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Pediatric infectious diseases. Vaccination programs

Pediatric infectious diseases. Vaccination programs. Prof. Dr. György Fekete. Localizing symptoms. Skin Upper respiratory Lower respiratory Genitourinary Gastrointestinal CNS Skeletal Cardiovascular Hepatic. Characteristics in infants and children.

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Pediatric infectious diseases. Vaccination programs

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  1. Pediatric infectious diseases. Vaccination programs Prof. Dr. György Fekete

  2. Localizing symptoms • Skin • Upper respiratory • Lower respiratory • Genitourinary • Gastrointestinal • CNS • Skeletal • Cardiovascular • Hepatic

  3. Characteristics in infants and children • Neonates, infants: non-specific initial symptoms (irritability, lethargy, poor feeding) • Specific rashes • Sites of infection • Prevention: vaccination/ immunization

  4. Group A Streptococcal infections • Acutepharyngitis • Otitismedia • Paranasalsinusitis • Impetigo, pyoderma • Cellulitis • Scarlatfever • Pneumonia • Septicarthritis • Osteomyelitis • Meningitis

  5. Streptococcaltonsillopharyngitis • 5- 15 years • Beta –haemolysingStreptococcusspp. • Otherbacteria: S. aureus, H. influenzaepositiveresultsinthroatmicrobiologicalculturesarenotpathogenic. Antibiotictreatment is notnecessary! • Aminopenicillinantibioticsarenotrecommended –possibleinfectiousmononucleosis

  6. Tonsillopharyngitisstreptococcica Diagnosis: microbiology (sensitivity: 90 -95%), streptococcalantigen test (specificity: >95%) Treatment: oral Penicillin, 10 days

  7. Complications • Abscess of the cervical lymphnodes • Peritonsillar abscess • Sepsis • Late: rheumatic fever, acute diffuse glomerulonephritis

  8. Scarletfever(Group A Streptococcus, erythrogenic toxin, /pyrogenicexotoxin/, finepapularrash)

  9. Scarlet fever • Incubationperiod: 1 – 4 days • Skin: diffuselyerythematous („sandpaperrash): confluentmaculo-papulous – 6 – 9 days • Petechiaeonthesoftpalate, ontheupperabdomen and trunk • Circumoralpallor • Desquamation (peeling) ontheface: end of thefirstweek, thengeneralized • Strawberrytongue

  10. Scarletfever

  11. Scarletfever

  12. Scarletfever Abdominalpain, vomiting Treatment: oral Penicillin, 10 days

  13. Kawasaki disease(Multisystemvasculitis)

  14. Kawasaki disease Coronaryaneurism / dilatation < 5 years, incidence: 3 – 6:100 000 Fever,non – suppurativeconjunctivitis, cheilitis, strawberrytongue, polymorphicrash, pharyngitis, lymphadenopathy, peelingontheextremities Treatment: highdose IVIG (2 g/kg bw.) + aspirin (80-100 mg/kg bw.)

  15. Erysipelas • Superficial and deepinflammation of theskin, demarkatedrash • Invasiveinfection • Streptococcuspyogenes, Staphylococcusaureus • Complication/ infants: sepsis • Treatment: penicillin, clindamycin

  16. Erysipelas(Group A Streptococcus, acute cellulitis and lymphangitis)

  17. Impetigo • Papule, vesiculation, then it breaks • Denuded area, covered by a honey- colored crust

  18. Impetigo 2 – 5 years Streptococcuspyogenes Staphylococcusaureus Local treatment Systemic: antibiotictherapy

  19. Cellulitis (phlegmone) • Inflammation of the subcutaneous connective tissue – may lead to abscess • Streptococcus pyogenes, Staphylococcus aureus, Haemophilus influenzae (<2 yrs) • Therapy: penicillin+ clindamycin

  20. Infectious diseases with rash • Stadium incubationis: in general- no symptom • Stadium prodromum: non-specific symptoms • Stadium floritionis

  21. Measles (Rubeola) • Paramyxovirus, RNA virus • 10-14 daysincubation • Rash: retroauricular, temporalregion, thenontheface - maculo-papulousexanthemes • Complications: encephalitis, cerebellitis, subacutesclerotizingpanencephalitis

  22. Measles (Rubeola)(RNA virus, maculopapulousrash, Koplikspots)

  23. Measles (Rubeola)

  24. Rubella (Germanmeasles) • Togavirus, RNA • Painful lymphadenopathy: retroauricular, cervical, occipital region: Theodor- Klatsch symptom • Peeling • Congenital rubella syndrome

  25. Rubella (Germanmeasles)(RNA virus, Togaviridae – Rubivirus,maculopapularrash, occipitallymphadenopathy)

  26. Congenital rubella syndrome • Infection of seronegative mother during pregnancy • Risk of fetal infection • I. trimenon: 75-90% • II. trimenon: 20-40% • III.trimenon: 25-50% • Fetal lesion • 1-8. gest. week: 80% • 9-12. gest. week: 30% • 13-20. gest. week: 10%

  27. Congenital rubella syndrome • Gestation • 14- 60. days: embryopathy – cataracta, microphthalmia, hearingloss, congenitalheartdisease, microcephalus, thymushypoplasia Rubellavaccination is prohibitedduringpregnancy!

