progressively worsening dyspnea, cough, wheezing, irritability, difficulty feeding, and air hunger, and apnea (more pronounced in young infants and those with prematurity).
• Investigations: chest X-ray, blood tests (ESR, CRP, & WBC count), nasopharyngeal aspirate to detect viruses via cell cultures or viral antigen/RNA by PCR.
• Management: Supportive care that includes humidified cool oxygen, nasal cannula, suctioning of secretions, monitoring hydration, and treatment of complications (parenteral fluids if risk of aspiration exists).

Scarlet Fever

• Etiology: Group A streptococcal (GAS) infection that produces erythrogenic toxins, through droplet infection.
• Clinical picture: Sudden onset of fever and sore throat; red, swollen tonsils with exudates and red pharinx and edema, white strawberry tongue; later red strawberry tongue (2nd–5th day). Red macular rash spreading to the trunk, extremities, and face—with desquamation, commonly 3–7 days after the rash appears.
• Investigations: Rapid antigen test (high sensitivity, 85-95%), blood tests (leukocytosis with neutrophilia), and throat culture. ASO titers may be elevated during the second week of the disease.
• Treatment: Symptomatic care, bed rest, light diet, fluids and adequate intake; once diagnosed antibiotics for 10 days are required; including penicillin, Amoxicillin, Cephalosporins, Zithromax, Clarithromycin.

Pertussis (Whooping Cough)

• Etiology: Infection by Bordetella pertussis
• Clinical picture: 3 phases: 1. Catarrhal stage(1–2 weeks); mild fever, runny nose, mild cough 2. Paroxysmal stage (4–6 weeks, sometimes as long as 10 weeks): repeated episodes of severe coughs followed by a "whoop" sound. 3. Convalescent stage (1–2 weeks): gradual decrease in the number of coughing episodes.
• Diagnosis: Nasopharyngeal swab for culture or PCR.
• Treatment: Supportive care, isolation, and antibiotics (azithromycin, clarithromycin, or erythromycin).

Measles (Rubeola)

• Etiology: Measles virus, an RNA virus, via droplet infection
• Clinical picture: high fever, cough, Coryza, non purulent conjunctivitis, Kopliks spots (grayish white dots with red areolae appearing opposite the lower molar teeth, disappearing in 2 days) , maculopapular rash that spreads down from the head.
• Prevention: MMR vaccine (at 9 months, and 36 months or at school age (4–6 years in USA) )
• Treatment for acute cases is mainly supportive bed rest, symptomatic management.

Rubella (German Measles)

• Etiology: Rubella virus; RNA virus; droplet infection; transmission via the placenta is possible.
• Clinical picture: Mild fever, mild nasopharyngitis;Characteristic tender enlargement of post-auricular lymph nodes. Rash appears usually on the second day; maculopapular, less intense than rubella; fades without desquamation in 2–3 days.
• Prevention: MMR vaccine.
• Treatment for acute cases is mainly supportive care.

Chicken Pox (Varicella)

• Etiology: Varicella-zoster virus (VZV); DNA human herpes virus, resulting in chicken pox in children and herpes zoster (shingles) in reactivation stages
• Clinical picture: Fever, malaise, anorexia, prodrome may occur (24–48 hours before the rash); rash appears on scalp, face, or trunk; distribution is centrifugal with little involvement of the limbs; erythematous macules; very itchy rash
• Prevention: Varicella vaccine
• Treatment: General antipruritic, calamine lotion/antihistamines, Antipyretics (paracetamol), Antibiotics to prevent 2rybacterial infection.

Mumps

• Etiology: RNA paramyxovirus affecting the salivary glands.
• Clinical picture: Mild fever, malaise, myalgia, acute non-suppurative inflammation of salivary glands. Parotid gland swelling may be unilateral. Swelling may be accompanied by symptoms in the submandibular and sublingual glands.
• Prevention: MMR vaccine.
• Treatment is mainly supportive (isolation, pain relief, and treatment of complications.

