Lecture2 Pediatrics Medwise Infections Final

Pediatrics
DR. AHMED YASINI

Lecture 2: Infections
• TORCH infections:-
• Toxoplasmosis
Toxoplasmosis
✓"cat litter"
✓ Food containing cyst (not cat fleas
containing larvae)
Toxoplasmosis
Maternal Sx:
✓ Usually asymptomatic
✓ (mild , flu-like sx).
Neonatal Sx:
✓ Chorioretinitis
✓ Hydrocephalus
✓Intracranial calcifications
✓Ct with enhanced lesions
Toxoplasmosis
Treatment.
✓ Pyrimethamine and sulfadiazine are used to
treat a known infection.
✓ Spiramycin is used to prevent vertical
transmission from the mother to the fetus.
Rubella
✓ Blueberry muffin spots
✓ PDA
✓ Congenital hearing loss
✓ Cataracts
CMV (cytomegalovirus)
✓90% subclinical infections

✓ ( no symptoms)
✓Congenital hearing loss
✓Hepatosplenomegaly
✓ Thrombocytopenia
✓ Periventricular calcification
✓Tx. Ganciclovir
Syphilis :-
rash (palm and skin)

✓Hutchinson teeth
✓Saddle nose
Lyme disease
Caused by Borellia burgdoferi

Can cause:-
Early
erythema migrans 3–32 days after
bite at site of the bite
Uveitis, Bell palsy, myocarditis,
heart block, meningitis
Late
Arthritis : weeks to months
later affecting large joints
Lyme disease
Dx. ELISA
Treatment:
✓Early: Doxycycline 14–21 days (patients >8
years old);
✓amoxicillin (patients age < 8 years).
✓Ceftriaxone with meningitis or carditis (heart
block 3 deg.)
✓Doxycycline or amoxicillin with Bell palsy
Rocky mountain spotted
fever RMSF
• Caused by rickettsia with a tick bite
clinical
✓ Extremities first
✓ Rash (palm and soles)
✓ Hepatosplenomegaly
✓ CNS: delirium, coma, and other neurologic
findings
✓ Myocarditis, acute renal failure, pneumonitis,
shock
Tx. Doxycycline regardless of age
Rocky mountain spotted fever
RMSF
Rocky mountain spotted fever
RMSF
Pertussis "Whooping
cough"
Pertussis "Whooping cough"
✓ Caused by Bordetella pertussis with lymphocytes
✓ Cough then vomiting/ rib fracture
✓ Most common complication – pneumonia Not immunized
child
prevention
✓ All close contacts should receive prophylactic antibiotics
for 5 days
✓ (azithromycin) or 7 to 14 days (clarithromycin)
✓ Underimmunized close contacts should receive a booster
dose of vaccination.
✓ Active immunity is acquired with “DTaP”.
Pertussis "Whooping
cough"
Tx. Azithromycin, clarithromycin, or
erythromycin are recommended for children
under 1 month of age.
✓In neonates Erythromycin should be avoided

due to the development of pyloric stenosis.
Cat scratch disease
✓ Caused by Bartonella henselae,

transmitted by cat flea
✓When the cat scratches/bites you
✓Most common cause of local lymphadenitis
✓Red tender papules+ chronic lymphadenitis
Tx. Supportive therapy, Azithromycin if severe/
immunosuppressed
Cryptococcus
neoformans
✓Fungal infection in HIV patients
✓Pneumonia is the most common presentation.
✓Encephalitis also occurs.
Neonatal Tetanus
✓Infants to unimmunized mothers
✓Poor obstetric procedures with umbilical
stump
✓Poor suckling, spasm, opisthotonus
Neonatal tetanus
MCC of Death in Tetanus = Respiratory arrest
Scarlet fever
✓Sandapaper like rash

✓Pharyngitis + strawberry tongue
Tx. Penicillin
Scarlet fever
Scarlet fever
Sandapaper like rash
Scarlet fever complications
Question
A 4 year old boy presents with fever up to 39c’ and

throat pain for 2 days. His examination reveals
pharyngitis, and the finding in the photo
Which of the following is the most common
complication of his likely disease?
A. Toxic shock syndrome

B. Bacterial meningitis
C. Acute encephalitis
D. Para pharyngeal abscess
E. Hemolytic uremic syndrome
Meningitis
Bacterial TB Viral
Cells PMN Lymphocytes Lymphocytes
Glucose Low (<40) Low (<10) Normal(>45)
Protein High High Normal/High

