·
FIRST DISEASE :
---> Measles.
·
Herpes gladiatorum is a term
used to describe ocular and cutaneous infection with herpes simplex virus type
1, which occurs in wrestlers and rugby players. The infection is
transmitted primarily by direct skin-to-skin contact and is endemic among
high-school and college wrestlers
SECOND DISEASE : ---> Scarlet Fever.
THIRD DISEASE :---> Rubella or German Measles.
FOURTH DISEASE :---> Duke's Disease
FIFTH DISEASE :---> Erythema Infectiosum caused by
Parvovirus B19
SIXTH DISEASE :---> Exanthem Subitum / Roseola
Infantum (HHV-6)(HHV-7 also mentioned)
( The terms "fourth disease" and "Dukes'
disease" are rarely used today.)
·
Salmonella is by far the most common cause of febrile gastroenteritis in early infancy. Campylobacter is second in frequency to Salmonella
as a bacterial cause of enteritis in infancy. Yersinia is a rare
cause. Shigellosis is a disease that is rare in infancy but common in the 1- to
3-yr-old child. Rotavirus rarely (or never) causes
bloody diarrhea.
·
A mean
bactericidal concentration (MBC) > 4 times the minimum
inhibitory concentration (MIC) defines bacterial
tolerance.
·
Antipyretic therapy is
directly beneficial in high-risk patients who have chronic
cardiopulmonary diseases, metabolic disorders, or neurologic diseases.
·
Periodic fever is used to
narrowly describe fever syndromes with a regular periodicity, such as cyclic neutropenia, and the syndrome of periodic
fever, aphthous stomatitis, pharyngitis, and adenopathy (PFAPA).
·
Temperatures in excess of 41°C are most often associated
with a noninfectious cause. Causes of very high temperatures (>41°C) include
central fever (resulting from central nervous
system dysfunction involving the hypothalamus), malignant hyperthermia,
malignant neuroleptic syndrome, drug fever, or heatstroke.
·
Occult bacteremia (bacteremia
without an obvious focus of infection) due to Streptococcus pneumoniae, H. influenza
type b, N. meningitidis, or nontyphoidal Salmonella occurs in
approximately 4% of relatively well-appearing children between 3 and 36 mo of
age with fever (rectal temperature >38.0°C). S.
pneumonia accounts for 90% of
cases of occult bacteremia.
·
Fever
of unknown origin is sometimes due to hypothalamic dysfunction. A clue to this disorder is failure of papillary constriction
due to absence of the sphincter constrictor muscle of the eye. This muscle
develops embryologically when the hypothalamus is also undergoing
differentiation.
·
Focal seizures in a febrile neonate with evidence of systemic shock and
hepatic dysfunction suggest the possibility of systemic herpes simplex virus
infection.
·
Toxic shock syndrome and Kawasaki disease share many features, but Kawasaki disease is
not accompanied by hypotension and shock. Kawasaki disease also
typically occurs in children younger than 5 yr. Toxic shock syndrome can
complicate focal infections caused by TSST-1-producing strains of Staphylococcus
aureus.
·
The classic
rash of scarlet fever has a texture
of gooseflesh or coarse sandpaper. Pastia lines are
areas of hyperpigmentation that do not blanch with pressure that may appear in
creases, particularly in the antecubital fossae. White strawberry
tongue is characteristic of the early illness; as the white coat desquamates,
the red strawberry tongue persists. Skin desquamation begins toward the end of
the first week of illness. Preauricular lymphadenopathy
is not typical.
·
Listeria isolates are usually sensitive to penicillin, ampicillin,
erythromycin, and tetracycline but are not
susceptible to the cephalosporins, including the third-generation
cephalosporins. The addition of an aminoglycoside (e.g., gentamicin)
lowers the minimum bactericidal concentration.
·
Nocardia infection
is characterized by remissions and exacerbations.
·
Chemoprophylaxis for contacts
of a person with proven or suspected N.
meningitidis infection is indicated for all household, daycare, and
nursery care contacts. The index patient should also receive rifampin prophylaxis if penicillin was used for
treatment.
Same way,Chemoprophylaxis for contacts of a person
with proven H. influenzae type b infection is indicated if the close contact
group includes one or more children younger than 48 mo of age who are not fully
immunized; under these circumstances, rifampin
prophylaxis is indicated for all members of the close contact group, including
the index patient.
·
Nonsuppurative complications of meningococcal disease appear to be immune complex-mediated and become apparent 4-9 days
after the onset of illness. Arthritis and cutaneous
vasculitis (erythema nodosum) are most common.
·
Pertussis is a "family" disease with various
degrees of symptoms and colonization. After diagnosis of pertussis in a
toddler, erythromycin should be given to the patient and to All family members regardless of age, symptoms, or immunization
status.
