Pediatric infectious Pediatric infectious diseases. Vaccination diseases. Vaccination

programsprograms

Prof. Dr. György FeketeProf. Dr. György Fekete

Localizing symptomsLocalizing symptoms

SkinSkin Upper respiratoryUpper respiratory Lower respiratoryLower respiratory GenitourinaryGenitourinary GastrointestinalGastrointestinal CNSCNS SkeletalSkeletal CardiovascularCardiovascular HepaticHepatic

Characteristics in infants and Characteristics in infants and childrenchildren

Neonates, infants: non-specific initial Neonates, infants: non-specific initial symptoms (irritability, lethargy, poor symptoms (irritability, lethargy, poor feeding)feeding)

Specific rashesSpecific rashes Sites of infectionSites of infection Prevention: vaccination/ Prevention: vaccination/

immunizationimmunization

ErysipelasErysipelas

Superficial inflammation of the skinSuperficial inflammation of the skin Streptococcus pyogenes, Streptococcus pyogenes,

Staphylococcus aureusStaphylococcus aureus Complication/ infants: sepsisComplication/ infants: sepsis

ErysipelasErysipelas(Group A Streptococcus, acute cellulitis and (Group A Streptococcus, acute cellulitis and

lymphangitis)lymphangitis)

Cellulitis (phlegmone)Cellulitis (phlegmone)

Inflammation of theInflammation of the

subcutaneous connective subcutaneous connective

tissue – may lead to abscesstissue – may lead to abscess Streptococcus pyogenes, Streptococcus pyogenes,

Staphylococcus aureus,Staphylococcus aureus,

Haemophilus influenzae (Haemophilus influenzae (<<2 yrs)2 yrs) Therapy: penicillin+ clindamycinTherapy: penicillin+ clindamycin

Infectious diseases with rashInfectious diseases with rash

Stadium incubationis: in general-Stadium incubationis: in general-

no symptomno symptom Stadium prodromum: non-specific Stadium prodromum: non-specific

symptomssymptoms Stadium floritionis :characteristic Stadium floritionis :characteristic

symptomssymptoms

Measles (Rubeola, Morbilli, Nine- Measles (Rubeola, Morbilli, Nine- Day Measles)Day Measles)

Paramyxovirus, RNA virusParamyxovirus, RNA virus 7-14 days incubation, prodromal fever7-14 days incubation, prodromal fever Coryza, hacking cough, conjunctivitisCoryza, hacking cough, conjunctivitis Koplik’s spots 2-4 days laterKoplik’s spots 2-4 days later Rash: retroauricular, temporal region, then Rash: retroauricular, temporal region, then

on the face - maculo-papulous on the face - maculo-papulous exanthemesexanthemes

Photophobia, high feverPhotophobia, high fever Complications: bacterial super- Complications: bacterial super-

infections,encephalitis, cerebellitis, infections,encephalitis, cerebellitis, subacute sclerotizing panencephalitissubacute sclerotizing panencephalitis

Measles Measles (RNA virus, macular rash, (RNA virus, macular rash,

Koplik’s spots)Koplik’s spots)

Koplik’s spotsKoplik’s spots

Resembling tiny grains of white sand Resembling tiny grains of white sand surrounded by inflammatory areolaesurrounded by inflammatory areolae

Buccal mucosa opposite the 1st and Buccal mucosa opposite the 1st and 2nd upper molars2nd upper molars

Rubella (German Measles, Three-Rubella (German Measles, Three-Day Measles)Day Measles)

Togavirus, RNATogavirus, RNA 14-21 days incubation14-21 days incubation Painful lymphadenopathy: Painful lymphadenopathy:

retroauricular, cervical, occipital retroauricular, cervical, occipital region: Theodor- Klatsch symptomregion: Theodor- Klatsch symptom

PeelingPeeling Congenital rubella syndromeCongenital rubella syndrome

RubellaRubella(RNA virus, maculopapular rash, occipital (RNA virus, maculopapular rash, occipital

lymphadenopathy)lymphadenopathy)

Congenital rubella syndromeCongenital rubella syndrome

Infection of seronegative mother during Infection of seronegative mother during pregnancypregnancy

Risk of fetal infectionRisk of fetal infection• I. trimenon: 75-90%I. trimenon: 75-90%• II. trimenon: 20-40%II. trimenon: 20-40%• III.trimenon: 25-50%III.trimenon: 25-50%• Fetal lesionFetal lesion

1-8. gest. week: 80%1-8. gest. week: 80% 9-12. gest. week: 30%9-12. gest. week: 30% 13-20. gest. week: 10% 13-20. gest. week: 10%

Congenital rubella syndromeCongenital rubella syndrome

GestationGestation• 14- 60. days: embryopathy – cataracta, 14- 60. days: embryopathy – cataracta,

microphthalmia, hearing loss, congenital microphthalmia, hearing loss, congenital heart disease, microcephalia, thymus heart disease, microcephalia, thymus hypoplasiahypoplasia

Rubella vaccination is prohibited during Rubella vaccination is prohibited during pregnancy! pregnancy!

