Pediatric infectious diseases and exanthems Mikolášek, Musil Department of Pediatric Infectious Diseases, Faculty of Medicine, Masaryk University, University Hospital, Brno, Czech Republic • 787px-Tonsillitis • Tonsillitis • •Streptococcus pyogenes •Fever •Chills •Sore throat •Lymphnodes submandibular 787px-Tonsillitis • •Unilateral sore throat (occasionally accompanied by ipsilateral ear pain) •Dysphagia with pooling of saliva and drooling •Trismus (inability to open the mouth due to muscle inflammation and spasm of the masticator muscle) •Torticollis Treatment of tonsillitis PNC!!! - first choice!!! •high susceptibility~ 100 % for S. pyogenes •bactericidal atb • compliance (short elimination half-time) – 4x/day •~30 % is secreted on oral mucous membranes CFS I. gen. •postantibiotic efect, compliance, cross-reactivity rates with PNC of ~ 1 % •wider spectrum, postantibiotic collitis, resistance? Clindamycin • ~100 % secretion on mucous membranes • bacteriostatic effect, resistance 5 % for S. pyogenes (2013 CZE), postantibiotic colitis Macrolides – compliance, ~ 100 % secretion on mucous membranes bacteriostaic effect, resistance 5 % for S. pyogenes (2013 CZE) AMINOPNC ? EBV infection + AminoPNC EBV infection + AminoPNC •Non- IgE-mediated reaction •Rash appears 5-10 days after iniciation of aminopnc treatment •EBV infection induces unrelated non-EBV heterophile antibodies •Mechanism: circulating Atb-Ab complexes → complement activation → inflammation •Not permanent C:\Users\26131\Desktop\13223_2014_589_Fig1_HTML.jpg • 38 69 ; 4a C:\Users\26131\Desktop\143308.jpg Scarlet fever • •S. pyogenes erythrogenic toxin (A, B, C) •Scarlet throat •Strawberry tongue •Skin desquamation 38 69 C:\Users\26131\Desktop\143308.jpg Scarlet fever •very small, confluent, fine red papules (trunk and extremities) •"Goose bumps" (cutis anserina) • N:\KDIN\FOTKY\fotky 54\Chlachulová Monika,r.č.1255141360, varciela, absces podbříšku, scarlatina\20151102_222405.jpg • • 5 N:\KDIN\FOTKY\fotky 54\Grénarová Aneta,r.č.9859214024 mononucl. infect. - krk\20151127_144152.jpg Infectious mononucleosis • •EBV, CMV •Herpesviridae •Mild fever •Sore throat •Membranous pharyngitis •Lymphadenopathy •Hepatosplenomegaly •Edema around eyes •Fatigability •Prolonged •Lymphomonocytosis,↑ LD Hepatopathy •Symptomatic therapy • N:\KDIN\FOTKY\fotky 54\Grénarová Aneta,r.č.9859214024 mononucl. infect. - krk\20151127_144152.jpg HerpLip herpes_simplex-1 1 1a Herpes simplex •HSV 1, 2 •Herpesviridae •High prevalence •Persistent in neural ganglion •Group of vesicles, pustules, crusts •Around mouth, nose •Complications • • HerpLip herpes_simplex-1 • herpes 17 Gingivostomatitis • herpes 17 Herpetic encephalitis 960757-969773-115 09 70 Varicella (chickenpox) •Primary infection of Varicella-zoster virus •Herpesviridae •Very contagious •10-21 (28) days of incubation •Macules-papules-vesicles-pustules-crusts •Eruption of eflorescence runs in the cycles •Also in the scalp, mucous membranes • 960757-969773-115 09 12 70a Herpes zoster (shingles) •Reactivation of Varicella-zoster virus from neural ganglion •Propagation along neural axon •Restricted to 1 or more dermatoms •Prodromal pain 12 • • C:\Users\26131\Desktop\image2.jpg C:\Users\26131\Desktop\image3.jpg Exanthema subitum (sixth disease) •90%- HHV 6, 10% HHV 7 •Herpesviridae •0-3 year old •3 days of high fever •After the temperature falls, onset of rush (pinkish) appears •Occipital lymph nodes •Bulging anterior fontanelle • C:\Users\26131\Desktop\image2.jpg • Hand-foot-mouth disease •Coxsackie