Childhood Childhood Infectious Infectious DiseasesDiseases

Dr Elham Dr Elham BukhariBukhari

Assistant Professor & Assistant Professor & ConsultantConsultant

Pediatric Infectious DiseasesPediatric Infectious DiseasesKing Khalid University HospitalKing Khalid University HospitalKing Saud University, RiyadhKing Saud University, Riyadh

Common Viral Infecions

Measles

Mumps

Rubella

Chicken pox

Erythema infectiousum (Fifth Disease) (Fifth Disease)

Roseola infantum(Sixth Disease)

Rashes caused by childhood infections.Macular/papular /maculopapular:

Macules-red/pink discrete flat areas,blanch on pressure ex rubella,measles..ect

Papules –solid raised hemispherical lesions,usually tiny ,also blanch on perssure.ex scarlet fever,kawasaki disease.Purpuric/petechial: Non-blanching red/purple spots.ex meningococcal.

Vesicular:

Raised hemispherical lesions,<0.5 cm diameter,contain clear fluid.ex chicken pox

Pustular/bullous:

Raised hemispherical lesions,>0.5cm diameter,contain clear or purulent fluid.

ex Imptigo

Cont……Desquamation:

Dry and flaky loss of surface epidermis, often peripheries. ex Kawasaki disease.

MeaslesMeasles RNA VirusRNA Virus Incubation Period: 6 – 12 daysIncubation Period: 6 – 12 days Clinical Clinical

Features.fever,rash,coryzaFeatures.fever,rash,coryza Complications:Complications:

Respiratory: pneumonia,omRespiratory: pneumonia,om Neurological:febrile Neurological:febrile

conv.encephalitis,SSPEconv.encephalitis,SSPE Others:diarrhoea,hepatitisOthers:diarrhoea,hepatitis

Treatment;symptomaticTreatment;symptomatic Isolation & Infectivity: 2 days Isolation & Infectivity: 2 days

before till 6 days after rashbefore till 6 days after rash

CLINICAL CLINICAL MANIFESTATIONSMANIFESTATIONS

1.Incubation period is approximately 6~18days,10days is the most common.

(3-4weeks) 2 .2 .predromal phase 3~4 days.3~4 days. 1.1. Fever. 2. Catarrhal inflammation of URT. 3. Koplik’s spots. 4. Transient prodromal rashes..

yy:yy:

3. 3. Eruption stageEruption stage 1. Time: the 3~5 days after fever ; but the 4th day is most 1. Time: the 3~5 days after fever ; but the 4th day is most

common;common; 2 . Shape: maculopapular2 . Shape: maculopapular 3. Sequence: behind the ear→along the 3. Sequence: behind the ear→along the

hairline→face→neck→chest→back→abdomen→limbs→hand hairline→face→neck→chest→back→abdomen→limbs→hand and feet(palm , sole)and feet(palm , sole)

4 . The temperature rise continuously and accompanied with the 4 . The temperature rise continuously and accompanied with the toxic symptoms .toxic symptoms .

4 . 4 . Convalescent stage brown staining. fine desquamation. course:10-14 days

COMPLICATIONS : 1 .Bronchopneumonia. 2 .Myocarditis. 3 .Laryngitis. 4 .Neurologic complications: Encephalitis and SSPE . subacute sclerosing panencephalitis Persistent infection of the brain. Rare,psychologic.neuro deterioration. Personality changes,seziure,coma.

MeaslesMeasles (cont.)(cont.)

Koplik’s spots

Measles Measles (Cont.)(Cont.)

Measles vs. Scarlet Measles vs. Scarlet feverfever

DIAGNOSIS.DIAGNOSIS.

