COMMON PEADIATRIC INFECTIONS
Abdum Muneeb (202020)
Iqra Mehmood (202018)
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LEARNING OBJECTIVES….
You will get to know about common pediatric infections that will include
• Typhoid fever
• Malaria
• Measles
• Mumps
• Chicken pox
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Typhoid (enteric) fever
• Typhoid fever is one of the commonest causes of PUO (Pyrexia of Unknown Origin).
• It is a bacterial disease caused by typhoid bacillus & is characterized by prolonged fever,
abdominal pain, diarrhea, delirium, rose spots, and splenomegaly and complicated
sometimes by intestinal bleeding and perforation
• Typhoid fever is caused by Salmonella typhi.
• Most cases occur in school-age children and young adults
• Infection is transmitted by ingestion of contaminated food, milk, water, or contact with an
infected animal.
• Person-to-person spread occurs by fecal-oral transmission.
• Attack rates peak in the first year of life and are higher for children younger than years of
age
• The incubation period for enteric fever is usually 7-14 days (range 3-30 days). It depends
upon the size of the ingested inoculum and the immune status of the host
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Pathogenesis
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CLINICAL FEATURES
In infants,
• It may cause mild gastroenteritis or severe sepsis.
• Vomiting, diarrhea and abdominal distension are common.
• Fever is continuous and high-grade and may cause febrile fits.
• There may be anorexia, weight loss, jaundice and hepatosplenomegaly.
The older child
• Presents with high-grade continuous fever.
• Headache is common with malaise, anorexia, lethargy, myalgia, abdominal pain and tenderness.
• The typical patient has an extremely toxic look with long drawn face and furred tongue (central).
• The child is pale looking and has lost weight.
• He may have cough with scattered rhonchi or crepitations giving suspicion of pneumonia.
Maculopapular 1-5 mm rash (rose spots) are common (25% of the patients) on the upper
abdomen and lower chest.
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DIFFERENTIALS LAB DIAGNOSIS
• Gastroenteritis Specimens
• Bronchopneumonia Sepsis • mainstay of diagnosis of typhoid remains
• Malaria clinical in much of the developing countries.
• Tuberculosis • CBC
• Acute hepatitis • Diagnosis is confirmed by the culture showing
• Amebic liver abscess Salmonella strain
• Shigellosis • Stool culture may be positive during the incubation
period,
• Miliary tuberculosis
• Widal Test (serological Test)
• Brucellosis
• Leptospirosis • PCR
• Bacterial endocarditis
• Infectious mononucleosis
• Malignancies such as leukemia or
lymphoma
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MALARIA
DEFINITION:
• Malaria is an acute and chronic illness
characterized by paroxysms of fever, chills, sweats,
fatigue, anaemia and splenomegaly.
• Its caused by one of the 5 species of Plasmodium
parasite
1. Plasmodium falciparum (most virulent}
2. Plasmodium vivax (most common}
3. Plasmodium malariae
4. Plasmodium ovale
5. Plasmodium knowlesi
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Life cycle of malaria
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MODE OF TRANSMISSION
• Standing water and warm climate.
• Transmit through blood transfusion and
contaminated needle.
• Congenital malaria
• Endemic areas having mutant gene i.e, chloroquine
resistant P.Falciparum.
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Sign & Symptoms:
• Fever
• Hypoglycemia
• Splenomegaly
• Anemia
• hyperkalemia, hyperbilirubinemia,
hemoglobinemia, and hemoglobinuria.
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World Health Organization criteria for severe
Malaria
• Impaired consciousness
• Prostration
• Respiratory distress
• Multiple seizures
• Jaundice
• Hemoglobinuria
• Abnormal bleeding
• Severe anemia
• Circulatory collapse
• Pulmonary edema
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DIFFERENTIALS: DIAGNOSIS:
• Pneumonia • Clinical history and examination are important
for diagnosis
• Meningitis
• The triad of malaria includes
• Tuberculosis
• 1) Fever
• Typhoid fever
• 2) Splenomegaly
• Septicemia
• 3) Anemia (with inc. retic count)
• Giemsa-stained smears of peripheral blood.
