Exanthematous and Infectious Diseases of Childhood PDF

Exanthematous and Infectious Diseases of Childhood Angela Mastronuzzi Exanthematous Diseases of Childhood Definitions  Exanthema  a rash that appears abruptly and affects several areas of the skin simultaneously  Enanthem  an eruption upon mucous membranae EXANTHEM: gene...

Exanthematous and Infectious Diseases of Childhood Angela Mastronuzzi Exanthematous Diseases of Childhood Definitions  Exanthema  a rash that appears abruptly and affects several areas of the skin simultaneously  Enanthem  an eruption upon mucous membranae EXANTHEM: generalized rash of transient character FEATURES Appearance: confluent or nonconfluent, flat, raised Symmetrical or asymmetrical, acral, diffuse Fleeting or persistent, cranio-caudal, centripetal, centrifugal Recurrent Chronological relationship with other symptoms: associated with infection (viral > bacterial) Evolution: sometimes the evolution is pathognomonic of a specific morbid entity, sometimes it is entirely nonspecific Presence of enanthem: rash on mucous membrane (palate, cheeks, tongue) ANAMNESIS Age of the patient Season Medical history: fever and associated symptoms, prodromal symptoms Recent infections or contact with infected people Vaccinations Travel Insect bites or contact with animals Immune status Medications CLASSIFICATION OF SKIN LESIONS Macula (or spot): limited variation in skin color Papule: small relief of the skin, solid and circumscribed, which does not exceed 5 mm Nodule: circumscribed lesion of the skin, solid and palpable, similar to the papule but affects deeper tissues (dermis and hypodermis) and is larger in size (> 0.5 cm in diameter) Vesicle/bubble: cavity with non-purulent serous or hemorrhagic contents: the vesicle is small ( 0.5 cm). The crust is the result of the drying of the liquid contained in the vesicle or bubble Pustule: cavity with purulent contents (pus) Petechiae/purpura: punctiform (petechiae) or diffuse (purpura) extravasation of blood, localized in the skin dermis or in the chorion of a mucosa VIRAL EXANTHEMAS Commonly described as “morbilliform” meaning “consisting of erythematous macules and papules that resemble a measles rash.” Prodrome: no indicative symptom complex, no specific associated symptoms. Fever, headache, myalgia, fatigue, respiratory or gastrointestinal disorders. Rash: No unique lesion morphology or distribution Difficult to distinguish from drug eruptions. The medical history will help in the diagnosis. Drug eruptions are more common in adults, viral rashes are more common in children. Common causes: non-polio enterovirus (more common in the summer months), respiratory viruses (Adenovirus, rhinovirus, parainfluenza viruses, etc. more common in the winter months) Prognosis: most nonspecific rashes resolve within 1 week without treatment MEASLES EPIDEMIOLOGY Etiology: Morbillivirus (Paramixoviridae) Epidemiology: variable age. In Italy 0.1 cases per million inhabitants (Epicentro, 2021), mostly imported cases. One of the leading causes of child mortality globally (>140,000 deaths in 2018, most papules -> papulo-vesicles -> vesicles -> pustules -> crusts. "Starry sky" rash: there are elements in all the different developmental stages, that is, there are successive ranges. Therapy: symptomatic (antipyretics, antihistamines, topical antibiotics), antiviral, only for immunocompromised subjects Complications: hepatitis, thrombocytopenia, acute cerebellar ataxia, encephalitis, pneumonia, nephritis, nephrotic syndrome, hemolytic uremic syndrome, arthritis, myocarditis, pericarditis, pancreatitis, orchitis and acute retinal necrosis, herpes zoster (remote) URTICARIA AND VESICULAR RASH (CHICKENPOX-LIKE) INFECTIOUS ERYTHEMA (FIFTH DISEASE) - SLAPPED CHEEKS Etiology: Parvovirus B19 Epidemiology: school age, winter/spring period Transmission: by air Symptoms: rarely low-grade fever, abdominal pain, headache Contagious: until the rash appears Exanthem: confluent papular maculus, localized to the face ("slapped cheeks") present only in 15%- 20% of infected people (children > adults); after 2 days centrifugal evolution, with reticular pattern (geographical rash)- spread to the trunk and limbs, with regression on the face Therapy: supportive care Complications: transient or chronic marrow aplasia (due to chronicity of the infection in immunosuppressed subjects), myocarditis EXANTHEMA SUBITUM (SIXTH DISEASE) Etiology: HHV6, HHV7 Epidemiology: age 6 months - 2 years, spring- autumn period Prodromes: high fever for 3-5 days, which disappears before rash, arthralgia, headache Transmission: by air Contagious: until the rash appears Skin rash: pale pink maculopapule (roseoliform) measuring 2-3 mm localized to the trunk, with centrifugal evolution on the face and limbs Resolution in 24-72 hours, but can also be fleeting and visible for only a few hours Therapy: supportive care Complications: exanthematous viral disease most frequently associated with febrile convulsions MONONUCLEOSIS Etiology: Epstein-Barr virus of the herpes-virus family Epidemiology: it is a widespread disease, and serum conversion increases with age. Adults are almost all serum-positive. Contagion occurs with saliva droplets ("kissing" or "college" disease) Clinical exam: - fever of very variable duration (a few days or even a month) - red angina (or pseudo-membranous or lacunar "plaque") - fatigue - diffuse polyadenomegaly - hepatomegaly and splenomegaly - maculo-papular rash (10%) similar to that of rubella or measles Therapy: supportive care PITYRIASIS ROSEA Etiology: not known, suspected HHV6, HHV7, HHV8 Epidemiology: children and young adults Prodromes: none, may be preceded by fever, malaise, arthralgia Initial appearance of the mother spot of 1-10 cm in diameter, ring-shaped with a raised and flaking edge. After 5-10 days smaller (< 1 cm), round/oval, pink/brown patches on the trunk and roots of the limbs. The lesions on the back have the long axis aligned with the skin folds and form the classic "Christmas tree" design. Reverse form: the rash affects the face, scalp, and distal regions of the extremities Duration: 2-12 weeks Therapy: none, skin emollients and oral antihistamines for itching. Sun exposure can shorten the duration of the rash HANDS FEET MOUTH Etiology: coxsackievirus A16, enterovirus 71; coxsackievirus A 5,6,7,9, coxsackievirus B 2 and 5, echovirus Epidemiology: children < 5 years, late summer-autumn period Symptoms: malaise, sometimes mild fever. Inflammation of the oropharynx with vesicles spread to the tongue, buccal mucosa, pharynx, palate, gums and lips. The vesicles may ulcerate Rash: 3-7 mm maculopapular lesions appear on the palmar surfaces of the hands, fingers, plantar surfaces of the feet and on the buttocks and groin Duration: 1 week Therapy: none, skin emollients and oral antihistamines for itching Complications: enterovirus 71 and coxsackievirus A16 are associated with a high number of neurological complications (meningitis, meningoencephalitis, poliomyelitis-like acute flaccid paralysis, Guillain-Barré, transverse myelitis, cerebellar ataxia, opsoclonus-myoclonus, benign intracranial hypertension, rhombencephalitis) and cardiological complications (cardiopulmonary failure, shock, coma) ATYPICAL HANDS FEET MOUTH Etiology: coxsackievirus A6 Epidemiology: children and adults Symptoms: fever, pain, dehydration and peeling of the palms and soles Exanthema: generalized rash also on the face, proximal extremities and trunk Other manifestations: onychomadesis, associated with coxsackievirus A6 and other coxsackieviruses GIANNOTTI CROSTI SYNDROME Etiology: associated with immunological reaction to viral infection. The viruses most commonly involved are EBV, HBV, coxsackievirus A16, parainfluenza virus Epidemiology: children < 5 yearsProdromes: viral infection in the previous 7-10 days Symptoms: malaise and low-grade fever Exanthem: monomorphic lesions, dark red/copper, 1-10 mm. They can become hemorrhagic. They appear in groups and can merge into plaques Symmetrical rash on the face, ears, buttocks, upper limbs, rarely palms and soles Koebner + phenomenon Duration: up to 2 months Therapy: none, skin