Edited By Dr.

Shahzad MBBS Peds Simpified: Chapter :Infectious Diseases:

1. Cholera: Severe diarrhea leads to hypovolemic shock ,metabolic acidosis and death. Cause:Gram -ve vibrio cholerae. C/F -sudden onset-massive ,frequent,painless watery stools"rice water stools with some mucous. -no pus cells. -low grade fever -projectile vomiting -severe dehydration-dimished urine ourput and collapse(hypotension and peripheral cyanosis). complications : -Seizure,altered consciousness,hypoglycemia,death. -Acute renal failure. -Hypokalemia(arrythmia and abdominal distension) and acidosis,Paralytic Ileus. -Pulmonary edema due to rapid fluid correction. -Transient tetany due to electrolyte imbalance.

Management: Ors Fluid replacement

Gravinate syp Tetracycline or ciprofloxacin syp Add Kcl to ringer lactate 100ml . paracetamol syp.

Bacillary Dysentry: Causes: S.dysenteriae(Gr:A),S.flexneri(Group B),S Boydii(Group c),S.sonnei(Group D). C/F -crampy Abdominal pain(non localized lower abd.pain),urgency,tenesmus and malaise. -Temp. upto104 F lasts 1-3d. -Vomiting and diarrhea -dehydration. -watery and mucoid stool with blood( more than amedic dysentry). -Seizure. Dx stool examination (Leukopcytes and RBC's) CBC shows leukocytosis with lft.shift. Toxic child needs blood culture. Stool culure-isolating shigella.

Complications: Dehydration,acidosis and shock. Bacteremia,metastatic infections Febrile seizures.

Rectal prolapse. Hemolyic-uremic synd.

Rx Ors -TMP_SMX -Nalixidic aacid -ciprofloxacin x B.i.D x5d -ceftriaxone -cefixime syp. -Metoclopromide -diazepam (over 6 Months) -Calopol6plus

Giardiasis: Cause:Giardia Lamblia. C/F -Watery stools without blood,mucus,eisinophilsor leukocytes. -Greasy,meladorous stools,flatulence,bloating,malaise and vomiting. -Fever not present -Headache,diffused abdominal pain. -Bouts of diarrhea with constipation. -chronic diarrhea lead to malabsorption,steatorrhea,vit:A,iron deficiency and secondary lactose intolerance.

Dx -stool sample:identification of parasite(trophozoite or cyst)

-Liquid stools have highest trophozoites. -Detection of Giardia antigen in stools

Rx Ors Flagyl syp.Tid x5d Metoclopromide Imodium

Amebic Dysentry: Cause:Entamoeba Histolytica. C/F -Watery stools containing blood and mucus,abdominal pain(lower abdominal quadrants) and tenesmus. -Fever and dehydration.

Dx -Antigen detection in stools.

Rx Flagyl syp 5ml Entamazole 5-10ml Tds x5d for 1-5yr ORS Paracetamol

Round worm(Ascaris Lumbricoides):Peak incidence 1-6y. C/F -Abdominal pain ,distension or intestinal obstruction. -Pulmonary symptoms rare-passage of large no. of larvae thtough lungs causing blood stained sputum,cough,eoisinophilia and pulmonary infiltrates(Loffer's syndrome). Dx: Blood counts may show eisinophilia. large ,pink and round worms may be passed in vomitus or stools. Microscopy:eggs are found in stools.

Rx Mebedazole 100mg xB.i.D x 3d

Hookworm(Ancylostoma Duodenale): C/F -Intense pruritis(Ground Itch)may be present aon soles of foot. -Abdominal pain ,indigestion,anorexia,fullness and dirrhea. -Anemia b/c worm consumes 0.2-0.5ml blood /d -chronic infection causes hypo-albuminemia and edema leading o HF. Dx: CBC:Microcytic hpochromic anemia and eisinophilia. Stool specimen:Hookworm eggs are found.

Rx Mebendazole 100mg B.i.Dx3d Iron Therapy

Pinworm(Enterobius vermicularis): C/F -Nocturnalperianal pruritis causing sleeplessness. Dx Egg detected by pressing adhesive cellophane tape against perianal region. Adults:Stool sample or inspection of perianal region.

Rx Mebendazole 100mg xsingle dose

Diptheria:Incubation period 1-6 d. Cause:UTI or skin infection caused byexotoxin producing organism,cornybacterium diptheriae. C/F -Insiddious onset mild to moderate fever,malaise ,headache,but sore throat is not conspicuous. A-Pharyngeal diptheria: -Diptheric pharyngitis -Grayish membrane may be on tosnsils,uvulaorsoft palate unilaterally or bilaterally. -Difficulty in breathing(stridor) -Difficulty in swallowing -toxic with or without fever. -palatal paralysis -cervical lymph node enlargement. B-Laryngeal Diptheria: -Hoarseness of voice,brassy cough,increasing stridor and respiratory obstruction

(nasal regurgitation of food) -anxiety,restlessness ,cyanosis and suffocation(Tracheostomy) C-Nasal Diptheria : -Serosanguineous nasal discharge and excoriation of upper lip causing unilateral or bilateral purulent dischage due to foreign body in nostril. -A foul odour may be noticed. D-Other Forms: -Cutaneous,vaginal and wound diptheria N.B.Diptheria may cause myocarditis,Toxic polyneuritis,Bronchopneumonia ,hepatitis , nephritis,adrenal hemorrhage and gastritis as complication.

Dx -clinical -Direct smear -serial ECG's should be done -Culture:nose ,throat and skin lesions are cultured. -CBC-slight leukocytosis,rapid destruction of erythrocytes and thrombocytopenia(due to peripheral destruction)

Rx O2 inhalation Fluid and electrolytes balance Nasogastric Feeding Diptheria antitoxin 20,000-40,000 u for 2d Penicillin G 6-12 l u I/M or Erythrocin 40mg/kg/d Brufen syp. Paracetamol

Tracheostomy/Intubation Immunisation for recovered pt.