viruses A 16, B1,3 a 5, enterovirus 71 •Picornaviridae •Spring, autumn •2 days fever •7 day papules and vesicles • C:\Users\26131\Desktop\fifth-disease.jpg C:\Users\26131\Desktop\U5ds4esvqkV7G2gjcRNtWMh1g9Wz2ti_1680x8400.jpg Megalerythema infectiosum •Fifth disease •Parvovirus B 19 •Parvoviridae •Distinctive „slapped cheek“ appearance •Irregular lacy papular-purpuric exanthema •"gloves and socks syndrome" •No fever, flu-like symptoms •Arthritis (older kids, adults) • C:\Users\26131\Desktop\U5ds4esvqkV7G2gjcRNtWMh1g9Wz2ti_1680x8400.jpg C:\Users\26131\Desktop\GlovesSocks1.jpg C:\Users\26131\Desktop\Measles2.jpg C:\Users\26131\Desktop\koplikove-mrlje2.jpg •Morbillivirus (Paramyxoviridae) •Highly contagious (air droplets for several hours) – 4 days before/after rash onset •incubation: 10 days (prodromal), 14 days (rash) • C:\Users\26131\Desktop\Measles2.jpg Measles (Rubeola) •2 stages: •Prodromal: fever, conjunctvitis, runny nose, fatigue, nausea, lymphadenopathy, Koplik's spots •Exanhematic: maculopapular, confluent rash (hypersensitivity of immune system!) Complications: respiratory tract, CNS Measles (Rubeola) C:\Users\26131\Desktop\koplikove-mrlje2.jpg C:\Users\26131\Desktop\Measles2.jpg Measles (Rubeola) •Facies morbillosa ("unhappy child") •conjunctivitis •runny nose •rash Measles outbreaks •MMR vaccination (since 1971) •≥ 95 % - the herd immunity works •Vaccine refusers → outbreaks •Czech Republic •2017 136 cases •2018 158 cases •2019 590 cases • • C:\Users\26131\Desktop\https-%2F%2Fblogs-images.forbes.com%2Fniallmccarthy%2Ffiles%2F2019%2F04%2F20 190416_Measles.jpg • C:\Users\26131\Desktop\mcv1_1980_2018.gif •Rubivirus (Togaviridae) •contagious (air-droplets, transplacental) •Incubation: 12 – 23 days •Prodromal signs +/- •subfebrile •swollen lymph nodes •pink maculopapular rash (no confluent) on the face which spreads to the rest of the body (3 days) •Forschheimer's sign (petechiae on the soft palate) occurs in 20% of cases German measles (Rubella) C:\Users\26131\Desktop\RubellaSquare.jpg C:\Users\26131\Desktop\forcheimer.jpg • C:\Users\26131\Desktop\reyalWfutOxQNUGorEpHchlg.png Giant_urticaria 9875_lores • Erythema migrans •Skin form of lyme disease •Tick-borne •Borellia •Asymptomatic •Penicilin Giant_urticaria 9875_lores • N:\KDIN\FOTKY\fotky 54\Horváthová - impetigo\IMG_2903.JPG N:\KDIN\FOTKY\Fotky 52\Rosecký, bulozní impetigo\IMG_3769.JPG Impetigo •Staphylococcus aures, Streptococcus pyogenes •Honey crusted •Epidermis •No fever •Progression •Transmission by contact •Ussualy superinfection • N:\KDIN\FOTKY\Fotky 52\Rosecký, bulozní impetigo\IMG_3769.JPG • N:\KDIN\FOTKY práce\fotky 54\Srostlíková, flegmona\IMG_20200120_125109.jpg Erysipelas •Streptococcus pyogenes •Localized skin infection •Distinct demarcation •Local edema •Fever, malaise and other general symptoms •Propagation along lymph veins – red strips N:\KDIN\FOTKY práce\fotky 54\Srostlíková, flegmona\IMG_20200120_125109.jpg • puch_1 pemfigus1 pemfigus2 pemfigus3 Staphyloccocal scalded skin syndrome •Exfoliative toxins A, B •(Staphylococcus aureus) •Neonates •Infected umbilicus •Vesicles or large bulla with yellow fluid •Epidermis (stratum granulosum) •Exfoliation •Hospital-acquired pemfigus2 mening1 IMD •purulent meningitis •septicaemia •mixed form • Menigococcal sepsis •Neisseria meningitis (A, B, C, Y, W, X) •Petechial rush on lower extremities •Rapidly progressive •Bleeding to skin, mucosa, organs •DIC •Death •Plastic surgery in recovery needed • mening1 mening3 mening2 Thank you for your patience, good bye •