1 .Epidemiologic data. 2 .Clinical manifestations. 3. Laboratory findings:. . 1 .Multinucleated giant cells are detected in

nasopharyax mucosa secretions. 2 .Measles virus can be isolated in tissues culture.. 3 . Antibody titer. specific antibody IgM.specific antibody IgM. 4 . Other Ag and multinucleated giant cells

EPIDEMIOLOGYEPIDEMIOLOGY

1.Source of infection1.Source of infection The patients are the only source of infection. The patients are the only source of infection. 2 .Routes of transmission2 .Routes of transmission air-borneair-borne 3. Susceptibility of population3. Susceptibility of population 1 . All age person is susceptible; 90% of contact people 1 . All age person is susceptible; 90% of contact people

acquire the disease. acquire the disease. 2 .The permanent immunity acquire after disease.2 .The permanent immunity acquire after disease. 4.Epidemic features4.Epidemic features season:winter and springseason:winter and spring age:6 months to 5 years oldage:6 months to 5 years old

DIFFERENTIAL DIFFERENTIAL DIAGNOSISDIAGNOSIS

1 .Rubella (German measles) 2. scarlet fever. 3 .Roseola infantum (infant subitum,exanthem

subitum) 4. Drug rashes.

MumpsMumps

RNA VirusRNA Virus Incubation Period: 14 – 21 Incubation Period: 14 – 21

daysdays Clinical Clinical

Features:fever,sweelingFeatures:fever,sweeling Complications:Complications:

GlandularGlandular Non glandularNon glandular

Isolation & Infectivity: 9 days Isolation & Infectivity: 9 days after onset of parotid swellingafter onset of parotid swelling

Clinical manifestation of mumps are:Clinical manifestation of mumps are:

Parotid inflammation (or parotitis) in 60–70% of infections and 95% of patients with symptoms Parotitis causes swelling and local pain, particularly when chewing. It can occur on one side (unilateral) but is more common on both sides (bilateral) in about 90% of cases.

Fever Headache Pancreatitis: inflammation of the affected pancreas. Orchitis: painful inflammation of the testicles

DiagnosisDiagnosis::

Person infected with mumps is contagious from approximately 6 days before the onset of symptoms until about 9 days after symptoms start.

Usually the disease is diagnosed on clinical grounds and no confirmatory laboratory testing is needed

RubellaRubella RNA VirusRNA Virus Incubation Period: 14 – 21 daysIncubation Period: 14 – 21 days Clinical Features:fever ,rash.Clinical Features:fever ,rash. Complications:Complications:

Acquired ;arthritis,encephalitis,Acquired ;arthritis,encephalitis, Congenital:fetal damage.Congenital:fetal damage.

Isolation & Infectivity: 7 days Isolation & Infectivity: 7 days from onset of rashfrom onset of rash Congenital Rubella: until 1 year of Congenital Rubella: until 1 year of

ageage

RubellaRubella

Symptoms include: low grade fever, swollen glands (sub occipital & posterior cervical lymphadenopathy), joint pains, headache and conjunctivitis.

The swollen glands or lymph nodes can persist for up to a week and the fever rarely rises above 38 oC (100.4 oF). The rash of German measles is typically pink or light red. The rash causes itching and often lasts for about three days.

RubellaRubella (Cont.)(Cont.)

Congenital rubella syndrome

Rubella can cause CRS in the newly born. The syndrome (CRS) follows intrauterine infection by the Rubella virus and comprises cardiac, cerebral, ophthalmic and auditory defects.

It may also cause prematurity, low birth weight, and neonatal thrombocytopenia, anaemia and hepatitis.

The risk of major defects or organogenesis is highest for infection in the first trimester.

Congenital Rubella Congenital Rubella SyndromeSyndrome

Chicken Pox (Varicella)Chicken Pox (Varicella) DNA Virus(VZV). Incubation Period: 10 – 21 days Clinical Features:Papules-vesicles-pusules-

crusts. Complications:

2nd bacterial infection:staph.strep Neurological :cerebellitis, encephalitis Reye syndrome Disseminated:immunocompromised

Treatment: (Acyclovir).ZIG. Isolation & Infectivity: 2 days before rash

till all skin lesions have crusted (6th day of rash)

