s
***Meningococemia
^^Gx:
Groups: A, B, C, D, E, H, I, K, L
Usually till 3y of age
More during cold season
With complement C5-9,C3 deficiency
^^Forms:
1. Carriers (2-30% of population)
2. Nasopharingitis
3. Meningoccocemia (without meningitis!)
4. Fulminant meningococcemia
(Waterhouse-Friderichsen syndrome) (without meningitis!)
5. Meningitis, meningoencephalitis
7. Rare forms : endocarditis, pneumonia, arthritis, chronic forms.
^^CF:
-Meningococcal Rash
all body
-No Not Fade Under pressure
^^Waterhouse-Frierechsen:
-N menigntiis—->massive Bleeing of adrenal Gland!
-Meningococcenia/low BP/ Shock/ DIC
**Meningitis:
^^Gx:
-Any Virus can give you meningitis!
-Tic bourne Encephalitis= Meningitis!
-Definition : Meningitis is an inflammatory procces of Leptomeninges!
ONLY Lumbar Puncture is 100% DX and tell us if its Bacterial or Viral
> Most Passed from Person to Person Via Resp Droplets!
—–>Depends on Age / Vaccination / County
^^Bacterial Causes
Most common | Neonate |
-H Influenza -Strpetococci Pn -N .meningitidis | -Strpetococcu -E Coli -Salmonella -Listeria Monocytogenes -Staph Aureus -Myco TB |
^CF of meningitis:
”FEVER(>38) + HEADACHE+NECK STIFFNESS”
In children Presentation is Nonspecific … Altered mental Status.Seizures
…Indicating increase in ICP!
…Also Photopia
…Petechial rash also possible if Nmeningitidis is the Cause
^^DX:(STUDY TABLES)
Viral Meningitis | Bacterial meningitis | TB (Aseptic) |
-Colorless -WBC>1 K - ↑ Lymphocyte -Glucose [N] | -cloudy -More Neutrophils -Glucose[ ↓] | -Not Cloudy,Clear -WBC<1K -More Lymphocyte -Glucose[ ↓ ↓] |
1- < 3 M: G3 Cephalosporine + AMpicllin (Ceftriaxone 50-100mg/kg IM /IV) (Cefotaxime 50mg/kg ) |
2- >3M: G3 Cephalosporine -We Tx all ifnection 14-21 Days except Hemicoccal and infleunxa 7 days! -Tb Meninitis We Tx for 6M !!! |
7-DURATION A-NEwborns are Treated Tx all infection 14-21 Days meningitis includes ) except Hemicoccal and infleunxa 7 days! B-Tb Meninitis We Tx for 6M !!! End Of Tx….Repeat Lumbar Puncture To check if CSF is Normal |
***MUMPS
^^Gx:
-Caused by Mumps Virus( Paramyovirida Family)- Genus Rubulavirus!
(Single stranded RNA)
-Only Affects Humans
-Tranmission :Air droplets!
-VERY Contagious
^CF:
-Typically affect 5-15 YO
I-During Prodromal: -General Mailase -Low Grade Fever -or even Asx |
II-Later(As it spreads in blood it wil laffect different systems!) 1-Parotid Gland (bilateral, For 7-10 day 2-CNS: -Aseptic Meningiis -Encephalitis -Hearing Loss 3-if affect GenitalsCan Cause ORchitis+ epididymitis! 4-if affects Kidney —->GNitis 5-if it affects the Joints——>Arthritis, Hips, Knees, ankles, Shoulders! 6-if it affects the heart——->Myocaridits 7-if it affect Pancreas———->Pancreatitis |
^^Dx:
1-Antibody titers High IgM |
2-Serology Test -Complement Fixation -Hemagglutination (-) Test -ELISA! |
3-Virus Isolation From saliva,urine, CSF |
4-Blood : ↑ Amylase & Lipase! |
^^Tx:
-Self Limited! No Specific Therapy!
