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Infections

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Infections
Disease
Etiology
MOI
IP
C/P

Scarlet Fever

Whooping Cough

Group A hemolytic streptococci

That elaborate erythrogenic toxin
Droplet
2-7 days

Prodromal Stage : ( 24 hours before rash )

- FAHM : Fever ( 41C acute onset )
- Sore throat : Severe
- Tachycardia
- Tonsils : Congested Covered by purulent
exudates

Non- Typhi Salmonella

G-ve Bacilli called:

Bordetella pertussis
7-14 days infec ve for 3 wks a er
start of paroxysms
:

Eruption Stage ( 24 hours after fever )

:
- Rash : * Diffuse erythematous eruptions , tht
Blanches on pressure
* fine popular rash : gooseflesh texture
- Start: Axilla , groin , neck
- Spread : generalized in 24 hours
* Flushed cheeks
* circum oral pallor
* white strawberry tongue
- End : by end of 24 hours :
* rash desquamated
* tongue red strawberry

(I) Catarrhal Stage ( 2 weeks)

Low grade fever - Coryza Mild cough

(II) Spasmodic Stage ( 2-6 weeks) :

= paroxysmal stage = cough attack
(((( Spasmodic Cough )))) char. By :
* Triggered By : eating drinking
physical Exertion Temp. change
* During Attack :
- 5 10 explosive cough
- rapidly in 1 expira on
- Face : dusky red
- Eye : Bulge
- Tongue : protrude
- Neck Veins : distended
- characteristic inspiratory whooping
* Followed by :
- vomiting of thick tinged sputum
- child is dazed & restless
* In between Attacks :
- child is fair
- chest examination : no abnormality
(III) Convalescence stage : (1-2 wks:)
Episodes gradually in frequency

Enteric Fever ( Typhi S )

- S. Choleraesuis
- S. entriditis
Feco-oral
6-72 hours ( 3 days max. )

- S. Typhi
-S. Paratyphi A,B,C
Direct/ Indirect Contact
7-14 days

1- Acute Gastroenteritis :
Local
.

Symptoms
:
* Fever : incideous onset ( rise in
a stepwise fashion & in a week
become unremittent )
* Anorexia Headache
Lethargy myalgia
* GIT : - abd. Pain
- early Diarrhea ( pea soup
consistency )
- late constipation
* N & V : not common & usually
indicate complications
Signs ( BHR )
:

- Acute onset of N,V

- Abdomen :
- Crampy Pain
- Tender , Distended
- severe watery diarrhea
General
.
- Fever ( 38 39 C )
- Headache , confusion
- seizers , meningismus
2- Bactremia :1-5% of cases
RF : - immunodefiencies
- children & neonates <3 m
3- Extra intestinal focal
salmonella infection :
Blood porn to many organs :
- Arthritis - Brain Abscess
- Meningitis - Osteomeylitis
- peritonitis
4- Asymptomatic carrier :
- After recovery
- fecal secretion of
salmonella for weeks

* Bradycardia :
disproportionate to fever
* HSM
* Rash : 50 %
- erythematous maculopapular
-in crops on lower chest and
abdomen

Disease

Scarlet Fever

Whooping Cough

Complications

1- Local Spread : O.M Sinusitis mastoiditis

cervical adenitis - bronchopneumonia - empyema
Abscess ( retropharyngeal parapharyngeal )
2- Hematogenous Spread : Meningitis - septicemia
osteomyelitis septic arthritis
3- Late immunological complications : RF, APSGN

Investigations

* CBC : PMN Leukocytosis

* ESR
* +ve CRP
* + ve ASOT > 1/333
* Throat swab culture : hemolytic streptococci

* Resp: - Pneumothorax
- Bronchopneumonia ( m/c & s )
- TB focus - Atelectasis -Emphysema
* GIT: - GE , Dehydration , PEM
- Prolapsed rectum , Hernias
- Tongue : bitting , Ulcer of frenulum
* CNS : Convultion & Coma
*Hemorrhages: dt VP & congestion
Epistaxis , SubConj. , IC , Hemoptysis
- leukocytosis
- lymphocytosis
- ( n ) ESR
- Culture : by cough plate technique
On Bordet Genue medium