Cont. Chicken PoxCont. Chicken Pox

Cont. Chicken PoxCont. Chicken Pox

Rubella, Smallpox, Rubella, Smallpox, ChickenpoxChickenpox

Poliovirus Poliovirus Incubation Period: 7 – 21 Incubation Period: 7 – 21

daysdays Clinical Features: <1% Clinical Features: <1%

classical paralytic polioclassical paralytic polio Complications: aseptic Complications: aseptic

meningitis.meningitis. TreatmentTreatment Isolation & Infectivity: Isolation & Infectivity:

several weeksseveral weeks

What is Poliomyelitis?What is Poliomyelitis?

polio= gray matterpolio= gray matter Myelitis= inflammation of the spinal cordMyelitis= inflammation of the spinal cord This disease result in the destruction of motor This disease result in the destruction of motor

neurons caused by the poliovirus.neurons caused by the poliovirus. Polio is causes by a virus that attacks the nerve Polio is causes by a virus that attacks the nerve

cells of the brain & spinal cord although not all cells of the brain & spinal cord although not all infections result in sever injuries and paralysis.infections result in sever injuries and paralysis.

How is polio transmitted?

Poliovirus is transmitted through both oral and Poliovirus is transmitted through both oral and fecal routes with implantation and replication fecal routes with implantation and replication occurring in either the oropharyngeal and or in the occurring in either the oropharyngeal and or in the intestine of mucosa.intestine of mucosa.

Polio cases are most infected for 7-10 days before Polio cases are most infected for 7-10 days before and after clinical symptoms begin. and after clinical symptoms begin.

What are the symptoms?

Many include fever, pharyngitis, headache, Many include fever, pharyngitis, headache, anorexia, nausea, and vomiting. Illness may anorexia, nausea, and vomiting. Illness may progress to aseptic meningitis and progress to aseptic meningitis and menigoencephalitis in 1% to 4% of patients. These menigoencephalitis in 1% to 4% of patients. These patients develop a higher fever, myalgia and sever patients develop a higher fever, myalgia and sever headache with stiffness of the neck and back. headache with stiffness of the neck and back.

Can it cause paralytic disease?

Paralytic disease occurs 0.1% to 1% of those who become infected with the polio virus.

Paralysis of the respiratory muscles or from cardiac arrest if the neurons in the medulla oblongata are destroyed.

Patients have some or full recovery from paralysis usually apparent with proximally 6 months

Physical therapy is recommended for full recovery.

Polio VaccinesPolio Vaccines

OPVOPV

IPV

VaccineVaccine Polio vaccine first appeared to be licensed in the United States in

1955. Advantages: Ease to administration Good local mucosal immunity Disadvantage: Strict cold shipping & storage requirements Multiple doses required to achieve high humeral conservation rates

against all virus types

Vaccine (continuation)

Babies are given 4 doses through out their infancy.Babies are given 4 doses through out their infancy. Adolescents and adults should get vaccinated as well. Adolescents and adults should get vaccinated as well.

Adolescents younger than 18 should receive the routine Adolescents younger than 18 should receive the routine four doses.four doses.

You should get it if you travel outside places where polio You should get it if you travel outside places where polio id still an epidemicid still an epidemic

TreatmentTreatment

Bed rest with close monitoring of respiratory and Bed rest with close monitoring of respiratory and cardiovascular functioning is essential during the cardiovascular functioning is essential during the acute stage of poliomyelitis along with fever acute stage of poliomyelitis along with fever control and pain relievers for muscle spasms.control and pain relievers for muscle spasms.

Mechanical ventilation, respiratory therapy may be Mechanical ventilation, respiratory therapy may be needed depending of the severity of patients.needed depending of the severity of patients.

CroupCroup

ParainfluenzaParainfluenza Incubation Period: 2 – 6 Incubation Period: 2 – 6

daysdays Clinical FeaturesClinical Features ComplicationsComplications TreatmentTreatment Isolation & Infectivity: Isolation & Infectivity:

contact precaution in contact precaution in hospital, infective up to 3 hospital, infective up to 3 weeksweeks

Croup (or laryngotracheobronchitis)

is a respiratory condition that is usually triggered by an acute viral infection of the upper airway.