Meningitis
✓6 month and older
✓Most common cause of bacterial meningitis
Strep pneumonia
Except teens (11-19) – N. meningitis
Diagnosis :-
✓Evaluation of bacterial meningitis:
blood cultures>> no indication for CT ??>>
LP>>AB
Meningitis
Indications for CT scan include:
✓immunocompromised state
✓ previous central nervous system disease
✓ new-onset seizures, papilledema
✓ altered mental status, or focal neurologic
deficits.
Meningitis
Clinical Manifestations –
✓ Several days of fever, lethargy, irritability,
anorexia, nausea,vomiting
Then meningeal irritation (photophobia, neck
and back pain and rigidity
✓ Kernig sign positive
✓ Brudzinski sign positive
Meningitis
Prevention:-
✓Rifampin for All close contacts regardless of
age or immune status.
Meningitis
Meningitis
Complications
Most common sequelae is hearing loss
✓ Increased ICP with herniation and seizures.
✓Cranial nerve palsies, stroke, thrombosis of
dural venous sinuses
✓Subdural effusion, can cause seizures
✓Less common: mental retardation,
developmental delay, visual impairment
Meningitis
Viral (Aseptic) meningitis

✓ 90% are caused by enterovirus like echovirus and coxsackie viruses
✓ children with viral meningitis usually recover completely with supportive
treatment in 7-10 days
HSV:-
✓ focal progresses to coma and death
✓ temporal lobe involvement (seizure).
Complications:
✓ Guillain-Barré syndrome
✓ transverse myelitis
✓ hemiplegia
✓ cerebellar ataxia.
most common presentation of viral meningitis is =cerebellar ataxia and
acute encephalitis.
Meningitis
Use steroids for TB meningitis

VIRAL INFECTIONS
VIRAL INFECTIONS
*Measles "Rubeola"
Measles "Rubeola"
✓ Unimmunized child
Clinical :-
✓ 3C (Cough, Coryza, Conjuctivitis)
✓ Then Koplik spots
✓ Final Rash and fever
✓ Maculopapular rash 14 days after infection:
✓ Rash: macular; starts at head (nape of neck and behind ears) and
spreads downward
Complications:
✓ otitis media (most common)
✓ pneumonia
✓ encephalitis
Tx. Vitamin A
Measles "Rubeola"
Measles "Rubeola"
Measles "Rubeola
*Rubella
✓Retro-auricular, posterior/occipital
lymphadenopathy
✓PDA(murmur?)
✓pulmonary artery stenosis.
✓Cataract
✓Rash similar to measles
Rubella
*Roseola ( sixth disase )

✓Human herpes virus 6
✓peaks in children age <5 years.
✓usually 6–15 months
✓"fever then rash"
*Roseola ( sixth
disase )
*Roseola ( sixth
disase )
TX
✓Amniofusion (saline) to dilute meconium
and prevent cord compression.
✓After the head is delivered, suction of the

oropharynx- not done routinely.
✓After the body is delivered, laryngoscope-

not done routinely.
*Mumps
Clinical :-
✓ fever, headache, and malaise
✓Salivary gland swelling (parotitis) most common sx
✓Orchitis
Dx.
✓Detection of viral RNA PCR in clinical sample
Complications:-
Meningoencephalomyelitis most common complication
others include
pancreatitis, thyroiditis, myocarditis, deafness, and dacryoadenitis
✓Aseptic Meningitis occurs in <10% and usually
self-limited.
*Mumps
*Varicella
✓Rash in different stages

✓ "papules, vesides, pustules"
*Varicella
Adenovirus
Sx.
✓ Acute upper and lower respiratory infection.
✓ Fever
✓ Bilateral conjunctivitis
✓ Sore throat (pharyngitis)
✓ Cervical adenopathy.
Dx.
✓ Isolation of the virus in tissue culture by ELISA.
✓ PCR testing.
Adenovirus
Coxsackie A virus
✓Cause Herpangina
✓Fever, sore throat, odynophagia
✓Grayish- white papulovesicular lesion on
erythematous base.
Coxsackie A virus Herpangina
Coxsackie B virus
Coxsackie B virus
✓Causes viral myocarditis
✓Causes viral pericarditis
EBV
First human virus to be associated with

