Childhood Disease

Question 1

Why are children susceptible to infections?

Answer 1

• Not yet developed immunity to them
• Tend to gather in groups
• May have difficulty with some aspects of hygiene

Question 2

What are Febrile Convulsions?

Answer 2

Seizures occurring in children aged 6 months to 5 years associated with Fever without other underlying cause such as: CNS infection or electrolyte imbalance.

• Aural temperature should be >37.8 degrees C or clinical History or Examination should be indicative of Febrile Convulsion.

Most common causes:

• Viral infections
• Otitis Media
• Tonsilitis
• Gastroenteritis
• Post immunisation

A family history of febrile convulsion is common (24%). Febrile seizures recur in about 30% of children.

Occur in about 2-5% of children

Question 3

What is Rubella?

Answer 3

Symptoms:

• Mild fever
• Enlarged tender lymph nodes at the base of the skull, back of the neck and behind the ears.
• A fine pink rash that begins on the face & quickly spreads to trunk and then to arms & legs before disappearing in the same sequence.
• Aching joints especially in young women.

Caused by: Rubella virus

Pathogenesis:
The disease is transmitted via direct or droplet contact with respiratory secretions. Rubella virus multiplies in cells of the respiratory system; this is followed by viremic spread to target organs. Congenital infection is transmitted transplacentally

Diagnosed by: Serology

Treatment: Supportive

Prevention: MMR vaccine LIVE ATTENUATED

Question 4

What is Mumps?

Answer 4

Symptoms: Parotitis (parotid gland inflammation), Orchitis (Testicular inflammation), Pancreatitis.

Caused by: Paramyxoviridae (virus)

Pathogenesis: virus attaches to upper resp. tract epithelia and spreads to blood. Infects glandular tissue. –> inflammation & oedema.

Treatment:
Supportive care.

Prevention:
Vaccine - MMR LIVE ATTENUATED

Question 5

What is Whopping Cough?

Answer 5

Symptom: Whoop cough

Caused by: Bordetella pertussis

Pathogenesis:
Adheres to cilia of resp. epithelia.
Releases exotoxin - Pertussis toxin (AB5 extoxin); –> Binds to Gi G-protein –> Activates adenylate cyclase –> increased cAMP –> increased cellular activity.

Tracheal cytotoxin.

Develops cough to promote spread.

It is unknown how the toxin causes the paroxysmal cough.

Treatment: Erythromycin (early) and supportive care.

Prevention:
Vaccine - subunit type

Question 6

What is Measles?

Answer 6

Symptoms: Flu like
- Koplik spots rash (indicative)

Caused by: Paramyxoviridae
Morbillivirus

Pathogenesis: Infects, replicates, lyses repiratory epithelia, leading to viraemia. Then infects reticuloendthelial cells - returns to blood and spreads to mucosa, dermis, respiratory tract and brain.

Diagnosed by: Isolate virus through urine.

Treatment: High dose Vitamin A (infants)

Prevention:
Vaccine - MMR LIVE ATTENUATED

Question 7

What is Chicken Pox?

Answer 7

Symptoms:

• Fever
• Fatigue
• Loss of appetite
• Headache
• Nausea
• Malaise
• Macules appear on face then spread to body before turning into pustules.

Caused by: Varicella zoster virus. (VZV)

Pathogenesis:
Acquired through inhalation of airborne respiratory droplets from an infected host.
Inflammatory response then remains latent in the Dorsal root Ganglia of sensory nerves. Reactivion of VZV results in clinically distinct syndrome of Herpes Zoster (Shingles)

Complication:
Reactivation of Latent Virus - Shingles
- Reyes syndrome

Diagnosed by: Symptoms

Treatment: Supportive care

Prevention: Vaccine but it is not used.

Question 8

What is Scarlet Fever?

Answer 8

Symptoms:

• Sore throat
• Headache
• High temperature (>38.3C)
• Flushed face & swollen tongue - ‘strawberry tongue’
• Distinctive pink rash develops 12-48 hours later.

Caused by: Streptococcos pyogenes (AKA Group A streptococcus)

Pathogenesis:
Spread of strep throat occurs by close contact via respiratory droplets.
Streptococcous produce a pyrogenic exotoxin –> known as ‘superantigen’ exotoxins –> able to cause extensive immune response within the body.

Complications:
Early stage small risk of:
- Ear infection
- Throat abscess
- Sinusitis
- Pneumonia

V. Rare complications:

• Rheumatic fever
• Glomerulonephritis
• Liver damage
• Osteomyelitis
• Blood poisoning
• Necrotising fasciitis
• Toxic shock syndrome

Question 9

Strep B infections in pregnancy

Answer 9

Early onset
Fever
Difficulty feeding
Lethargy

Late onset
Difficultly breathing
Irritability 
Lethargy
Difficultly feeding

Adult
Asymptomatic
UTI, bacteraemia, pneumonia

Caused by
Group B streptococcus (GBS) strep. Agalactiae

Diagnosing
Swabs from vagina and rectum

Pathogenesis
Part of normal flora in GI and Urinary tract
Capsule coat which evades phagocytosis and produces beta hemolytic toxin that lyses RBC.
Colonises baby during delivery.
Main cause of neonatal meningitis

Treatment
IV antibiotics in infants - may need sepsis
Antibiotics for adults (adults)

Prevention
C section reduces risk
And start antibiotics to reduce risk