·
A 7- to
10-fold relative risk for infantile hypertrophic pyloric stenosis (IHPS) has been reported in infants younger than 6 wk
of age treated with orally administered erythromycin.
The highest risk appears to be in the first 2 wk of life in term infants, and
with courses of 14 days or longer. The risk of IHPS after treatment with azithromycin
or clarithromycin is unknown.
·
Only Shigella dysenteriae serotype
1 and certain Shiga toxin-producing E. coli (STEC) commonly produce significant amounts of
Shiga toxin and cause hemolytic-uremic syndrome.
·
STEC
organisms represent a particularly difficult therapeutic dilemma; antibiotic
treatment can induce toxin production and phage-mediated bacterial lysis with
toxin release. Current data suggest that antibiotics should not be given
for STEC infection because they may increase the risk for HUS.
·
Many patients
affected by Y. pseudotuberculosis do not have diarrhea, and thus a stool culture is
not even considered as part of the diagnostic evaluation. If the extent of
infection is limited to the mesenteric lymph nodes, the stool culture results
may be negative.
·
The unusually
severe lymph node tenderness, especially in
the presence of systemic toxicity, distinguishes bubonic plague caused by Y. pestis from the typical
lymphadenopathy associated with cat-scratch disease or tularemia.
·
Mucoid strains of P. aeruginosa
are common in persons with cystic fibrosis,
causing insidious but progressive respiratory deterioration, but are rarely
encountered in other persons. B. cepacia is
an opportunist that rarely infects immunocompetent persons but is common in
persons with cystic fibrosis and causes an acute respiratory syndrome with
fever, leukocytosis, and progressive respiratory failure.
·
Because of
the difficulty in culture techniques and the inconsistency of seroconversion, the urinary antigen test for Legionella is a useful
method in the prompt diagnosis of Legionella infection.
·
The oculoglandular syndrome (conjunctivitis, lymph
node) is the most frequent atypical manifestation of cat-scratch disease. Fever occurs in only 30% of cases of cat-scratch disease.
·
The first and
essential step in treatment of Clostridium
difficile-associated diarrhea is the discontinuation
of the current antibiotics, if at all possible. In most instances this
course combined with appropriate fluid and electrolyte replacement is
sufficient. C.difficile is frequently isolated from
the stool of healthy infants. The interpretation of a positive stool
culture or toxin requires clinical correlation. Treatment
would not be indicated for an asymptomatic infant.
·
Pulmonary
tuberculosis is best confirmed by culture and isolation of M. tuberculosis. The
best culture specimen in young children is three consecutive early-morning
gastric aspirates obtained before the child has arisen and before peristalsis
has emptied the stomach contents. The yield is
approximately 50%, but the yield from bronchoscopy is even lower.
Negative cultures never exclude the diagnosis of tuberculosis.
·
There is
limited cross-reactivity of the treponemal test
(MHA-TP, FTA-ABS) material with other spirochetes, esp. Borrelia burgdorferi, the causative organism
of Lyme disease.
·
Periostitis, occurring in the
long bones, is most typical of congenital syphilis.
Osteochondritis is a common finding
in congenital cytomegalovirus, rubella, and
syphilis infections.
·
A biphasic course is characteristic of icteric
leptospirosis (Weil syndrome).
Hepatorenal dysfunction follows anicteric leptospirosis in less than 10% of
cases.
·
Doxycycline (for 14-21 days)
is the treatment of choice for Lyme
borreliosis in children older than 8 yr of age, but amoxicillin
(for 14-21 days) is the treatment of choice in children younger than 8 yr. Where effective
alternatives are available, children younger than 8 yr should not be treated
with doxycycline because it may cause permanent discoloration of the teeth.
Erythromycin is an alternative for persons who cannot take either doxycycline
or amoxicillin.
Paralysis of the facial (7th) cranial
nerve is relatively common in children with Lyme disease and may be the initial
or the only manifestation of infection. The paralysis usually lasts 2 to 8 wk and resolves completely in most
cases. There is no evidence that the clinical course of the facial palsy with
Lyme disease is affected by antimicrobial treatment
·
C. trachomatis pneumonia is
characterized by insidious onset of persistent cough and tachypnea, with the
notable absence of fever. Rales are common, but wheezes are uncommon, which helps
distinguish C. trachomatis from RSV pneumonia.
·
Chloramphenicol
and tetracyclines have proven efficacy against
Rocky Mountain spotted fever, but chloramphenicol
may be associated with higher mortality.
Dental staining is unlikely with a single course of a tetracycline. Doxycycline is recommended because the risk of
dental staining is less than with other tetracyclines.
·
Catheter-related infections and fungemia with Malassezia furfur
occur almost exclusively in patients receiving intravenous lipids.
The use of lipid emulsions containing medium-chain triglycerides inhibits the
growth of Malassezia.
