childhood infections Flashcards
are congenital (infection in utero) infections common?
no, rare
what infections are most risky as congenital infections?
syphilis
rubella
CMV
if mother is infected during pregnancy
what infections do we look for when worried about birth related/vertical infections from mom?
(are uncommon)
HIV HSV hep B GBS gonococcal chlamydial conjunctivitis
maternal immunity may modify outcome
why do we care about congenital rubella
cataracts are common aftermath
retinal and cerebral damage is often severe
can cause congenital heart malformations
CRS now rare with rubella vaccination
why do we care about congenital CMV infection
features include enlarged liver, spleen, petechial rash, thrombocytopenia, brain injury, retinitis and deafness
consequence of primary maternal infection in early gestation
why do the first 6 months of life post low infection risk?
what are the exceptions to this?
thanks to protection from maternal antibodies
exceptions–> pertussis, RVS
why do we care about pertussis in infancy?
high rate of hospital adission
features include apnea, pneumonitis, tussive vomiting with malnutrition, seizures and encephalitis
significant mortality
when is the pertussis vaccine given in infancy?
2, 4, 6 and 18 months of age
gives 90% protection
protection gradually wanes
boosters restore protection at kindergarten which extends to adolescence
another booster in grade 9 extends protection into early adulthood when it wanes again
what population is the main reservoir of pertussis disease?
adults (main reservoir of mild disease) who spread infection to under vaccinated children
when is RSV bronchiolitis most common?
early infancy
what is RSV bronchiolitis?
wheezy bronchitis from narrowing of tiny airways
risk of pneumonia
recurrences occur in later infancy and in childhood, milder
when is the highest risk for invasive bacterial infections? what infections?
ages 6-24 months.. period of “first encounters”
i.e H. influenzae, pneumococcus, meningococcus and others
now greatly reduced by vaccines
also rotavirus gastroenteritis is nearly universal without vaccination
social mixing increases risk for colds and exanthems (roseola)
what are the characteristics of invasive bacteria?
peak incidence rate in early childhood
normally colonize NP without disease
colonized individuals spread organism to others (only small % get sick)
colonization lasts weeks to months and stimulates immunity (specific antibody)
high rate of natural immunity by adulthood
viral URT infection during colonization increases the risk of invasion
why do we care about HIB meningitis
affected 1 in 500 kids by age 5
leading cause of acquired deafness and mental retardation (in 20% of survivors)
mortality rate 5%
which diseases of childhood have a conjugate vaccine available?
conjugate vaccines are the basis of control of HiB, pneumococcal (13 valent) and meningococcal infections
pending for GBS
how does rotavirus gastroenteritis present?
nearly universal
begins with explosive vomiting for 1-2 days
evolves to profuse, watery diarrhea
risk for dehydration
parenting challenge, best avoided by vaccination
what are signs of dehydration on exam?
sunken fontanelle
new or no tears
sunken eyes and cheeks
sunken abdomen
decreased skin turgor
dry mouth or tongue
what is roseola infantum
caused by HHV6
nearly universal in the first two years
begins as high fever often 40C, lasts 2-3 days
as fever breaks, rash appears, child is happy
describe the rash of roseola infantum
pink, macular, variable, truncal
“baby measles”
how many viral URTIs are normal in preschool kids per year
about 6-10 per year –risk for pna
goes down to 4-5/year in school years
what is the number 1 reason for abx prescriptions in childhood
middle ear infections
what is the most common age group for high fevers and febrile convulsions
preschoolers
what is the rate of influenza infection in the school years
about 20% annually
low risk for invasive infections
what is a common exanthem in school years
parvovirus (slapped cheek rash)
the risks of what infections go up in the teen years?
EBV (infectious mono)
STI, HIV, HAV, HBV–behavioural risks
dorm risks–meningococcal, GAS
what vaccines should teens have?
catch up for MMR, hep B
HPV vaccination to avoid later cancers
TdaP booster to extend protection into adulthood
meningococcal vaccine
influenza vaccine for those with “high risk” health conditions
symptoms of EBV/infectious mono
fever
fatigue
sore throat
swollen lymph glands