emollients and oral antihistamines for itching PAPULAR-PURPURIC GLOVES AND SOCKS SYNDROME Etiology: parvovirus B19 Epidemiology: adolescents Symptoms: rarely fever and oral lesions Rash: Initial edema and erythema on the hands and feet stopping at the wrists and ankles, then progressing to itchy purpuric papules Complications: mononeuritis multiplex Therapy: none, oral antihistamines for itching  VIRAL EXANTHEM: SUMMARY TABLE Viral Syndrome Causative Exanthem/Enanthem Age/Epidemiol Associated Symptoms Virus ogy Roseola HHV-6 Erythematous macules and Infant-Preschool High fever x 3 days, then rash. (HHV-7) papules surrounded by Mild URI sx. white halos. Complications: febrile sz. Erythema Infectiosum Parvovirus B19 Erythematous School-age Low-grade fever “slapped” cheeks, followed by reticulate erythema on body Hand-Foot-and-Mouth Coxsackie A16, Oval vesicles on palms, Infant-Preschool Fever, sorethroat, respiratory Disease A6; Enterovirus soles, buttocks; oral and GI sx. 71; others erosions. Measles Measles Erythematous macules and Majority of cases Prodrome: Fever, Malaise, papules; spread from head in US are Conjunctivitis, Cough, Coryza down. White erosions on imported. Infectious complications. buccal mucosa (Koplik spots) Rubella Rubella Pruritic pink macules and Majority are Fever, HA, URI sx, papules, spread from head vaccinated. conjunctivitis, down over 24 hrs. lymphadenopathy. Petechial lesions on soft Congenital rubella syndrome. palate (Forsheimer’s sign) SCARLET FEVER Etiology: group A B hemolytic streptococcus (SBEGA) Epidemiology: school age (> 5 years), autumn- spring period Transmission: by air Symptoms: pharyngitis, adenopathy, fever, abdominal pain Infectivity: from 1-5 days before up to 48 hours from the beginning of the habit Rash: spotty, “sandpaper” skin. Sometimes confluent, erythematous-purple. Localization on the trunk and on the roots of the limbs, involving the folds (groin, armpits, neck). Centrifugal evolution, with desquamation. Spare the perioral area ("Filatov mask") Enanthem: strawberry tongue Diagnosis: throat swab Therapy: antibiotic (Amoxicillin 50 mg/kg in 2 administrations for 10 days) Complications: (if untreated) glomerulonephritis, endocarditis, rheumatic disease TAKE HOME MESSAGES Exanthems are rashes that appear suddenly and affect multiple areas of the skin at the same time Morbilliform means “composed of erythematous macules and papules similar to a measles rash” Most cases of viral rashes are nonspecific and resolve without treatment Distinct viral exanthems are seen in erythema infectiosum, roseola infantum, foot-and-mouth disease, measles, and rubella A careful history and physical examination help establish the diagnosis Infectious Diseases of Childhood  BRONCHIOLITIS DEFINITION ETIOLOGY Acute respiratory inflammatory process caused ❖ Respiratory syncytial virus (RSV) the most common mainly by viral infection. causative agent (infects more than 60% of all children Determines the highest rate of hospitalization in in the first year of life and almost all children within 2 the first year of life. years) ❖ Rhinovirus (RV), Parainfluenza virus, Metapneumovirus AMERICAN: acute respiratory infection in (MPV), Influenza virus and Adenovirus, as single children < 2 years, with initial upper respiratory infections or co-infection. involvement, followed by dyspnea and the appearance of "wheezing"; EUROPEAN: acute respiratory infection in children < 12 months, characterized by dyspnea, tachypnea, respiratory distress, "wheezing" and crackling wheezes. PATHOGENESIS Virus replication in the cells of the respiratory mucosa Cell death Edema Increased secretion of mucus Bronchial obstruction or bronchoconstriction Air trapping Pulmonary atelectasia Increased respiratory work Reduced ventilation Alteration V/Q DIAGNOSIS Diagnosis is clinical ⮚ Symptoms: irritability, respiratory distress, difficulty feeding, fast and noisy breathing, dry cough ⮚ Signs: - initial signs: cold, sneeze, cough, appetite reduction, sometimes fever - signs of clinical worsening: wheezing or rapid