Pediatric infectious diseases Vaccination programs Sallai gnes MD

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

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

Localizing symptoms • • • Skin Upper respiratory Lower respiratory Genitourinary Gastrointestinal CNS Skeletal

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

Characteristics in infants and children • Neonates, infants: non-specific initial symptoms (irritability, lethargy, poor

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

Group A Streptococcal infections • • Acute pharyngitis Impetigo Cellulitis Scarlat fever Pneumonia Septic

Group A Streptococcal infections • • Acute pharyngitis Impetigo Cellulitis Scarlat fever Pneumonia Septic arthritis Osteomyelitis Meningitis

Tonsillopharyngitis streptococcica • Treatment: Penicillin for 10 days • Other bacteria: S. aureus, H.

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

Complications • • Abscess of the cervical lymphnodes Peritonsillar abscess Sepsis Late: rheumatic fever,

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

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

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

Scarlet fever • Skin: diffusely erythematous („sandpaper rash) • Petechiae on the soft palate,

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

Erysipelas • Superficial inflammation of the skin – • • acute cellulitis and lymphangitis

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

Impetigo • Papule, vesiculation, then it breaks • Denuded area, covered by a honeycolored

Impetigo • Papule, vesiculation, then it breaks • Denuded area, covered by a honeycolored crust

Cellulitis (phlegmone) • Inflammation of the subcutaneous connective tissue – may lead to abscess

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

Infectious diseases with rash • Stadium incubationis: in general no symptom • Stadium prodromum:

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

Measles (Rubeola) • Paramyxovirus, RNA virus • Rash: retroauricular, temporal region, then on the

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

Rubella • Togavirus, RNA • maculopapular rash • Painful lymphadenopathy: – retroauricular, cervical, occipital

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

Congenital rubella syndrome • Infection of seronegative mother during pregnancy • Risk of fetal

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!

Congenital rubella syndrome • Gestation – 14 -60. days: embryopathy – cataracta, microphthalmia, hearing

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

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

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

Varicella (chickenpox)

Varicella (chickenpox)

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

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

Varicella (toxic)

Varicella (toxic)

Infectious mononucleosis (Epstein-Barr virus infection)

Infectious mononucleosis (Epstein-Barr virus infection)

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

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

Infectious mononucleosis

Infectious mononucleosis

Lyme disease (Borrelia Burgdorferi, erythema chronicum migrans)

Lyme disease (Borrelia Burgdorferi, erythema chronicum migrans)

Immunization schedule Hungary - 2016 • • • BCG DTPa+IPV+Hib+PCV MMR DTPa+IPV+Hib DTPa+IPV MMR

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

Types of vaccines • Live attenuated viruses (measles, mumps, rubella, varicella, polio) • Inactivated

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)

Non-mandatory vaccines (but recommended) • Polysaccharid vaccines – Meningococcus A, B, C, W-135, Y

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)

Antibiotic prophylaxis to prevent endocarditis I. • For all patients with significant cong. heart

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

Antibiotic prophylaxis to prevent endocarditis II. • During dental / respiratory procedures : oral

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

Oral-dental procedures requiring endocarditis prophylaxis • • • Extractions Periodontal procedures Dental implant placement

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

Kawasaki disease (Multisystem vasculitis)

Kawasaki disease (Multisystem vasculitis)

Tetanus (Clostridium tetani exotoxins)

Tetanus (Clostridium tetani exotoxins)

AIDS • Occurrence is rare in children • 80% intrauterine, intra partum, breast feeding,

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%

AIDS / clinical forms • Rapidly progressing: intrauterine infection • Repeated, severe infections with

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!

AIDS / clinical forms • Slowly progressing form: intra partum, post partum infection •

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%

AIDS / prevention • Antiviral treatment of infected mother during pregnancy • Isolation of

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