Seizure

• Definition: Transient, paroxysmal, temporary, involuntary disturbance of brain function manifested by abnormal motor, sensory, behavioral or autonomic activities, with or without impaired consciousness; convulsion is the general term for the uncontrollable muscle contractions.
• Causes: Acute: Febrile seizures, first epileptic fits, and secondary seizures (etiology related to infection; meningitis, encephalitis, brain abscesses; irritation; tumors; toxic; hemorrhagic diseases; hypoxic, ischaemic encephalopathy; and hypertension encephalopathy; and metabolic) Recurrent seizures include epilepsy and symptomatic seizures (degenerative brain diseases, genetic inborn error of metabolism, hepatic, and uremic encephalopathy, and tetany
• Investigations: EEG, metabolic tests, CSF examination, imaging (MRI), and serum electrolytes for seizure disorders, and genetic diagnosis.
• Treatment involves anti-epileptic drugs (AEDs), such as carbamazepine, lamotrigine, levetiracetam, and valproate, along with appropriate supportive care for injuries, based on etiology and any comorbidities.

Acute Bronchiolitis

• Cause: Respiratory syncytial virus (RSV) in 50% of cases, Others; human metapneumovirus, Adenovirus, Para influenza and Mycoplasma
• Clinical picture: Mild upper respiratory catarrh, fever, progressively worsening dyspnea and cough, wheezing, symptoms which can be more prominent in younger infants and those with prematurity; irritability, difficulty feeding, and air hunger, and apnea.
• Investigation: Chest x-ray, blood tests, and PCR using nasopharyngeal aspirate.
• Management: Supportive care—which includes humidified cool oxygen, high-flow nasal cannula, suctioning of secretions, monitoring hydration, and treatment of complications (parenteral fluids if risk of aspiration exists).

Cerebral Palsy

• Definition: A group of permanent disorders of movement and posture caused by non-progressive lesions to the developing fetal or infant brain affecting mainly the motor centers, cerebral cortex, cerebellum, and basal ganglia.
• Causes: Prenatal (80%): antenatal infections, congenital malformations, fetal asphyxia, Natal (10%): birth asphyxia, birth trauma. Postnatal (10%): VLBW with intracranial hemorrhage, meningitis, encephalitis, metabolic disorders such as phenylketonuria, hypoglycemia, hyperbilirubinemia, and hydrocephalus.
• Clinical picture and types include: Spastic diplegia, spastic hemiplegia, spastic quadriplegia, spastic monoplegia, spastic paraplegia, ataxic cerebral palsy, extrapyramidal or dyskinetic cerebral palsy, and mixed cerebral palsy.
• Diagnosis is a clinical diagnosis; excluding other progressive CNS disorders (metabolic, spinal cord tumor), physical examination should rule out the cause or any possible associated conditions (CT & MRI, genetic evaluations, metabolic screening (TORCH), and hearing, vision, or seizure evaluations)
• Treatment: Multidisciplinary approach is most helpful and includes a team of physicians from various specialties such as occupational and physical therapists and speech pathologists

Febrile Convulsions

• Definition: Seizures in children due to a rapid rise in body temperature; due to extra cranial causes mostly viral
• Incidence: Affect 4% of children generally between 6 and 60 months.
• Diagnostic criteria: Age of onset; fever occurring within 8 to 12 hours from the onset of fever; without signs or symptoms of infection, or metabolic disease, extracranial infection, or a history of prior afebrile seizures.
• Investigations: lumbar puncture, EEG, neuroimaging (CT or MRI), and blood tests for electrolytes, and glucose (if indicated).
• Treatment: Symptomatic care, fever control, fits lasting more than 5 minutes are treated with diazepam, lorazepam or midazolam, investigation and treatment for underlying cause

Epilepsy

• Definition: A seizure is defined as a transient, paroxysmal, time-limited, involuntary disturbance of brain function with abnormal motor, sensory, behavioral, and/or autonomic activity with or without loss of consciousness
• Types: Focal and generalized
• Causes: Idiopathic, organic (secondary) such as congenital cerebral malformation and degenerative brain diseases
• Investigations include: EEG, metabolic screen, CSF examination (suspect infections), MRI, and genetic diagnosis in certain cases.
• Treatment: Anti-epileptic drugs (AEDs)—e.g., sodium valproate, carbamazepine, levetiracetam, or lamotrigine.