TTT

Prevention

ABs for at least 10 days

- Procaine Penicillin (400,000-800,000 u/d IM)
In 4 divided doses for 10 days
- Pen. G / Pen. V ( 50,000 100,000 u/Kg/d )
In 4 divided doses for 10 days
-Erythromycin ( 40 mg/d) for 10 days if allergic to P

* Cough sedatives & avoid

precipitating factors
* ABs : Erythromycin 50 mg /kg / day
Or Ambicillin 100 mg/Kg/day
For 10 days

Active Immunization: DPT (2,4,6,18)

Chemoprophylaxis : Erythromycin
50 mg/Kg/ day for 10 days

Non- Typhi Salmonella

Enteric Fever ( Typhi S )

st

- Culture :
* Stool culture : in GE
* Aspirated specimens in
focal suppuration
- Serology : to detect Abs

- GE : correct dehydration
& electrolytes
- Bacteremia &
Extraintestinal focal inf :
Antimicrobial therapy
after C&S

A er 1 week
* Intestine : Hge , perforation
* Liver : Hepatitis , cholecystitis
* Pancrease : pancreatitis
* Chest : Pneumonia
* Cardio : Toxic myocarditis
* -itis : peylonephritis
meningitis orchitis parotitis endocarditis
- Bl. Culture : +ve early (40-50%)
- Stool & Urine culture :
st
+ve a er 1 week
- Monoclonal Abs : direct
detection of Sal.T. Sp. Ags
- PCR : Sal.T. Sp. genes in Bl.
- Widal Test : +ve after 1 week
( of a little help )
* Antimicrobial Therapy :
- uncomplicated 14 days
- complicated 3 weeks
Chloramphenicol
Ampicillin/Amoxicillin 3rd
Generation cephalosporines :
ceftriaxone Trimethoprim
* Dexamethazone : improve the
survival in shock
Several Vaccines :
* Parentral heat-phenol
inactivated vaccine
* Oral live attenuated vaccine

Etiology

Cerebrospinal Meningitis
* Bacterial :

Poliomyelitis

Up to 2 Ms
2Ms4ys
4 ys Older
- Group B Strept
- H. influenza B
- G -ve enteric bacilli - N. meningitides - N. meningitides
- Lysteria Monocytog. - Strept. Pneum. - Strept. Pneum.

MOI
IP
C/P

PolioVirus ( enterovirus ) in 3 strains :

P1 : Brunhild
P2: Lansing
P3 : Leon

* Non-Bacterial :
- Viral : Entero>80% , HSV, Arbo-, EBV, Mumps * Feco-oral ( m/c) * Droplet infection ( rare )
7 10 days
-Neoplatic Chemical Post-Vaccination
( Non Specific MsMs Fn Cn )
(I) Asymptomatic : Infection pass unnoticed (m/c)
* Non Specific :
(II) Abotrive
: - last for 3-5 days - suspected in epidemics - influenza or GE like symptoms
Anorexia Poor Feeding
(III) Non Paralytic : Meningeal irritation signs ( ) - recover completely or progress to paralysis
* Mental Status Alteration :
(IV) Paralytic :
(V) Respiratory :
Level of coniousness
paralysis may be : initial presentation
Spinal ( Dry = peripheral Type )
Bulbar ( wet = central type )
* Seizers : ( Focal / Generalized )
or preceded by meningeal irritation
st
Paralysis
of
diaphragm
&
IC
ms
RC
affection & bulbar palsy
1 symptom in infants & young
Spinal
Bulbar
Encephailitic
- Respiratory Distress ( rapid shallow - Accumulation of secretions
children
* ((( True Bulbar Palsy )))
- Terminate fatally
Respiration & working ala nasi )
inability to cough , hoarsness
Paralysis of ms of :
* Meningeal Irritation :
- Impaired
- weak thoracic expansion with resp. - weak irregular respiration
- pharynx ( dysphagia )
Nuchal rigidity Back Pain
consciousness
- Palate ( nasal tone
Kernig sign Brudziniski sign
- Convulsions
&
fleuid
Regurge
)
* Signs of ICT :
- Larynx ( Horseness, stridor, repeated chocking ,
Headache Projectile vomiting
aspiration wet polio )
Blurring of vision
*Affection of : RC irr breathing , VC Arrhythmia
*Focal Neurological signs :
* Cranial Neuropathies :
Characterized By: (LAMS)
Distribution :
( m/c Abducent nerve )
-LMNL ( flaccid paralysis )
- LL : (m/c) Adductors of : Hip & Ant. Tipial
-Acute onset
-Asymetrical
-Maximal from start
-Motor purely ( no sensory loss )
-Spotty distribution