malignancy ?
✓ Infectious mononucleosis(90%)
✓ MC complication in Infectious mononucleosis -
Splenic Hemorrhage
sport? spleen?
✓ Rash after taking amoxicillin
✓ Blood smear: Atypical lymphocytes
✓ Monospot test
(Heterophile antibodies)
Erythema infectiosum
(fifth disease)
✓ Parvovirus B19
✓ Low-grade fever
✓ Facial (slapped – check ) rash.
✓ Few days later, a lacy, reticular rash may spread to
the extremetities.
Complications
✓ aplastic crisis in patients with hemolytic anemia
✓ hydrops fetalis in neonates during maternal infection
in first trimester.
Question?
6 years old child with spherocytosis present with 2 days
of fever and the findings presented in the photo his 10
years old sister had the same symptoms 2 weeks before
.Which of the following complications may appear in
this child ?
A. aplastic anemia -
B. hyperbilirubinemia
C. thrombocytosis
D. leukemia
E. lymphoma
shehzor (2020)
Otitis media (OM)
Examination of the ears is essential for

diagnosis and should be part of the physical
examination of any child with fever.
Etiology:
✓Both bacteria and viruses can cause OM.
Otitis media (OM)
✓ first 2 years (rhinovirus, RSV most often) Strep
Pneumonia
bacterial pathogens:
✓ Streptococcus pneumoniae
✓ Non-typable Haemophilus influenzae
✓ Moraxella catarrhalis,
Viruses :
✓ rhinoviruses, influenza, and respiratory syncytial virus
Dx.
✓ Pneumatic otoscopy :
✓ bulging tympanic membrane
✓ air fluid level
Otitis media (OM)
TX.
✓ Acetaminophen are recommended for fever.
✓ 1st line : Amoxicillin (80 to 90 mg/kg/day in two
divided doses)
✓ Persistent >3 days after amoxicillin give:
✓ high-dose amoxicillin-clavulanate (Augmentin).
✓ Ceftriaxone (IM)- especially for children >3
years with vomiting who cant take oral drugs.
✓ If don’t respond → Tympanocentesis.
Otitis media (OM)
OTITIS EXTERNA
known as swimmer’s ear

bacterial pathogens
✓ Pseudomonas aeruginosa -most common
✓ Staphylococcus aureus- second MC
Sx.
✓ Ear Pain, tenderness, and aural discharge.
✓ Fever is absent, and hearing is unaffected.
✓ Tenderness with movement of the pinna
TX.
✓ Topical antimicrobial/corticosteroid
✓ ciprofloxacin with hydrocortisone
OTITIS EXTERNA
pharyngitis
Bacterial Causes:
✓ Group A streptococci
Streptococcus pyogenes (most common)
viruses:
✓ Adenoviruses
✓ EBV
✓ enteroviruses (herpangina)
SX
Pharyngeal inflammation causes

✓ Cough
✓ sore throat
✓ dysphagia,
✓ fever
Conjunctivitis, cough, coryza, hoarseness, or ulcerations suggest a viral etiology
pharyngitis
TX
Streptococcal pharyngitis:
✓ Cephalosporins (cephalexin, cefadroxil) is more
effective than penicillin.
✓ amoxicillin-clavulanate (Augentin)
✓ Clindamycin
✓ Patients allergic to beta-lactams: erythromycin ,
azithromycin (azenil).
viral pharyngitis :
✓ supportive (fluids, analgesics).
pharyngitis
Rabies
✓Racoons, bats "caves", dogs

✓Presents with encephalitis, hydrophobia,
pharyngeal spasm
✓Pos- texposure prophylaxis with Rabies
immunoglobulin and Rabies vaccine is
important
✓Vaccine alone is given for pre-exposure
prophylaxis
Pinworms
✓Enterobius vermicularis
✓Nocturnal perianal itching
Dx.Scotch tape
Tx. Albendazole/ Mebendazole
✓ Pyrantel pamoate
Scabies
✓"Rashes in the webs of the fingers"
Tx. Permethrin, Ivermectin

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Pediatrics

DR. AHMED YASINI

✓90% subclinical infections

rash (palm and skin)

Caused by Borellia burgdoferi

✓In neonates Erythromycin should be avoided

✓ Caused by Bartonella henselae,

✓Sandapaper like rash

A 4 year old boy presents with fever up to 39c’ and

A. Toxic shock syndrome

Cells PMN Lymphocytes Lymphocytes

Glucose Low (<40) Low (<10) Normal(>45)

Protein High High Normal/High

Viral (Aseptic) meningitis

Use steroids for TB meningitis

*Roseola ( sixth disase )

✓After the head is delivered, suction of the

✓After the body is delivered, laryngoscope-

✓Rash in different stages

First human virus to be associated with

Examination of the ears is essential for

known as swimmer’s ear

Pharyngeal inflammation causes

✓Racoons, bats "caves", dogs

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