• TLC (total leukocyte count)
• Hypoglycemia
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MEASLES
DEFINITION:
• It is an acute highly contagious viral disease characterized by maculopapular rash erupting over
neck, face, body, arms and legs accompanied by high grade fever.
Etiology:
• Measles is an RNA virus.
• Virus is present in the nasopharyngeal secretions, blood, and urine for short time after the
appearance of maculopapular
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PATHOLOGY:
• The lesion in skin, respiratory tract, intestinal tract and
conjunctivae.
• There is serous exudate and proliferation of
mononuclear cells around the capillaries.
• Koplik spots consist of serous exudate and proliferation
of endothelial cells.
• Lymphoid hyperplasia with formation of multinucleated
giant cells.
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DIFFERENTIAL DIAGNOSIS
• Scarlet fever • Primarily clinical
• Rubella • Multinucleated giant cells are seen on a
• Drug rash or serum sickness smear of nasal mucosa
• Infectious mononucleosis • Virus can be isolated in tissue culture or
antibody titer can be detected in serum.
• Kawasaki disease
• Lumbar puncture in encephalitis shows an
increase in protein and a small increase in
lymphocytes
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MUMPS:
DEFINITION:
• It is an acute contagious viral disease characterized by fever, bilateral or unilateral parotid
swelling and tenderness and sometimes meningoencephalitis.
EPIDEMIOLOGY:
• Occurs in age group of 5-10 years.
• Transmitted by direct contact, droplet infection.
• Equally effects both gender.
PATHOGENESIS:
• Virus enters the cells of respiratory tract and multiply there.
• After last multiplication virus enter in blood and infect many tissues but salivary glands are
selectively affected.
• Edema and infiltration with lymphocytes in glands .
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DIAGNOSIS: DIFFERENTIALS:
• Leucopenia with lymphocytosis • Parotitis
• Culture via saliva, CSF, Blood, • Cervical adenitis
Urine • Tumor
• Immunoassays for igG and igM • Recurrent parotitis
antibodies
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Chickenpox
• Chickenpox is caused by Herpes Virus and varicella
zoster virus.
• After chickenpox immunity is lifelong.
• Incubation period is 14 to 15 days
• When a person recovers from chickenpox, virus
remains in the dorsal root(sensory) ganglion cells in
a latent state for decades. As immunity decreases
in late adulthood, the virus may reactivates and
causes dermatomal exanthem called shingles.
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PATHOGENESIS:
• Initial site of infection is the conjunctiva or upper respiratory tract.
• The virus then replicates for 4-6 days at a local site in the head and neck.
• Thus viremia occurs after some days.
• Virus is released in large amounts 1 week later after a second replication and invades the
cutaneous tissues.
• When the virus leaves the capillaries and enters the epidermis, vesicles of chickenpox appear on
skin.
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TRANSMISSION: COMPLICATIONS:
• Chickenpox is transmitted by droplets of This disease includes following infections i.e;
respiratory secretions. • BACTERIAL INFECTION
e.g staphylococcus aureus and streptococcus
• Varicella is contagious from 24-48 hours group A etc.
before the rash appears
• VIRAL SEQUELAE
e.g. pneumonitis(cough, dyspnea, cyanosis etc.
• PROGRESSIVE VERICELLA
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DIAGNOSIS: DIFFRENTIALS:
• Primarily by clinical examination. • Papular urticaria
• Leukocytosis is seen in secondary bacterial • Coxsackie virus
infections. • Impetigo
• Virus can be identified by obtaining vesicle • Scabies
fluid (cell culture)
• FAMA (florescent antibody to membrane
antigen) and ELISA(enzyme linked
immunosorbent assay) most reliable tests
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