- UL : Ms of Shoulder Girdle ( specially : Deltoid )

- Trunk : Skoliosis Kyphosis Kyphoscoliosis , Tripod sign
- Abdomen : Localized Bulge , on : crying or straining
- Diaphragm & IC muscles : Respiratory Distress
- Neck Muscles : Inability to support the Head

Paraly c Polio pass through 3 stages : a) Acute : 1st 3 weeks b) Subacute : ll 6 months c)Old : a er 6 months"deformity"

Cerebrospinal Meningitis
Complication

Investigations

TTT

Prevention

Systemic : sepsis , purpera fuminans

Neurologic :
- Herniation : cerebral / cerebellar
- Hydrocephalus /+ ICT
- Motor deficits
- Thrombosis of dural venous sinuses
- Seizers - Stroke
- Subdural effusions : resistant H. influenza &
pneumoncoccal infec ons in infant <18 ys
prolonged fever , bulging Ant. Fontanelle , OFC
Lubar Puncture :
(Pressure Leukocytes PMN Protein Glucose)
- Viral : Normal or
- Bacterial : except Glucose
Blood Culture : reveal organisms in 80-90% of
meningitis in childhood
CBC : Leukocytoisis , PNL leucopenia = bad prong.
1- ABs : 3rd Generation Cephalosporines : for ic pts
( Ceftriaxone , Cefotaxime )
2- ttt of ICT : Dehydration measurements
3- Steroids : in Bacterial Meningitis , Prevent :
- Cytokines Mediated Infl. Response
- Edema - Neutrophil infiltration - neurologic injury

Poliomyelitis
* Chest : Respiratory Failure
* Cardio : HTN , HF
* GIT : Acute Gastric Dilatation , Melena ( dt intestinal erosions )
* Renal : Acute Retension , UTI , stones
*Bone : Bone deformties & Joint contractures
* Psychiatry : Pstpilio $ ( PPS ) : Psychological Trauma
* Due to prolonged recumbency : Osteoporosis , DVT , Constipation , Bed Sores

- Viral isolation :
- from stool up to 6-8 weeks from the onset of the disease
- from nasopharynx up to 2 weeks
- CSF : proteins & Pleocytosis ( 20-300 / cmm ) = picture of asep c meningi s

( ACUTE STAGE )
- Bed rest in best position of function - Hot moist packs
- Analgesics & Antipyretics
- Care of Bladder
- Management of Respiratory polio : (A) Spinal polio : -ve pressure respirator
(B) Bulbar polio : - Clear airway by postural drainage
- NasoGastric tube Feeding
- Monitoring of Blood pressure
- Mechanical ventilation in severe cases
( Subacute , Chronic & Old Cases )
(a) Physiotherapy : for 1.5 2 years
( b) Plastic Splints & Supporting braces : ( Old Cases Physio therapy Orthopedic operations )
- H. Infleunza B : - Rifambicin : for household contact 10 mg/kg/d for 4 days
- TPOV
- Vaccine : Conjugate polysaccharide vaccine
- Sabine Vaccine / IPV
- N. Meningitidis : - Rifambicin : for close contact 10 mg/kg/d for 4 days
- Salk Vaccine
- Vaccine : used with Rifambicin & during epidemics
- Strept Pneumonia : Vaccine for high risk patient & Sickel Cell Anemia : daily Chemoprophylaxis + Oral Penicillin

Dis.
Etiol.
MOI
IP
Infec.

Measles ( Rubeola )
Measles Virus
Droplet infection( Direct / InD.)
10-14 days
7days (Rash)
5 days .

Rubella ( German measles )

Rubella virus
Droplet inf. / Transplacental
14-21 days
7days (Rash)
7 days .

Mumps ( Epidemic parotidis )

Chicken Box (Varicella )

Mumps virus
Droplet infection ( Direct / Indirect)
14-21 days
1 d (Symptoms , swelling) 3 d.