Roseola infantum (exanthema Roseola infantum (exanthema subitum)subitum)

(Human Herpesvirus-6, high fever,maculopapular rash)(Human Herpesvirus-6, high fever,maculopapular rash)

ChickenpoxChickenpox

Extremely contagiousExtremely contagious 14-16 days incubation, 14-16 days incubation,

communicability is possible from 10 communicability is possible from 10 to 21 days after exposureto 21 days after exposure

Varicella (chickenpox)Varicella (chickenpox)

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

crusting)crusting)

Varicella (toxic)Varicella (toxic)

Infectious mononucleosisInfectious mononucleosis (Epstein- Barr virus infection) (Epstein- Barr virus infection)

Infectious mononucleosisInfectious mononucleosis(Epstein-Barr virus, enanthema=pharyngeal (Epstein-Barr virus, enanthema=pharyngeal

petechiae)petechiae)

Infectious mononucleosisInfectious mononucleosis

Scarlat feverScarlat fever(Group A Streptococcus, erythrogenic toxin, (Group A Streptococcus, erythrogenic toxin,

fine papular exanthem, palmar/ plantar fine papular exanthem, palmar/ plantar peeling)peeling)

Kawasaki diseaseKawasaki disease(Multisystem vasculitis)(Multisystem vasculitis)

Mumps (Epidemic Parotitis)Mumps (Epidemic Parotitis)

Paramyxovirus, infected salivaParamyxovirus, infected saliva 14-21 days incubation14-21 days incubation Headache, anorexia, malaise, feverHeadache, anorexia, malaise, fever Pain on chewing or swallowing acidic Pain on chewing or swallowing acidic

liquidsliquids Parotid and other salivary glands are Parotid and other salivary glands are

tender, tissue edematender, tissue edema The oral duct openings of the glands The oral duct openings of the glands

are „pouting” and inflamed are „pouting” and inflamed

MumpsMumps

Tonsillopharyngitis Tonsillopharyngitis streptococcicastreptococcica

Other bacteria: S. aureus,Other bacteria: S. aureus,

H. influenzae positive in throat H. influenzae positive in throat microbiological cultures are not microbiological cultures are not pathogenic. Antibiotic treatment is pathogenic. Antibiotic treatment is not necessary!not necessary!

Aminopenicillin antibiotics are not Aminopenicillin antibiotics are not recommended –possible infectious recommended –possible infectious mononucleosismononucleosis

ComplicationsComplications

Abscess of the cervical lymphnodesAbscess of the cervical lymphnodes Peritonsillar abscessPeritonsillar abscess SepsisSepsis Late: rheumatic fever, acute diffuse Late: rheumatic fever, acute diffuse

glomerulonephritisglomerulonephritis

Lyme diseaseLyme disease(Borrelia Burgdorferi, erythema chronicum (Borrelia Burgdorferi, erythema chronicum

migrans)migrans)

TetanusTetanus(Clostridium tetani exotoxins)(Clostridium tetani exotoxins)

TetanusTetanus

Neonatal: contamination of the Neonatal: contamination of the umbilical cordumbilical cord

Muscle stiffnessMuscle stiffness Difficulty in swallowingDifficulty in swallowing PainPain Trismus associated with tooth, Trismus associated with tooth,

peritonsillar, retropharyngeal peritonsillar, retropharyngeal abscessabscess

Influenza Viral InfectionInfluenza Viral Infection

RNA orthomyxoviruses, types A, B, CRNA orthomyxoviruses, types A, B, C Young children: bronchiolitis, Young children: bronchiolitis,

pneumonia, myositispneumonia, myositis Secondary bacterial infection of the Secondary bacterial infection of the

respiratory tractrespiratory tract Salicylates should be avoided (risk of Salicylates should be avoided (risk of

Reye syndrome)Reye syndrome) Th: oral oseltamivir (Tamiflu)Th: oral oseltamivir (Tamiflu)

Human Immunodeficiency Virus Human Immunodeficiency Virus Infection (AIDS)Infection (AIDS)

RNA retrovirusesRNA retroviruses Occurrence is rare in childrenOccurrence is rare in children 80% intrauterine, intra partum, 80% intrauterine, intra partum,

breast feeding, 10- 15% blood and breast feeding, 10- 15% blood and blood products, 5% unknown originblood products, 5% unknown origin

Risk of children of HIV infected Risk of children of HIV infected mother: 20-40%mother: 20-40%

AIDS/ clinical formsAIDS/ clinical forms

Slowly progressing form: intra Slowly progressing form: intra partum, post partum infectionpartum, post partum infection

Frequent and severe infections after Frequent and severe infections after latency (1-2 yrs)latency (1-2 yrs)

Lymphoid interstitial pneumonitis, Lymphoid interstitial pneumonitis, hypergammaglobulinemiahypergammaglobulinemia

Death before the age of 6 yrs in 60%Death before the age of 6 yrs in 60%

AIDS / preventionAIDS / prevention

Antiviral treatment of infected Antiviral treatment of infected mother during pregnancymother during pregnancy

Isolation of newborn baby from Isolation of newborn baby from infected motherinfected mother

No breast feedingNo breast feeding BCG vaccination is prohibited!BCG vaccination is prohibited!