  28. Roseola (exanthema subitum)(Human Herpesvirus-6, maculopapular rash)

  29. Varicella (chickenpox)

  30. Varicella (chickenpox)(Varicella-Zostervirus/HHV -3, vesicles)

  31. Varicella (chickenpox) Incubationperiod: 10 – 21 days (14-15 days) Complications: secondarybacterialinfection – streptococcaltoxicshocksyndrome Pneumonitis

  32. Progressivevaricella (toxic)Treatment: aciclovir

  33. Infectiousmononucleosis (Epstein-Barrvirusinfection, CMV, adenovirus, toxoplasma)

  34. Infectiousmononucleosis Incubationperiod: 4 – 8 weeks Incidence: <10 years: <1:1000 10 – 19 years: 6 -8 :1000 Fever, lymphadenopathy,pharyngitis Hepato –splenomegaly Jaundice Rash Atypiclymphocytes

  35. Infectious mononucleosis(Epstein-Barr virus, enanthema=pharyngeal petechiae)

  36. Infectious mononucleosis

  37. Lyme disease(Borrelia Burgdorferi, erythema chronicum migrans)

  38. Lyme borreliosis Skin, joints,CNS, heart Erythemamigrans – regionallymphadenopathy Treatment: oraldoxycyclin, amoxicillin, cefuroxim-axetil 10days Ceftriaxoniv.

  39. Tetanus(Clostridium tetani exotoxins)

  40. AIDS • Occurrence is rare in children • 80% intrauterine, intra partum, breast feeding, 10- 15% blood and blood products, 5% unknown origin • Risk of children of HIV infected mother: 20-40%

  41. AIDS/ clinical forms • Slowly progressing form: intra partum, post partum infection • Frequent and severe infections after latency (1-2 yrs) • Lymphoid interstitial pneumonitis, hypergammaglobulinemia • Death before the age of 6 yrs in 60%

  42. AIDS / prevention • Antiviral treatment of infected mother during pregnancy • Isolation of newborn baby from infected mother • No breast feeding • BCG vaccination is prohibited!

  43. AIDS / clinical forms • Rapidly progressing: intrauterine infection • Repeated,severe infections with classical and opportunistic pathogens (Pneumocystis carinii, Cryptosporidium, Candida, HSV, EBV, CMV) • Failure to thrive,enlargement of parotid gland, lymphadenopathy, cortical atropy, demyelinisation of the brain, death at the age of 3 yrs • BCG sepsis!

  44. Immunizationschedule/ Hungary • BCG Birth • Hepatitis B1 12yr • H.infl. Typ b 2,3,4,18 mo • DTP+IPV 2,3,4,18 mo, 6yr • PCV13 x 2,4,12 mo • MMR 15 mo, 12 yr • HPV 12, 13 yr /females/ • Recommended: varicella, hepatitis A • X = pneumococcalconjugatevaccine European Centre forDiseasePrevention and Control

  45. Immunizationschedule/ Norway • (BCG)Birth • Rotavirus 6w, 3mo • (Hepatitis B1) Birth • H.infl. Typ b 3,5,12 mo • DTP+IPV 3,5,12 mo, 7yr, 15 yr • PCV13 x 3,5,12 mo • MMR 15 mo, 11 yr • HPV 12yr /females/ • X = pneumococcalconjugatevaccine • European Centre forDiseasePrevention and Control

  46. Types of vaccines • Live attenuated viruses (measles, mumps, rubella, varicella, polio) • Inactivated viruses (polio, hepatitis B, influenza) • Inactivated bacteria (pertussis, diphtheria, tetanus, H. influenzae type b, pneumococcus)

  47. Non- mandatory vaccines • Polysaccharidvaccines • Meningococcus A, C, W-135, Y serotypes • Pneumococcus, 13, 23 serotypes, 7 serotypes • Hepatitis- A, A+B • Human papillomavirus (HPV) • Influenza • Tick - borneencephalitis • Rotavirus • Chickenpox (varicella) • RSV

  48. Dental Procedures and Infective Endocarditis Infective endocarditis (IE), or bacterial endocarditis (BE), is an infection caused by bacteria that enter the bloodstream and settle in the heart lining, a heart valve or a blood vessel

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