breathing, cyanosis of the lips and nail, nasal fin winging and/or chest retractions TREATMENT RESPIRATORY SUPPORT  LARYNGOTRACHEOBRONCHITIS (CROUP) DEFINITION Acute stenosis syndrome of the subgloptic larynx usually caused by viral agents. It is one of the most common respiratory diseases and is the most common cause of upper respiratory obstruction in children from 6 months to 4 years of age, with peak incidence during the second year of life and in the autumn-winter period. ETIOLOGY ❖ Parainfluenza virus 1 and 3 ❖ RSV, parainfluenza 2, influenza A, metapneumovirus, rhinovirus and adenovirus CLINICAL FORMS 1. Hypogloptic laryngitis (laryngotrachitis): "stroke disease" 2. Laryngospasm (spasmodic croup): recurrent nature DIAGNOSIS Diagnosis is clinical ❖ Nocturnal onset ❖ Barking cough (barking cough) ❖ Dysphonia (moderate) ❖ Noisy breathing (cornage) and inspiratory difficulty (tirage) ❖ There may be a prodromal phase in previous 24-72 hours with non specific symptoms such as cough, fever, and rhinorrhea ❖ Duration: a few hours (laryngospasm) to 1-2 days More severe cases may present other associated symptoms such as tachycardia, tachypnea, supraclavicular intercostal and sternal retractions, stridor and cyanosis 1-2: mild 3-8: moderate 9-11: severe >/=12: imminent respiratory arrest  TREATMENT PURPOSE: Reduce airway edema Provide respiratory support (if needed) ⮚ CORTICOSTEROIDS: local anti-inflammatory and vasoconstrictive properties 1. Inhalation route (aerosol) same effectiveness in 2. Systemic route (orally, im, ev) improving severity score within 6 h and reducing hospitalizations In case of moderate-severe croup or failure to respond to the first steroid administration: ⮚ ADRENALIN (aerosol): local vasoconstrictor (reducing edema) and bronchodilator effect ⮚ SUPPORTIVE THERAPY WITH O2 (SpO2 < 92-94% in room air) Other remedies (water vapor, humidifier, aerosol with saline, going outdoors) are not effective in improving the "croup score," although they may be a useful placebo to calm child and parents in home management of mild forms.  ASTHMATIC BRONCHITIS ❖ Most common form of recurrent expiratory "whistle" in pediatric age ❖ Etiology: viral infectious nature in more than 80% of episodes: - Rhinovirus - RSV - Chlamydia and Mycoplasma pneumoniae (rarely, in school age). ❖ Peak incidence from September to June and between 2 and 4 years of age ❖ Pathophysiology: constitutional bronchial hyperresponsiveness, which allows the infectious stimulus to produce the bronchospastic response (the "whistle") ❖ Clinical diagnosis: the child presents in rapid succession: Rhinitis → dry cough → wheezing and/or wheezing on auscultation of the chest with more or less obvious difficulty breathing ❖ Duration: approximately 7 days TREATMENT ⮚ Bronchodilator therapy: salbutamol (main drug used during asthmatic bronchitis) 1. Aerosol 2. Pre-dosed spray with spacer chamber ⮚ Anti-inflammatory therapy: Oral or intravenous corticosteroids ⮚ Oxygen therapy If Sat02 < 92%  PNEUMONIA DEFINITION ETIOLOGY Inflammatory process affecting the BIRTH – 20 DAYS 4 MONTHS – 4 YEARS parenchyma of one or both lungs, S.group B Respiratory viruses characterized by exudation within the alveoli gram negative bacteria S.Pneumoniae and/or in the interstitium. Cytomegalovirus H.Influenzae M.Pneumoniae 3 WEEKS – 3 MONTHS M.Tubercolosis Classification: C. Trachomatis RSV, Parainfluenza 5-15 YEARS CAP (community-acquired pneumonia): in a S.Pneumoniae M.Pneumoniae previously healthy patient who acquired the B. Pertussis S.Pneumoniae infection outside the hospital, or before three S.Aureus M.Tubercolosis days after the start of hospitalization NOSOCOMIAL PNEUMONIA: acquired in the hospital after at least 48 hours since the onset of hospitalization. DIAGNOSIS Diagnosis is clinical Symptoms Signs Fever Tachypnea Cough Dyspnea Chest pain Tachycardia Abdominal pain Retractions (intercostal, subcostal, at the jugular), nasal fin winging Sistemic symptoms (asthenia, poor feeding, drowsiness) Localized reduction of vesicular murmur, crackling, bronchial murmur TREATMENT ⮚ Stabilization of the patient (if necessary) ⮚ Treatment of general symptoms (e.g., fever) ⮚ Correction of possible dehydration ⮚ Oxygen therapy (if SpO2 ≤ 92%) ⮚ Oral or intravenous antibiotic therapy  BRONCHIOLITIS ASTHMATIC BRONCHITIS CROUP PNEUMONIA Most frequent airway infectious Annual incidence of pediatric disease in the first year of life, Peak incidence from Peak incidence during the pneumonia of 2.5 cases per with the highest hospitalization Epidemiology September to June and second year of life and the 1000, with a peak in the first rate in the first six months. between 2 and 4 years of age autumn-winter period year of life and a decreasing Higher frequency in winter and trend with age early spring months. Virus Parainfluenzali 1 e 3, RSV, < 1 month: Streptococcus RSV Rhinovirus Parainfluenzale 2, agalactiae Rhinovirus (RV), Parainfluenza RSV Influenza A, 4m-4aa: RSV Etiology virus, Metapneumovirus (MPV), Chlamydia Metapneumovirs, > 5 yr: Atypical: Mycoplasma Influenza virus Mycoplasma pneumoniae Rhinovirus pneumoniae and Chlamydia Adenovirus Adenovirus pneumoniae Onset: rhinorrhea and Overnight onset of barking symptoms of upper respiratory cough (barking cough), Signs and symptoms of tract infection. dysphonia (modest), noise respiratory compromise: fever, Followed by: coughing, (cornage), and inspiratory tachy/dyspnea, use of Rhinitis, dry cough, wheezing crackling noises and/or difficulty (tirage) accessory respiratory muscles, and/or wheezing on chest Clinic bronchospasm, possible coughing, whistling and auscultation,with more or less respiratory distress (intercostal, Possible prodromal phase in wheezing.Extrapulmonary obvious difficulty breathing subcostal, jugular reentry, nasal the preceding 24-72 h with symptoms such as abdominal fin winging), tachypnea, fever, nonspecific symptoms such pain, headache, nausea and decreased oxygen saturation, as cough, fever, and vomiting difficulty feeding and irritability rhinorrhea Diagnosis Clinic Clinic Clinic Clinic Antibiotic therapy if bacterial Bronchodilator therapy Corticosteroids Respiratory support etiology Therapy Corticosteroids Adrenaline Hydration Supportive therapy if viral Respiratory support Respiratory support etiology  GASTROENTERITIS DEFINITION ETIOLOGY Infection of the gastrointestinal Various pathogens, in order of frequency: tract characterized by reduced Rotavirus stool consistency and/or Salmonella increased frequency of Adenovirus evacuations (> 3 episodes in 24 E. coli enterotossigeni hours) with or without vomiting Campylobacter and fever Giardia Yersinia enterocolitica Shigella DIAGNOSIS Diagnosis is clinical It varies in relation to the causative agent: ❑ Rotavirus: dehydration, vomiting, watery diarrhea ❑ Salmonella, Campylobacter, Shigella: fever, abdominal pain, blood in the stool Who is at risk of dehydration? ❖ Children < 1 year old (especially < 6 months) ❖ More than 5 evacuations in the previous 24 hours ❖ More than 2 vomits in the previous 24 hours ❖ Refusal of oral rehydration ❖ Discontinuation of breastfeeding during symptoms ❖ Children with signs of malnutrition TREATMENT ⮚ Rehydration: oral route with glucoelectrolyte solutions parenteral route: in few severe cases (severe dehydration, shock) ⮚ Correct rehydration: - breastfed infant: as needed without interruption+ sol. rehydration ab libitum - artificially breastfed infant: hydrolyzed formulas (transient intolerance to cow's milk protein) + oral rehydrators - older infants: after 4-6 hours of oral rehydration, resume normal feeding ⮚ Drugs: Antibiotics: bacterium detected at co-culture sepsis neonates, premature, immunocompromised child Probiotics: useful in reducing the incidence of intestinal dysmicrobisms following infection OTITIS Inflammation in ear or ear infection, inner ear infection, middle ear infection of the ear, in both humans and other animals. When infection is present, it may be viral, bacterial or fungal. It is subdivided into the following: Otitis externa, external otitis, involves inflammation of the external auditory canal, Otitis media, or middle ear