***Diphteria:
^^Gx:
acute illness caused by corynebacterium diphteriae, a G+ bacillus,
-EpidemiologyAirborne or direct contact. Diphtheria is caused by toxin-producing strains
^^CF:
1. Fever
2. Malaise
3. Dyspnea
4. Sore throat
5. Dysphagia
6. Hoarsness
7. LN enlargement and swelling (bullneck appearance)
8. Pseudomembrane formation(tonsils/nasopharynx)
9. Myocarditis
10. Neurologica
^^DX:
-Culture From NPS Phanrygal membrane
-serology for Ab
-ECG/CBC/imaging
^^Tx:
I-Antibiotics: -Penicillin 100 000 U/kg/day I.V. q6 for 10 days -Erythromycin (if allergy) 20-50 mg/kg/day I.V. q6 for 10 days |
II-Antitoxin: dilute 1:20 09%NaCl + infusion not exceeding 1ml/min <48 hr + mild 40 000U |
III-supportive: Airway protection and aspiration preventionETI Mechanical Ventilationfor respiratory insuff with paralysis of resp muscles Hydration and bed rest for 2-3 weeks until risk of myocarditis decrease Prednisone 1-1.5mg/kg for 2 w (if myocarditis) |
Prevention 
PT vaccine (3.5-5years)
PT vaccine (3.5-5years)***Rubella:
^^Gx:
-rubella virus
-causes rubella(German (3-day) measles)
-transmission via respiratory secretions
^^Px:
-the virus replicates in the upper respiratory tract and lymph nodes
^^CF:
-low-grade fever
-polyarthritis and polyarthralgia
^^Dx:
I-CF:
lymphadenopathy before the rash
fine, pink, non-confluent maculopapular rash
Petechial Rash
II-LAb:
Sergoly IgM or IgG
^^Tx:
-Supperive
(Analgeisa/antipyretics/Hydration)
***Rubeola:(measles)
^^Gx:
-Meases(rubeola Virus)
-RNA Virus
^^CF:
-high-grade fever
-Cough
-Conjunctivitis
-Coryza
^^DX:
CF | LAb |
Koplik Spots (White macules) maculopapular Rash | Serology IgMor IgG |
^^Tx:
Supportuve Care
(Antipyretic/analegeisa/H2O)
Vita A
***Pertussis(whooping cough)
^^Gx:
-Bordetella Pertussis
-Resp Droplet
^^CF:
Catarrhall | Paroxysmal | |
-Low Fever -Coryza | Dry cough Vommit |
^^Dx:
I-Culture(Bordet/regan Agar)
II-PCR
III-Serology
(Froom nasophanyrgeal septum)
^^Tx:
Macrolides
Azithromycin)
^^Prevention:
-DTaP :vaccine -acellular pertussis vaccine -5 doses before school-age, completed by 4-6 years of age |
-Tdapvaccine -booster vaccine at 11-12 years of age -should also be given to pregnant mothers and those around them |
Salmonella Enteritidis | Campylobacteira | Yersinia Enterocolytica |
Via Poultry/Egg -#2 in LT -Warm Season | -Via Poultry/Egg -#1 in LT -Warm Season (Needs Microaerophilic condition=baggs) | -Refrigerator Disease (Meat/milk/CAKE) -Cold season |
-Stool=Green+Mucous | -Bloody stool on day 3-4 days | -Stool With Mucous -Possible Non Specific RASH -Cause by meadenitis (Gland inflammation) Only One where we Look for Ab |
Possiblity of sepsis | Possibility of spesis | -Possible sepsis -Diahrea Stops -Fever+ Pain in Abd Last for Weeks -Hepatosplenomegaly |
Tx: Ampiccilin ,TMP-SMX | Tx: Clarithromycin | -Gentamycin -TMS-SMX |
Shigella Flexneri(Dysentry) | E Coli |
-Last Place as Cause of Bacterial Diarrhea! -Humans Most Severe -Any Food (Small dose 100 mo) -Warm Season -NOT ZOONOTIC Uncommon in LT! | 1-ETEC=Enterotoxigenic 2-STEC/EIEC=Shiga Toxin producing/Enteroinvasive 3-EHEC: Enterohemorrgagic (Related to Hemolytic Uremic Syndrome) 4-EPEC :Enteropathogenic!  |