The infection leads to swelling inside the throat, which interferes with normal breathing and produces the classical symptoms of a "barking" cough, stridor, and hoarseness

croupcroup

Croup is characterized by a "barking" cough, stridor, hoarseness, and difficult breathing which usually worsens at night.

The "barking" cough is often described as resembling the call of a seal or sea lion.

The stridor is worsened by agitation or crying, and if it can be heard at rest, it may indicate critical narrowing of the airways. As croup worsens, stridor may decrease considerably

DiagnosisDiagnosis

The first step is to exclude other obstructive conditions of the upper The first step is to exclude other obstructive conditions of the upper airway, especially airway, especially epiglottitis, an airway , an airway foreign body, , subglottic stenosis, , angioedema, , retropharyngeal abscess, and , and bacterial tracheitis..

Diagnosis Diagnosis

A frontal A frontal X-ray of the neck is not routinely performed, but of the neck is not routinely performed, but if it is done, it may show a characteristic narrowing of the if it is done, it may show a characteristic narrowing of the trachea, called the trachea, called the steeple sign, because of the subglottic , because of the subglottic stenosis, which is similar to a stenosis, which is similar to a steeple in shape in shape

steeple sign..

Croup treatment:Croup treatment:

Corticosteroids, such as dexamethasone and budesonide, have been shown to improve outcomes in children with all severities of croup, single dose is usually all that is required.

Moderate to severe croup may be improved temporarily with nebulized epinephrine

BronchiolitisBronchiolitis Respiratory Syncytial Respiratory Syncytial

VirusVirus Incubation Period: 2 – Incubation Period: 2 –

8 days8 days Clinical FeaturesClinical Features ComplicationsComplications TreatmentTreatment Isolation & Infectivity: Isolation & Infectivity:

3 – 8 days (up to 4 3 – 8 days (up to 4 weeks in infants)weeks in infants)

Bronchiolitis

most often affects infants and young children because their small airways can become blocked more easily than those of older kids or adults

typically occurs during the first 2 years of life, with peak occurrence at about 3 to 6 months of age

is more common in males, children who have not been breastfed, and those who live in crowded conditions.

Signs & Symptoms

Sudden breathing difficulty, usually preceded by fever and Sudden breathing difficulty, usually preceded by fever and a mild common cold and cough, and characterized by the a mild common cold and cough, and characterized by the following: following:

Wheezing. Wheezing. Rapid, shallow breathing (60 to 80 times a minute). Rapid, shallow breathing (60 to 80 times a minute). Retractions (seesaw movements) of the chest and Retractions (seesaw movements) of the chest and

abdomen, and nasal flaring. abdomen, and nasal flaring. Fever (occasionally). Fever (occasionally). Blue discoloration of skin or nails (severe cases).Blue discoloration of skin or nails (severe cases).

Treatment General Measures Keep the humidity in the child's room as high as possible,

preferably with an ultrasonic cool-mist humidifier. Clean humidifier daily. If you don't have a humidifier, run cold or hot water in the shower with windows and doors closed to produce a high-humidity room. Hold the child in this room for 20 minutes several times a day, especially at bedtime. If the child awakens at night with wheezing or shortness of breath, repeat the process.

Erythema InfectiosumErythema Infectiosum(Fifth Disease)(Fifth Disease)

Parvovirus B19Parvovirus B19 Incubation Period: 4 – Incubation Period: 4 –

21 days21 days Clinical Clinical

Features:fever,,slapped Features:fever,,slapped cheek rash.cheek rash.

Complications:aplastic Complications:aplastic crisescrises

TreatmentTreatment Isolation & Infectivity: Isolation & Infectivity:

droplet precautions for 7 droplet precautions for 7 daysdays

Fifth disease symptoms disease symptoms Bright red Bright red cheeks are a defining symptom of the infection are a defining symptom of the infection

in children (hence the name "slapped cheek disease"). in children (hence the name "slapped cheek disease"). Occasionally the Occasionally the rash will extend over the bridge of the will extend over the bridge of the nose or around the mouth.nose or around the mouth.