Varicella Zoster virus

Droplet inf. / Direct contact vesicles
14-21 days
1 d (rash) till all lesions are crusted.

EBV
Human Herpovirus type 4
Oral Saliva Contaminated food
5-15 days
Pharyngeal excretion persist for ms

period

C/P

Prodromal Stage (3 days ) .

Fever Malaise
Nasal Catarrhal
Associated :
2 Eyes : - Conjunctivitis
- Photophobia
2Mouth : - Dry Cough
- Hoarseness of voice
Skin : Koplik Spot
LNs : Generalized
Lymhadenopathy
Eruptive Stage

(7-10 d )

* Rash : Pink maculopapular

* Start : Along Hairline & behind
ears
* Spread : Face Neck
rd
Trunk UL LL ( 3 Day )
*Associations : Temperature
( up to 40 C ) for 2 3 days +
mild itching & may be
Hemorrhagic ( Black measles )
Convalescence Stage (7-10 d )
- Symptoms improve with
disappearance of rash
- Desquamation isnt infectious
- Takes 7 10 days

Prodromal Stage (24 hours ).

mild Catarrhal symptoms
before rash ( pass unnoticed )
Enlarged Tender LNs :
- retro auricular
- post cervical
-sub occipital
LN enlargement & persist for a
weak
Eruptive Stage

(3 d )

* Rash : Pink maculopapular

* Start : face
* Spread : so quickly , cover
en re body within 24 hours
rd
* End : by the 3 day with
minimal desquamation if any

(1) Start By : FAHM , a er 24 hours

Salivary Glands ++
(2) Paro s : (m/c) = Painful
swelling of one/ both parotids ( one
parotid may proceed the other )
Pain is by : - mastication
- sour liquids ( lemon juice )
- Palpation of gland
Swelling - reach maximum size
within 1 -3 days
- Obliteration of angle between
mandible & mastoid process
-Push ear lobule outward & upward
- +ve erythema around : orifice of
nd
Stenson's duct ( opposite upper 2
molar )
- subside within 4 7 days
(2) Submandibular Swelling :
(3) Sublingual swelling :

Prodromal Stage (24 hours ).

Fever : very mild
AHM ( pass unnoticed )
Short for 24hours before rash
Eruptive Stage

* Rash : Pleomorphic ; many forms of

lesion at the same time
Centripetal more profuse in trunk
-present also in : m.m - conj. - cornea
* Form : macule papule vesicle
ulcerate & crust
*liquid : Clear then Cloudy
*Associations : Pruritis + generalized
Lymphadenopathy
- New Lesions appear up to 3-4 days
- Whole Dura on : 10-14 days
* End : disappear with no residual
scarring

Pharyngitis * Sorethroat
* Enlarged Tonsils
* covered by white
membrane

Triad

Lymphadenopathy

- Cervical (m/c)
- may be generalized
- Discrete , firm , tender
HSM .
Hepatomegaly .

Splenomegaly .

- (1/3 of cases )
- Anicteric
Hepatitis
- Jaundice : rare

- ( 50 % of cases)
- Lt. upper quadrant
discomfort
- Tenderness

+ Fever : - high fever ( 39.5C )

- Gradually along 7 days
- May be low grade prolonged
+ Rash : ( 5 15 % )
- Maculopapular
- related to Ampicillin

Dis.
Comp.

Measles ( Rubeola )
Neurological manifestation .
* Encephalitis : - Early viral
- Late Post viral
* SSPE : Subacute Sclerosing Pan
Encephalitis ( rare )
( 4-8 years a er infec on )
-WHY ? slow viral infection &
reactivation Brain Cell
degeneration & dementia
-WHAT ? personality changes
convulsions - & extra manifest.
* Others : GB$ - TM ON - HP

Rubella ( German measles )

Mumps ( Epidemic parotidis )

( CP TEN )
1- Congenital Rubella $ :
2- Polyarthritis : ( more in )
- affect small joints of hands
- appear as the rash is fading
- clear spontaneously after
5-10 days
3- Trombocytopenia, Purpera
4- Encephalitis
5- Neuritis , GB $

( MOOD PEM itis )