Nephrotic Syndrome

• Definition: A clinico-laboratory condition including nephrotic range proteinuria (protein excretion > 3 g/24 hr), hypoalbuminemia, and generalized edema and or hyperlipidemia
• Types include Idiopathic (minimal change disease), genetic, and secondary.
• Causes: Idiopathic (minimal change disease), genetic (e.g., Alport syndrome), secondary infections (streptococcal pyogenic exotoxin), allergies, drugs, diseases (e.g., sickle cell disease, tumors), and others.
• Clinical presentation: Generalized edema (initial presentation), especially morning periorbital puffiness becoming evident in the lower limbs and genitalia; abdominal wall edema, ascites, and pleural effusion are also common. and or gastrointestinal manifestations or or hypertension
• Complications: Hypovolemia, acute renal failure, and intravascular thrombosis, Infection
• Investigations: Urine analysis; showing marked proteinuria, low serum albumin < 2.5 gm/dl, Low total protein < 4.5 gm/dL, and elevated cholesterol > 220 mg/dL. Urine microscopy and culture to assess the increased rate of UTI. CBC; complete blood count
• Treatment: Fluid balance, low sodium and low protien diet, broad spectrum antibiotics, low dose aspirin, Prednisone 2 mg/kg/day for 4 weeks, Cyclorphosamide/Cyclosporine if needed, and treatment of complications.

Urinary Tract Infections (UTIs)

• Types: Upper (pyelonephritis) and lower (cystitis, urethritis), and asymptomatic bacteruria.
• Risk factors in females include short urethra.
• Causes include several bacterial organisms; most common is E. coli.
• Clinical picture in neonates/ infants presents with sepsis (jaundice, poor feeding, irritability), and in older children it is characterized by urgency, dysuria, frequency, or suprapubic pain. Upper UTIs can present with high fever, rigor, and pain; lower UTIs can present with mild fever and or high blood pressure
• Investigations: Urinalysis with urine sample to detect; pyuria & nitrates. Additional tests include leukocytosis, neutrophilia, elevated ESR, and C-reactive protein, blood cultures, and imaging (kidney and bladder ultrasound to identify obstructive uropathy).
• Treatment: Supportive care, antibiotics including ampicillin+cefotaxime or oral antibiotics( Cotrimoxazole, Amoxicillin, Cefixime). Prevention strategies include treatment of risk factors, adequate hydration, and frequent bladder emptying.

Meningitis

• Definition: Inflammation of the membranes covering the brain and spinal cord.
• Causes: Bacterial (neonate-E.coli, Listeria monocytogenes, Streptococci, and infant-child- Nesseria meningitides, pneumococci, staphylococci, H.influenzae), viral, and fungal. Transmitted through droplet infection.
• Clinical picture: Non-specific (high fever, poor feeding, general unwell appearance/toxic appearance) and specific presentations that include increased intracranial pressure: tense/bulging fontanel in infants; severe bursting headache(irritability); blur of vision; projectile vomiting (in the morning, not associated with nausea);features of meningismus: neck rigidity (stiffness), opisthotonus (arch back), Kernig's sign, Brudzinski leg sign, and Brudzinski neck sign; neurologic manifestations; drowsiness, convulsions, coma
• Investigations: CBC, blood culture, C-reactive protein, and erythrocyte sedimentation rate (ESR). Lumbar puncture (LP) for CSF.
• Treatment: Parenteral antibiotics (culture and sensitivity) for 2-4 weeks (e.g., ceftriaxone or cefotaxime), or third-generation cephalosporin, plus appropriate supportive care.

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