In addition to red cheeks, children often develop a red, In addition to red cheeks, children often develop a red, lacy rash on the rest of the body, with the upper arms and lacy rash on the rest of the body, with the upper arms and legs being the most common locations.legs being the most common locations.

Fifth disease Fifth disease

RoseolaRoseola (Sixth Disease)(Sixth Disease)

HHV-6HHV-6 Incubation Period: Incubation Period:

9 – 10 days9 – 10 days Clinical Clinical

Features:fever Features:fever followed by followed by macular rash as macular rash as fever wanes.fever wanes.

Complications;assComplications;associate e febrile ociate e febrile convulsionconvulsion

TreatmentTreatment

Roseola Roseola Typically the disease affects a child between six months and two Typically the disease affects a child between six months and two

years of age, and begins with a sudden high years of age, and begins with a sudden high fever (39–40 °C; 102.2- (39–40 °C; 102.2-104 °F).104 °F).

This can cause, in rare cases, febrile convulsions (also known as This can cause, in rare cases, febrile convulsions (also known as febrile seizures or "fever fits") due to the sudden rise in body or "fever fits") due to the sudden rise in body temperature, but in many cases the child appears normal.temperature, but in many cases the child appears normal.

After a few days the fever subsides, and just as the child appears to After a few days the fever subsides, and just as the child appears to be recovering, a red rash appears. This usually begins on the trunk, be recovering, a red rash appears. This usually begins on the trunk, spreading to the legs and neck. The rash is not itchy and may last 1 spreading to the legs and neck. The rash is not itchy and may last 1 to 2 daysto 2 days

Infectious MononucleosisInfectious Mononucleosis Epstein-Barr VirusEpstein-Barr Virus Incubation Period: 30 – 50 Incubation Period: 30 – 50

daysdays Clinical Clinical

Features:fever ,tonsillopharngFeatures:fever ,tonsillopharngitis.cx lymphadenopathy,rash.itis.cx lymphadenopathy,rash.

Complications:Complications: Hepatitis Hepatitis Hemolytic AnemiaHemolytic Anemia GBS GBS Splenic raptureSplenic rapture MyocarditisMyocarditis MalignacyMalignacy

TreatmentTreatment

COMMON BACTERIAL INFECTIONS

Staphyloccoacl and Group A streptoccocal infections.

By direct effect –abscess,celluitis ,imptigo,orbital celluitis.

Toxin mediated:toxic shock syndrome Toxic epidermial necrolysis.

Continue….

Group A streptococcus: Direct effect.tonsillitis ,osteomyelitis,om,celluitis Toxin mediated:toxic shock like syndrom,scarlet

fever Post infectious.rheumatic

fever,glomerulonephritis.

Haemophilus influenzaeHaemophilus influenzae type b (Hib)type b (Hib)

Clinical FeaturesClinical Features ComplicationsComplications TreatmentTreatment Isolation & Isolation &

Infectivity: droplet Infectivity: droplet precautions for 24 precautions for 24 hours after starting hours after starting antimicrobial therapyantimicrobial therapy

VaccineVaccineCerebrospinal fluid culture

positive for Hib (Gram stain)

HibHib (Cont.)(Cont.)

Pertusis (Whooping Pertusis (Whooping Cough)Cough)

Bordetella PertusisBordetella Pertusis Incubation Period: 7 – 14 daysIncubation Period: 7 – 14 days Clinical FeaturesClinical Features Complications:Complications:

Pneumonia & BronchiectasisPneumonia & Bronchiectasis HaemorrhageHaemorrhage HerniaHernia HypoxiaHypoxia

TreatmentTreatment Isolation & Infectivity: up to 6 weeks, Isolation & Infectivity: up to 6 weeks,

but with treatment => 5 days after but with treatment => 5 days after starting therapystarting therapy