1-Stool: Bloody+ Mucous 2-Tenesmus! | 1-EPEC : -Enteritis of infants with mucous -No Blood -Possible Spesis -Big infective dose 2-ETEC: -Watery Stool -Travellers Diarrhea! 3-EIEC-STEC: Like Dysentry 4-EHEC: -Hemolytic Uremic Syndrome -Hemocolitis DO NOT Tx with Ax!! |
-CNS involvented (Irritability, Apathy,Seizures) -Tenesmus | 1-EPEC/ETEC/EIEC—–>T with TMP -SMX 2- EHEC NOT WITH Ax |
Tx Reccomended: First Ax—–>Cephalospon II+ IIIG + TMP-SMX |
Viral GE | Bacterial GE | Parasitic GE | |
CAUSE | -RotaVirus(most common Cause) | -E Coli/Salmonella/ -Campylobacteria | Entameoba-Giardia |
Characteristics: | -↑ Frequency (15-20 x Day) -Watery Yellowish -NEVER BLOODY -NO MUCOUS | -↑ Frequnecy -Greenish Offensive -BLOODY -Some Mucous | -Less Frequent (4-5x/day) -Semi Solid -BlOODY -High Mucous! |
Clinical Features | -Vommiting Before Diarrhea -No Tenesmus -No Abdominal Pain -Low Grade Fever <38.5 -Well Appearance of Child | -Vommiting After Diarrhea -Moderate Strain -severe Abdominal Pain -High Grade >38.5 -Child toxic Appearance | -No Vommiting -Tenesmus -Cramps -No Fever -No signs of Toxemia |
Stool Analysis | -Free -No Pus -No Mucous | - ↑ Pus cells -Blood(++) -Mucous | -Mucous(+++) - ↑ Pus Cells -Fat Globules |
***Scarlet Fever(BACTERIAL) :
”Syndrome cayed by Toxcin Producing Goup A B hemolytic Streptoccoci)…Affected Children between 5-15YO”
”CF are Fever…Pharyngeal erythema.. Tonsilar Exudate….sclart colored Rash on Groin,elbow, Fowem….
Ax Tx with Penicillin,Cephalosrpone 10 d + marolide 7 days … to prevent progression and Streprocci infectio
***RUBELLA :
”caused by Rubella virusCountered by MMR Vaccine…Airborne Transmission …CF Non speicfic Flu like Sx + Post aurical suboccpital LNopathy….Exanthems may overlap or follow after”
”Rash behind the ears and proress into maculopapular Rash…
T is it Self Limiting and need Sx Treatment”
”MMr vaccine between 12-15 M and btween 4-6 Y
***Meseales(Viral)
”Highly Infectious disease Casued bu Paramyxovirs…2 Phases Catarrhal+ Exantheme Stage…
-Catarrhal : Fever/conugivtie/ Coryza/Cough/Lp[;ol Sorts
-Exanthema: Development of Fever, Erytmatous manupilapular rash From Behind the eart and spread to rest of body toward Feet”
…No Need for Tc as it is Self limiting and wil have lifelong immunity
…You can Give suppotive Therpy
**Varicella VZV (Chickenpox)
”Primary Caused by Varicella -Zooster Virus…Airborn….Droplet….Sx are FEver,Prritic Rash Covering Enitre Body…Erythema changes….Dx is Clinical on Base of the Rash …. Tx it it Self Limiting so we focus on supportive….
however Antivital(Acyclovir) Maybe given for High Risk Group
RASH is itching + Painful! with elements of Rash in the Mouth and stomach
Varicella Vaccine 12-15 M
***EBV(Inf Monocunelosis)
^^Gx:
-kissing disease related to tonsilitis!
-initially its hard to distinguish btwn Steptocoocal tonsilitis and EBV tonsilitis….
^^CF:
-Fever
-Exudative pharyngitis
-LNdenopathy
-Hepatosplenomegaly
-Atypical Lymphocytocis
>HEPATOLSPLENOMEGALY + submanifbular LN are Enlarged+posterior Cervical LN are enlarged