·
Sporothrix thrives in decaying vegetation but also can be transmitted by
bites and scratches of animals, most frequently cats
and armadillos.
·
Hand, foot, and mouth disease caused by enterovirus 71 is frequently more
severe than that due to coxsackievirus A16, with high rates of associated neurologic disease including aseptic
meningitis, encephalitis, and paralysis.
·
Resistant HSV: Foscarnet
·
The
IgM-VCA is the best single test to identify acute EBV infection.
·
Sensorineural hearing loss is a risk after asymptomatic congenital CMV
infection. The incidence of
neonatal CMV-positive urine is much greater than the incidence of symptomatic
neonatal CMV inclusion disease (e.g., microencephaly, retinitis, being small
for gestational age, petechiae).
·
The incidence
of congenital CMV infection ranges from 0.2 to 2.4% of all live births, with
the higher rates among populations with a lower economic standard of living. The risk for fetal infection is greatest with maternal
primary CMV infection (30%) and much lower with recurrent infection (<1%).
·
The generally
benign nature of roseola precludes consideration of antiviral therapy. Although HHV-6 is inhibited by ganciclovir, cidofovir,
and foscarnet (but not acyclovir), the clinical efficacy and
benefit of antiviral therapy for roseola has not been established.
·
RSV-IVIG
is contraindicated and palivizumab is not recommended for infants with cyanotic
heart disease. In studies of RSV-IVIG
given for prophylaxis, mortality is higher in treated patients with heart
disease.
·
ICAM-1 is present on the
epithelium covering the lymphoepithelium of the adenoids and other epithelial
cells of the nose and is the cell receptor for most
rhinoviruses.
·
HIV gp120 has significant heterogeneity among HIV strains, which
is one reason for the difficulty in developing an effective HIV vaccine.
·
Serologic
diagnosis of HIV infection by ELISA and Western immunoblot analysis is reliable
only after 18 mo of age.
Before this age, residual maternal antibodies acquired transplacentally may be
responsible for the positive serologic test results.
·
All infants 6 wk to 1 yr of age born to HIV-infected mothers should receive
prophylaxis for P. carinii regardless of CD4 cell count and percentage. After 12 mo of age, prophylaxis is prescribed
according to the CD4 cell count and percentage.
·
HTLV-I is prevalent in Japan
and the Caribbean, where breast-feeding is a
major mode of transmission.
·
Naegleria organisms are found
in many freshwater sources, including ponds, lakes, and stagnant pools. It
occurs most commonly in previously healthy children and adults. Therapy is
often difficult, and morbidity and mortality are high.
The clinical manifestations and course of Acanthamoeba and Balamuthia
infection of the central nervous system are similar. Most patients with
Acanthamoeba are immunocompromised, in contrast to Balamuthia infection.
·
All persons with Entamoeba histolytica trophozoites or cysts in their
stools should be treated, whether they have symptoms or not.
·
Cryptosporidium is prevalent
in developing countries and in children younger than 2 yr of age. It causes
watery, nonbloody diarrhea that is usually
self-limited but may persist for several weeks. Because illness is self-limited
in immunocompetent persons, no specific therapy is required. Treatment of
immunocompromised persons is with paromomycin, with
or without azithromycin.
·
The
combination of clindamycin (20-40
mg/kg/day divided tid PO) and quinine
(25 mg/kg/day divided tid PO) for 7 to 10 days is the therapy of choice for babesiosis in children.
·
Congenital toxoplasmosis is
associated with organ dysfunction, inflammation, growth retardation,
thrombocytopenia, hepatitis, retinitis, and microcephaly, but not with true congenital anomalies like such as cleft
palate or patent ductus arteriosus.
·
Most persons are infected with P. carinii before 4 yr of age. Most primary infections in immunocompetent
persons are asymptomatic.
·
The
recommended treatment regimen for pinworms
(Enterobius vermicularis) is mebendazole,
100 mg orally, with a repeat dose in 2 wk. An alternative treatment is
albendazole, 400 mg orally, with a repeat dose in 2 wk.
·
Hydatid disease (echinococcosis) does not respond to praziquantel, probably due to failure to penetrate the liver
cyst. Except for Fasciola hepatica, all other trematode and cestode infections (flukes and
tapeworms) will respond to praziquantel.
·
Preterm infants, including
those of very low birthweight, should be vaccinated
at the same chronological age as for full-term infants and according to
the routine childhood immunization schedule. One exception
to this recommendation is hepatitis B vaccination of those born of
HBsAg-negative mothers with low birthweights (i.e., <2 kg). Initiation of
vaccination in this case should be delayed until the infant is 1 mo of age.
·
Upward
pressure applied to the angle of the mandible produces tenderness with mumps
(Hatchcock's sign); this maneuver
produces no tenderness with adenitis.
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