AIDS / clinical formsAIDS / clinical forms

Rapidly progressing: intrauterine infectionRapidly progressing: intrauterine infection Repeated,severe infections with classical Repeated,severe infections with classical

and opportunistic pathogens and opportunistic pathogens (Pneumocystis carinii, Cryptosporidium, (Pneumocystis carinii, Cryptosporidium, Candida, HSV, EBV, CMV)Candida, HSV, EBV, CMV)

Failure to thrive,enlargement of parotid Failure to thrive,enlargement of parotid gland, lymphadenopathy, cortical atropy, gland, lymphadenopathy, cortical atropy, demyelinisation of the brain, death at the demyelinisation of the brain, death at the age of 3 yrsage of 3 yrs

BCG sepsis!BCG sepsis!

Immunization scheduleImmunization schedule BCGBCG Birth Birth Hepatitis B1Hepatitis B1 Birth to 2 moBirth to 2 mo 22 1 to 4 mo1 to 4 mo 33 6 to 18 mo6 to 18 mo H.infl. Typ b 2,4,6 moH.infl. Typ b 2,4,6 mo DTP+IPVDTP+IPV 3 mo3 mo DTP+OPVDTP+OPV 4,5 mo4,5 mo MMRMMR 15 mo, 6 yr (12 yr)15 mo, 6 yr (12 yr) Recommended: varicella, hepatitis A, Recommended: varicella, hepatitis A,

pneumococcal conjugate vaccine pneumococcal conjugate vaccine

Types of vaccinesTypes of vaccines

Live attenuated viruses (measles, Live attenuated viruses (measles, mumps, rubella, varicella, polio)mumps, rubella, varicella, polio)

Inactivated viruses (polio, hepatitis Inactivated viruses (polio, hepatitis B, influenza)B, influenza)

Inactivated bacteria (pertussis, Inactivated bacteria (pertussis, diphtheria, tetanus, H. influenzae diphtheria, tetanus, H. influenzae type b, pneumococcus)type b, pneumococcus)

Non- mandatory vaccinesNon- mandatory vaccines Polysaccharid vaccinesPolysaccharid vaccines

• Meningococcus A, C, W-135, Y serotypesMeningococcus A, C, W-135, Y serotypes• Pneumococcus, 23 serotypes, 7 serotypesPneumococcus, 23 serotypes, 7 serotypes

Hepatitis- A, A+BHepatitis- A, A+B Human papillomavirus (HPV)Human papillomavirus (HPV) InfluenzaInfluenza Tick - borne encephalitisTick - borne encephalitis RotavirusRotavirus Chickenpox (varicella)Chickenpox (varicella) RSV RSV

Endocarditis prophylaxisEndocarditis prophylaxis

Antibiotic prophylaxis for dental Antibiotic prophylaxis for dental procedures is now recommended only in procedures is now recommended only in patients with a prosthetic heart valve; patients with a prosthetic heart valve; previous IE; cyanotic congenital heart previous IE; cyanotic congenital heart disease that is unrepaired, within 6 disease that is unrepaired, within 6 months of a repair procedure, or repaired months of a repair procedure, or repaired but with residual defect at or near the but with residual defect at or near the location of prosthetic material; or in location of prosthetic material; or in cardiac transplant recipients with cardiac cardiac transplant recipients with cardiac valvulopathy valvulopathy

Antibiotic prophylaxis to prevent Antibiotic prophylaxis to prevent endocarditis endocarditis

During dental / respiratory During dental / respiratory procedures : oral amoxicillin, 50 procedures : oral amoxicillin, 50 mg/kg 1 hr beforemg/kg 1 hr before

For patients allergic to penicillin: For patients allergic to penicillin: clindamycin, 20 mg/kgclindamycin, 20 mg/kg

Oral-dental procedures requiring Oral-dental procedures requiring endocarditis prophylaxisendocarditis prophylaxis

ExtractionsExtractions Periodontal proceduresPeriodontal procedures Dental implant placementDental implant placement Root canal surgery beyond the apexRoot canal surgery beyond the apex Subgingival placement of orthodontic Subgingival placement of orthodontic

bands but not bracketsbands but not brackets Prophylactic cleaning of teeth / bleeding is Prophylactic cleaning of teeth / bleeding is

anticipatedanticipated Intraligamentary local anesthetic Intraligamentary local anesthetic

injectionsinjections