infection, involves the middle ear Otitis interna, or labyrinthitis, involves the inner ear OTITIS MEDIA 80% of children experience at least one episode of Acute Otitis Media (AOM) before 2 years Risk Factors: - Children with anatomical anomalies (e.g. cleft palate) or immunological deficiencies - Environmental: childcare attendance, exposure to older siblings, exposure to tobacco smoke, bottle feeding in a supine position, dummy use - Male - Family history of AOM - Certain ethnic groups (Native Americans & Native Alaskans)  Etiology: - Mostly caused by respiratory viruses - Bacterial causes: Streptococcus pneumoniae (40%), Haemophilus influenzae (25-30%)  Examination: - Bulging (bagel sign)- red tympanic membrane - Loss of Light/Reflex - +/- discharge AOM: acute otitis media OME: otitis media with effusion COM: chronic otitis media  Admit if: - Person with severe infection - Person with suspected complications of AOM - Child 38°C Consider admission if: - Child 39°C All people with AOM - Course of AOM 3-7 days - Advise regular analgesia such as paracetamol/ibuprofen Who benefits from immediate antibiotics: - Those with presence of otorrhea - Anyone aged less than 2 years with bilateral infection - The systemically unwell - those with high risk of complications Treatment: - Amoxicillin or Erythromycin/Clarithromycin URINARY TRACT INFECTIONS (UTI) Urinary tract infections (UTIs) are common in kids. They happen when bacteria (germs) get into the bladder or kidneys. They can affect the urinary tract, including the: - bladder - urethra (the tube where urine leaves the body) - Kidneys Types of UTI - upper UTI: infection of the kidneys or ureters - lower UTI: infection of the bladder (cystitis) or urethra  Etiology: - microorganisms (usually bacteria): they typically enter through urethra and may infect the bladder. The infection can also travel up and eventually infect kidneys. - E.coli causes more than 90% of bladder infections; it typically exists in lower intestines - much more common in girls because a girl's urethra is shorter and closer to the anus (where poop comes out) Other risk factors: - a problem in the urinary tract - bladder up the ureters and toward the kidneys (vesicoureteral reflux - VUR) - poor toilet and hygiene habits - family history of UTIs  Symptoms: - Temperature > 38 ̊C - Dysuria - frequency - Urgency - Incontinence - abdominal pain - supra-pubic discomfort - back pain Risk factors: - Poor urine flow, dysfunctional voiding and/or constipation - Previous urinary tract infection - Antenatal diagnosed renal abnormality - Underlying spinal lesion - Family history of vesico-ureteric reflux or renal disease - Enlarged bladder and/or abdominal mass - Poor growth - High blood pressure  Diagnosis: - child’s symptoms and health history - Urine testing - Kidney ultrasound. - Voiding cystourethrogram (VCUG) Treatment: - Antibiotics - A heating pad or medicines to relieve pain - Drinking plenty of water Prevention: - drinking plenty of fluids - emptying the bladder fully when urinating - Teaching girls to wipe from the front to back after going to the bathroom MENINGITIS Meningitis is an infection that causes inflammation of the three thin layers of tissue, known as meninges, which cover the brain and spinal cord. Meningitis may be caused by a virus or by bacteria. In general, bacterial meningitis is more dangerous than viral meningitis. Bacterial meningitis may cause permanent damage, including hearing loss, mental retardation, or even death.  