VaccineVaccine

DiagnosisDiagnosis

Isolation by cultureIsolation by culture Media: Regan-Lowe, Bordet-Gengou, or charcoal agarMedia: Regan-Lowe, Bordet-Gengou, or charcoal agar

Polymerase Chain Reaction PCR Polymerase Chain Reaction PCR Kids & ChildrenKids & Children

Direct fluorescent antibody (DFA)Direct fluorescent antibody (DFA) NO Freezer or Refrigeration of samplesNO Freezer or Refrigeration of samples

Route of TransmissionRoute of Transmission

Spread through direct contact of respiratory secretions.Spread through direct contact of respiratory secretions. Most contagious during first few stages of infectionMost contagious during first few stages of infection

Resides in upper airway pathways, mostly the trachea and bronchi.Resides in upper airway pathways, mostly the trachea and bronchi. Very contagiousVery contagious

Progession of Whooping Progession of Whooping Cough Cough

Incubation period 4-21 daysIncubation period 4-21 days 3 Stages3 Stages

11stst Stage- Catarrhal Stage 1-2 weeks Stage- Catarrhal Stage 1-2 weeks runny nose, sneezing, low fever, and a mild cough (common mistaken for cold)runny nose, sneezing, low fever, and a mild cough (common mistaken for cold)

22ndnd Stage- Paroxysmal Stage 1-6 weeks Stage- Paroxysmal Stage 1-6 weeks whooping cough, which consists of bursts or paroxysms of numerous, rapid coughs, severity whooping cough, which consists of bursts or paroxysms of numerous, rapid coughs, severity

of the infection is at its greatestof the infection is at its greatest

33rdrd Stage- Covalescent Stage weeks-months Stage- Covalescent Stage weeks-months gradual recovery startsgradual recovery starts

Complications

ChildrenHypoxia

Apnea

Pneumonia

Seizures

AdultsPneumonia

Rib Fracture

Weight Loss

Hernias

Urinary Incontinence

TreatmentTreatment

Antibiotic TherapyAntibiotic Therapy ErythromycinErythromycin Azithromycin Azithromycin ClarithromycinClarithromycin

Prevention

CDC recoomends children be given the Diphtheria, Tetanus, and Pertussis (DTaP) vaccine as early as 6 weeks but no later than 6 y/o.

Good hygiene

Cover mouth/nose when coughing and sneezing.

DiphtheriaDiphtheria Corynebacterium diphtheriaeCorynebacterium diphtheriae Incubation Period: 2 – 7 daysIncubation Period: 2 – 7 days Clinical FeaturesClinical Features Complications:Complications:

ThrombocytopeniaThrombocytopenia MyocarditisMyocarditis Vocal cord paralysesVocal cord paralyses

TreatmentTreatment Isolation & Infectivity: up to 6 Isolation & Infectivity: up to 6

weeks, but with treatment weeks, but with treatment communicable for fewer than 4 communicable for fewer than 4 daysdays

VaccineVaccine

Diphtheriais an upper respiratory tract illness caused by Corynebacterium diphtheriae, a facultative anaerobic, Gram-positive bacterium. It is characterized by sore throat, low fever, and an adherent membrane (a pseudomembrane) on the tonsils, pharynx, and/or nasal cavity.

Case classificationProbable: a clinically compatible case that is not laboratory-confirmed and is not epidemiologically linked to a laboratory-confirmed caseConfirmed: a clinically compatible case that is either laboratory-confirmed or epidemiologically linked to a laboratory-confirmed caseEmpirical treatment should generally be started in a patient in whom suspicion of diphtheria is high.

Antibiotics are used in patients or carriers to eradicate C. diphtheriae and prevent its transmission to others. The CDC recommends either:MetronidazoleErythromycin (orally or by injection) for 14 days (40 mg/kg per day with a maximum of 2 g/d), orProcaine penicillin G given intramuscularly for 14 days (300,000 U/d for patients weighing <10 kg and 600,000 U/d for those weighing >10 kg).- Patients with allergies to penicillin G or erythromycin can use rifampin or clindamycin.

