Pediatric infectious diseases. Vaccination programs

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. Erysipelas • Superficial inflammation of the skin • Streptococcus pyogenes, Staphylococcus aureus • Complication/ infants: sepsis

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

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

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

8. Measles (Rubeola, Morbilli, Nine- Day Measles) • Paramyxovirus, RNA virus • 7-14 days incubation, prodromal fever • Coryza, hacking cough, conjunctivitis • Koplik’s spots 2-4 days later • Rash: retroauricular, temporal region, then on the face - maculo-papulous exanthemes • Photophobia, high fever • Complications: bacterial super- infections,encephalitis, cerebellitis, subacute sclerotizing panencephalitis

9. Measles (RNA virus, macular rash, Koplik’s spots)

10. Koplik’s spots • Resembling tiny grains of white sand surrounded by inflammatory areolae • Buccal mucosa opposite the 1st and 2nd upper molars

11. Rubella (German Measles, Three-Day Measles) • Togavirus, RNA • 14-21 days incubation • Painful lymphadenopathy: retroauricular, cervical, occipital region: Theodor- Klatsch symptom • Peeling • Congenital rubella syndrome

12. Rubella(RNA virus, maculopapular rash, occipital lymphadenopathy)

13. 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%

14. Congenital rubella syndrome • Gestation • 14- 60. days: embryopathy – cataracta, microphthalmia, hearing loss, congenital heart disease, microcephalia, thymus hypoplasia Rubella vaccination is prohibited during pregnancy!

16. Roseola infantum (exanthema subitum)(Human Herpesvirus-6, high fever,maculopapular rash)

17. Chickenpox • Extremely contagious • 14-16 days incubation, communicability is possible from 10 to 21 days after exposure

18. Varicella (chickenpox)

19. Varicella (chickenpox)(Varicella-Zoster virus, vesicles, crusting)

20. Varicella (toxic)

21. Infectious mononucleosis (Epstein- Barr virus infection)

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

23. Infectious mononucleosis

24. Scarlat fever(Group A Streptococcus, erythrogenic toxin, fine papular exanthem, palmar/ plantar peeling)

25. Kawasaki disease(Multisystem vasculitis)

26. Mumps (Epidemic Parotitis) • Paramyxovirus, infected saliva • 14-21 days incubation • Headache, anorexia, malaise, fever • Pain on chewing or swallowing acidic liquids • Parotid and other salivary glands are tender, tissue edema • The oral duct openings of the glands are „pouting” and inflamed

27. Mumps

28. Tonsillopharyngitis streptococcica • Other bacteria: S. aureus, H. influenzae positive in throat microbiological cultures are not pathogenic. Antibiotic treatment is not necessary! • Aminopenicillin antibiotics are not recommended –possible infectious mononucleosis

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

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

31. Tetanus(Clostridium tetani exotoxins)

32. Tetanus • Neonatal: contamination of the umbilical cord • Muscle stiffness • Difficulty in swallowing • Pain • Trismus associated with tooth, peritonsillar, retropharyngeal abscess

33. Influenza Viral Infection • RNA orthomyxoviruses, types A, B, C • Young children: bronchiolitis, pneumonia, myositis • Secondary bacterial infection of the respiratory tract • Salicylates should be avoided (risk of Reye syndrome) • Th: oral oseltamivir (Tamiflu)

34. Human Immunodeficiency Virus Infection (AIDS) • RNA retroviruses • 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%

35. 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%

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

37. 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!

38. Immunization schedule • BCG Birth • Hepatitis B1 Birth to 2 mo 2 1 to 4 mo 3 6 to 18 mo • H.infl. Typ b 2,4,6 mo • DTP+IPV 3 mo • DTP+OPV 4,5 mo • MMR 15 mo, 6 yr (12 yr) • Recommended: varicella, hepatitis A, pneumococcal conjugate vaccine

39. 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)

40. Non- mandatory vaccines • Polysaccharid vaccines • Meningococcus A, C, W-135, Y serotypes • Pneumococcus, 23 serotypes, 7 serotypes • Hepatitis- A, A+B • Human papillomavirus (HPV) • Influenza • Tick - borne encephalitis • Rotavirus • Chickenpox (varicella) • RSV

41. Endocarditis prophylaxis • Antibiotic prophylaxis for dental procedures is now recommended only in patients with a prosthetic heart valve; previous IE; cyanotic congenital heart disease that is unrepaired, within 6 months of a repair procedure, or repaired but with residual defect at or near the location of prosthetic material; or in cardiac transplant recipients with cardiac valvulopathy

42. Antibiotic prophylaxis to prevent endocarditis • During dental / respiratory procedures : oral amoxicillin, 50 mg/kg 1 hr before • For patients allergic to penicillin: clindamycin, 20 mg/kg

43. Oral-dental procedures requiring endocarditis prophylaxis • Extractions • Periodontal procedures • Dental implant placement • Root canal surgery beyond the apex • Subgingival placement of orthodontic bands but not brackets • Prophylactic cleaning of teeth / bleeding is anticipated • Intraligamentary local anesthetic injections

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