Etiology: Meningitis can be caused by several species of bacteria, viruses, fungi and parasites. Most infections can be transmitted from person to person. There are four main causes of acute bacterial meningitis: - Neisseria meningitidis (meningococcus) - Streptococcus pneumoniae (pneumococcus) - Haemophilus influenzae - Streptococcus agalactiae (group B streptococcus) Risk factors: - close contact with someone who has bacterial meningitis (especially when it's due to meningococcus) - having a compromised immune system - having traveled to an area of the world where meningitis is widespread  Symptoms: - viral meningitis: fever, headache, stiff neck, sensitivity to light, drowsiness, confusion - bacterial meningitis: high fever, severe headache, stiff neck, sensitivity to light, drowsiness, confusion. A rash, nausea, vomiting, and sore throat can also occur. In infants, the symptoms to be aware of are: - Fever - irritability (fussy and crying a lot) - lethargy - high-pitched cry - arching back - crying when moved - a bulging fontanelle (the soft spot on an infant's head) - seizures  Diagnosis: - Clinical exam - blood tests - Collecting spinal fluid  Treatment: - viral meningitis: bed rest, Tylenol - bacterial meningitis: hospitalization and antibiotics. Early treatment of antibiotics can reduce swelling and inflammation in the brain and prevent injury and death. Corticosteroids also may be given to reduce inflammation. Timing is crucial! Prevention: - four vaccines available to prevent bacterial meningitis - antibiotics, if close contact - Good hygiene, such as regular hand washing - Not sharing food, drinks, or utensils TUBERCOLOSIS Tuberculosis (TB) is an ongoing (chronic) infection caused by bacteria. It usually infects the lungs, but also kidneys, spine, or brain may be affected. TB is most often spread through droplets breathed or coughed into the air. A child can be infected with the TB bacteria and not have active disease. The stages of TB are: - Exposure: this occurs when a child has been in contact with a person who may have or does have TB. [negative skin test, a normal chest X-ray, and no symptoms] - Latent TB infection: this occurs when a child has TB bacteria in his or her body, but does not have symptoms. The infected child’s immune system causes the TB bacteria to be inactive. [positive skin test but a normal chest X-ray] - TB disease: this is when a child has signs and symptoms of an active infection. [positive skin test and a positive chest X-ray]  children are at risk for TB: TB can grow and cause an active disease in a child with a weak immune system. - Having HIV - Having diabetes - being treated with medicine that can weaken the immune system, such as corticosteroids or chemotherapy Very young children are more likely than older children to have TB spread through their bloodstream and cause complications, such as meningitis.  Etiology: TB is caused by bacteria. It’s most often caused by Mycobacterium tuberculosis (M. tuberculosis). Many children infected with M. tuberculosis never develop active TB and remain in the latent TB stage. TB bacteria is spread through the air when an infected person coughs, sneezes, speaks, sings, or laughs. A child usually does not become infected unless he or she has repeated contact with the bacteria. Good air flow is the most important way to prevent the spread of TB.  Symptoms: Symptoms can occur a bit differently in each child, and they depend on the child's age. The most common symptoms of active TB in younger children include: - Fever - Weight loss - Poor growth - Cough - Swollen glands - Chills The most common symptoms of active TB in adolescents include: - Cough that lasts longer than 3 weeks - Pain in the chest - Blood in sputum - Weakness - Tiredness - Swollen glands - Weight loss - Decrease in appetite - Fever - Sweating at night - Chills  Diagnosis: - TB skin test: a small amount of testing material is injected into the top layer of the skin. If a certain size bump develops within 2 or 3 days, the test may be positive for TB infection - chest X-ray - Sputum test - Eventually a blood test called interferon-gamma release assays (IGRA)  Treatment: - For latent TB, the child is given a 6- to 12-month course of the medicine isoniazid - For active TB, a child may take 3 to 4 medicines for 6 months or more Children usually start to get better within a few weeks of starting treatment. After 2 weeks of treatment with medicine, a child is usually not contagious. Treatment must be fully finished as prescribed. It is important that children take all of the medicines for the entire period.  Thank you for your attention [email protected]