DiphtheriaDiphtheria (Cont.)(Cont.)

TetanusTetanus Clostridium tetaniClostridium tetani Incubation Period: 2 days to Incubation Period: 2 days to

months, most within 14 months, most within 14 daysdays

Clinical FeaturesClinical Features Complications:Complications:

Lock jawLock jaw Neonatal mortalityNeonatal mortality Generalized muscle spasmGeneralized muscle spasm

TreatmentTreatment Isolation: no person to Isolation: no person to

person transmissionperson transmission VaccinesVaccines

Tetanus.-medical condition characterized by a prolonged contraction of skeletal muscle fibers.-The primary symptoms are caused by tetanospasmin, a neurotoxin produced by the Gram-positive, rod-shaped, obligate anaerobic bacterium Clostridium tetani.- Infection generally occurs through wound contamination and often involves a cut or deep puncture wound. As the infection progresses, muscle spasms develop in the jaw (thus the name "lockjaw") and elsewhere in the body

The wound must be cleaned. Dead and infected tissue should be removed by surgical debridement. Administration of the antibiotic metronidazole decreases the number of bacteria but has no effect on the bacterial toxin. Penicillin was once used to treat tetanus, but is no longer the treatment of choice, owing to a theoretical risk of increased spasms.

Guide to Tetanus Prophylaxis in Guide to Tetanus Prophylaxis in Routine Wound ManagementRoutine Wound Management

History of Adsorbed Tetanus Toxoid (Doses)

Clean, Minor Wound All Other Wounds*

Td TIG Td TIG

Unknown or <3 Yes No Yes yes

≥3§ No" No No¶ No

" yes if more than 10 years since last dose¶ yes if more than 5 years since last dose

Tetanus can be prevented by vaccination with tetanus toxoid..

The CDC recommends that adults receive a booster vaccine every ten years, and standard care practice in many places is to give the booster to any patient with a puncture wound who is uncertain of when he or she was last vaccinated, or if he or she has had fewer than three lifetime doses of the vaccine

ThrushThrush

Candida AlbicansCandida Albicans

Clinical FeaturesClinical Features

ComplicationsComplications

TreatmentTreatment

Kawasaki disease

Affect infant and young children Clinical criteria Fever >5days Conjunctival injection Red mucous membrane Cervical lymphadenopathy Rash Oedema of palms & soles with peeling

Further ReadingFurther Reading

RED BOOK by Report of the committee on RED BOOK by Report of the committee on Infectious Diseases.Infectious Diseases.

Viral HepatitisViral Hepatitis

FeatureFeature Hepatitis Hepatitis AA

Hepatitis Hepatitis BB

Hepatitis Hepatitis CC

Hepatitis Hepatitis DD

Hepatitis Hepatitis EE

VirusVirus HAVHAV HBVHBV HCVHCV HDVHDV HEVHEV

GenomeGenome RNARNA DNADNA RNARNA RNARNA RNARNA

IncubationIncubation 15-50 15-50 daysdays

45-160 45-160 daysdays

7-9 weeks7-9 weeks 2-8 weeks2-8 weeks 15-60 15-60 daysdays

OnsetOnset AcuteAcute InsidiousInsidious InsidiousInsidious AcuteAcute AcuteAcute

TransmissioTransmissionn

OralOral ParenteralParenteral

PerinatalPerinatalParenteralParenteral ParenteraParentera

llOralOral

Sequelae:Sequelae:

Fulminant Fulminant liver failureliver failure

CarrierCarrier

Chronic Chronic hepatitishepatitis

RareRare

NoNo

NoNo

UncommoUncommonn

YesYes

YesYes

UncommoUncommonn

YesYes

YesYes

YesYes

YesYes

YesYes

YesYes

NoNo

NoNo

MortalityMortality 0.1-0.2 %0.1-0.2 % 0.5-2 %0.5-2 % 1-2 %1-2 % 2-20 %2-20 % 1-2 %1-2 %