* Meningeo-Encephalitis :
- most dangerous
- either viral / post infectious
* Orchitis & Epidedynitis :
( 30% of adolescence & adult )
- Tender swollen testis
- red edematous scrotum
- OR Testicular Atrophy dt tough
tunica albugina
- No infertility
*Oopheritis:(7% of postpupertal )
- Pelvic Pain & Tenderness
- No infertility
* Deafness: ( usually unilateral )
*Pancreatitis : - F,V,Shock
- Epigastric Pain & Tenderness
- Serum Lipase
- DM : late
* mumps Emryopathy : Endocrinal
*it is : Nephritis Myocarditis
Thyroididtis Mastoiditis arthritis

Respiratory manifestation .
* Pneumonia :
( m/c cause of death )
- Early interstitial Viral
- Late 2ry Bacterial
* Obstructive Laryngitis &
Tracheobronchitis : marked
Hoarseness & Stridor
* Dormant TB Focus Activation
* Otitis Media : infective &
secretory ( dt obstruction )

TTT

Prev.

- Vit. A supplementation
- Sedatives & antipyretics
- Care of the eye : Eye drops +
Avoid Direct Light

((((

Investigaions

1- Isolation of the virus :

From nasopharynx during
rash & 7 days a er
2- Serological Tests : As :
Hemagglutination inhibition
test to detect anti-Rubella
Abs
1- Isolation at home for 7
days after onset of rash
2- Symptomatic ttt :
Antipyretics
3- Complication ttt

Active Imm. : Measles Vaccine :

Active Imm. : MMR

either Sparate or MMR

Passive Imm. :

Passive Imm. :

Immune serum Igs

SerAttenuation
- 0.05 dose IM
- acquired imm

Seropervention
- 0.25 dose IM
- rst 5 days
- no acquired imm

))))

( usually not needed except when

there is contact with pregnant )

1- Symptomatic : - Analg & AntiPyr.

- Bed rest till swelling subside
- Diet : Soft / Semisolid , avoid sour
liquid & spices
2-ttt of complication :
- Orchitis : Bed res + Local Support
+ CorticoSteroids + Analgesics
- Pancreatitis : Antiemetics +
adequate fluid intake + Analgesics

Chicken Box (Varicella )

( Noha CT Skin )
1- Neurological :
- Cerebellitis ( viral / post viral )
- GB$ - TM transient ON FP
2- Ocular : Keratitis
Vesicular Conjunctivitis
3- Hepatitis & Reye $
4- Arthritis & acute myoscitis
5- Cardiac : Pancarditis
6- Congenital Varicella : charac. By :
- LBW - Cortical Atrophy seizures
MR cataract microcephaly
chorioretinitis
7- Thrompocytopenia , Purpera
8- Skin Lesions : ( m/c)
2ry Bacterial infec on Scarring
TTT
1- General Measures :
Local antiseptics - daily change of
clothes & bed linens
2- Antipyretics :
paracetamol 10-15 mg/Kg/dose
3- systemic ABs : for 2ry bacterial
infections
4- AntiViral Agents :
Acyclovir 10 mg / Kg 8 hours , for :
- immunocompromised patients
- < 2 ys
- Viral encephalitis
- Occular affection

Active Imm. : Mumps Vaccine :

Active Imm. : Live attenuated

either Sparate or MMR

Vaccine for 1 year

st

Passive Imm. :
For immunocompromised

EBV
( Neuro FORCH )
1- Neurological :
- aseptic meningitis GB $ - TM
2-Fulminent EBV : in IC patients
3- Oncogenic :
- Burkitt's lymphoma
- Nasopharyngeal Carcinoma
4-Rupture Spleen
5- Cardiorespiratory : myocarditis
- atypical pneumonia
6- Hematology : ITP Hemolytic
Anemia Aplastic Anemia

((((

Investigaions

))))

-CBC :Leukocytosis lymphocytosis

- Paul Bunnel Test : agglutination test
detecting heterophil Abs ( with sheeps
RBCs )
- EBV specific serology test
- (1) An viral Capsid Ag :
IgM early
Ig G late
- (2) EBNA " EB Nuclear Ag " an bodies
, late to appear

1- Antipyretic
2- Steroids indicated in :
- Pharyngeal Edema
- Autoimmune phenomena :
ITP , hemolytic Anemia , GB $ , TM