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Pediatric infectious diseases Vaccination programs

Pediatric infectious diseases Vaccination programs. Sallai Ágnes MD, Ph.D. 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. PediatricinfectiousdiseasesVaccinationprograms Sallai Ágnes MD, Ph.D.

  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 • Acute pharyngitis • Impetigo • Cellulitis • Scarlat fever • Pneumonia • Septic arthritis • Osteomyelitis • Meningitis

  5. Tonsillopharyngitis streptococcica • Treatment: Penicillin for 10 days • 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

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

  7. Scarlet fever(Group A Streptococcus, erythrogenic toxin, fine papular exanthem)

  8. Scarlet fever • Skin: diffusely erythematous („sandpaper rash) • Petechiae on the soft palate, on the upper abdomen and trunk • Circumoral pallor • Desquamation on the face: end of the first week, then generalized • Strawberry tongue

  9. Erysipelas • Superficial inflammation of the skin • acute cellulitis and lymphangitis • Streptococcus pyogenes, Staphylococcus aureus • Complication/ infants: sepsis

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

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

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

  13. Measles (Rubeola) • Paramyxovirus, RNA virus • Rash: retroauricular, temporal region, then on the face, spreads over most of the body in 24 hours - maculo-papulous exanthemes (Koplik spots on the buccal mucosa opposite the lower molars) • Complications: otitis media, interstitial pneumonia, encephalitis, cerebellitis, subacute sclerotizing panencephalitis

  14. Rubella • Togavirus, RNA • maculopapular rash • Painful lymphadenopathy: • retroauricular, cervical, occipital region: Theodor - Klatsch symptom • Peeling • Congenital rubella syndrome

  15. 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% • Rubella vaccination is prohibited during pregnancy!

  16. Congenital rubella syndrome • Gestation • 14-60. days: embryopathy – cataracta, microphthalmia, hearing loss, congenital heart disease, microcephalia, thymus hypoplasia

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

  18. Varicella (chickenpox)

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

  20. Varicella (toxic)

  21. Infectious mononucleosis (Epstein-Barr virus infection)

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

  23. Infectious mononucleosis

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

  25. Immunization scheduleHungary - 2016 • BCG Birth to 4 week • DTPa+IPV+Hib+PCV 2 mo • DTPa+IPV+Hib 3 mo • DTPa+IPV+Hib+PCV 4 mo • PCV 12 mo • MMR 15 mo • DTPa+IPV+Hib 18 mo • DTPa+IPV 6 yr • MMR 11 yr (6. school yr) • dTap 11 yr (6. school yr) • Hepatitis B 12 yr (7. school yr) PCV: pneumococcal conjugate vaccine , a: acellular, i: inactivated

  26. 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)

  27. Non-mandatory vaccines(but recommended) • Polysaccharid vaccines • Meningococcus A, B, C, W-135, Y serotypes • Hepatitis A, A+B • Human papillomavirus (HPV) – 12 yr (girls: 7. school yr) • Influenza • Tick - borne encephalitis • Rotavirus (from 6 weeks till 6-8 mo) • Chickenpox (varicella) - > 1 yr • RSV (premature babies)

  28. Antibiotic prophylaxis to prevent endocarditis I. • For all patients with significant cong. heart defect (unoperated, palliated or repaired) • Rheumatic valve lesions • Prosthetic heart valves • Mitral heart prolapse • Subaortic stenosis • Transvenous pacemaker leads • Previous endocarditis • NOT indicated: isolated secundum ASD, repaired sec. ASD and VSD 6 mo after patch placement, ligated PDA 6 mo after repair

  29. Antibiotic prophylaxis to prevent endocarditis II. • During dental / respiratory procedures : oral amoxicillin, 50 mg/kg 1 hr before • During gastrointestinal / genitourinary procedures: oral amoxicillin or parenteral ampicillin + gentamicin, iv. 30 min before • For patients allergic to penicillin: clindamycin, 20 mg/kg

  30. 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

  31. Kawasaki disease(Multisystem vasculitis)

  32. Tetanus(Clostridium tetani exotoxins)

  33. 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%

  34. 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!

  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!

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