Pertussis(Whooping cough): Cause:Bordetella pertussis). C/F -infants>6m have apnea,cyanotic spells and couph but no whoop. -Three stages ,catarrhal,paroxysmal and convalescent. A- Catarrhal stage: -Mild viral UTI. -Coryza -Low grade fever ,wheexing and cough. -Dx difficult at this stage B-Paoxysmal stage: -Episode of coughing rises. -Whoop -infants not producing whoop are cyanosed -infants have poor appetite and lose weight C-Convalescentstage: -cough becomes less frequent -child's appetite may improve but recover in several months. Complications: -Bronchpneumonia,Atelectasis,Interstial and subcutaneous emphysema,OM and sinusitis,convulsions,epistaxissubconjunctival,intracraneal and subarachnoid hemorrhage,rupture of frenulum,rectal prolapse,umblical or inguinal hernia,reactivation of tb,malnutrition,apnea and sudden death.pneumomediastinum,pneumothorax,interstitial or subcutaneous emphysema and metabolic acidosis. D/D

-Bronchiolitis -Pneumonia -cystic fibrosis -TB -Asthama -Intratoracic lymphadenopathy. -Foreign body inhalation. Rx -O2 -Erythrocin 30-50mg/kg/d in 3 divided dosesx 14 d -or azomax 10mg/kg/d Od x5d -Brufen -Prednisone -salbutamol

Tetanus: Cause:clostridium tetani -anaerobic gram +ve bacillus. C/F A- Tetanus neonatorum:3-10d after bith.,failure to suck,spasm of facial muscles immobilizes jaw. -within 12-24 hours generalized tonic muscular convulsion occur. -baby may devlop temp.and jaundice. -involuntary defecation and urination(more commonly constipation andurinary retention. -baby may die due to severe spasms from exhaustion. B-Genralized Tetanus: -Most common form of tetanus -Trismus(difficulty in opening mouth.

-Difficulty in swallowing -Lockjaw -Facial distortion -Arched posture spasms may cause fractures and hemorrhages.

C-Cephalic Tetanus:rare form.inc.period 1-2d -Injury near head,trauma to head and face -cranial nerve involvement.

D-Localized Tetanus: -In the proximity of injury there is pain ,continuous rigidity and apsm of muscles. -resaolves within weeks Dx -clinical -Non-vaccination history -Gram stain of C.tetani +ve

D/D Tetany,bacterial meningitis,encephalitis,birth trauma,epilepsy,rabies,strychnine poisning and abscesses(parapharyngeal,retropharygeal or dental abscesses). Rx O2 inhalation Nasogastric Feeding Ats(Imatat) I/M Human tetanus immunoglobulin (TIG) 500 u /d Crystalline penicillin 200,000u/kg/d in four divided dosesx 10-14d Add Gentamycin

erythrocin or Flagyl Diazepam 0.1-0.2mg/kg I/v 3-6 hrly Largectil syp.

Measles:Inc.period 10-12d. Cause:RNA virus C/F A-incubation stage

B-Prodromal stage -5d cough coryza and conjunctivitis. -Kopic spots on buccal mucosa and lower molars. -Post.cerv.lymphadenopathy may occur.

c-Maculopappular rach with hi grade fever(104degree F) -Faint macules on face,behind ear and along hairline. -rash spreads to trunk and limbs. -slight splenomegally -Abd.pain due to mesentric lymphadenopathy. -face is swollen in severe cases. Black measles (hemorrhagic mesle ) is sever form. Dx Virus can be isolated in tissue culture or antibody titre. WBC's low D/D Roseola in fantum,Rubella,Scarlet fever,Meningococcemia,,drug rash and serum sickness,erythema infectiosum,infectiious mononnecleosis,toxoplasmosis,and kawasaki's disease

Complications: OMN ANd Pneumonia,encephalitis,SSPE,hemorrhagic measle,thrombocytopenia,post-measle gastroentritis,Noma(gangrene of mouth) may occur,corneal ulceration,conjunctivitis nad optic nerve damage,Myocarditis and cardiac failure. Rx -Brufen -Vit.aA supplement -Pseudoephedrine hydrochloride -Dextromethorphan for cough

Mumps:inc.period 14-20d Cause: RNA Mumps virus. C/F painful swelling of parotid gland. edema of soft pate,larynx or pharynxedema may extend upto upper chest.

Dx clinical. -leukopenia and lynphocytosis. -virus can be isolated from saliva,csf,blood or urine.-Enzyme immunoi assay for mumps IgG and IgM D/D -cervical adenitis,suppurative protitis,tumors. Complications: -Meningoencephalomyelitis,Orchitis,pancreatitis,Deafness

Rx Apply ice /heat on affected area

Tab brufen Tab deltacortril Interferon alpha 2 b Od.x7d salt water gargles.

Chickenpox(Varicella): Cause :Herpes virus Varicella-zoster(VZV). C/F vesicle,macule and pustules Low grade fever -Blisters may also occur on the palms, soles, and genital area.,face ,trunk and extremities

Dx The diagnosis of varicella is primarily clinical. Examination of the fluid within the vesicles of the rash, or by testing blood for evidence of an acute immunologic response. Compliocations: -Bacterial Infection:Toxic shock syndrome,sepsis,cellulitisimpetigo,subcutaneous abscesses and suppurative lymphadenitis. -Viral sequele:Pneumonia,hepatitis,arthritis,pericarditis,glomerulonephritis and orchitis and encephalitis. -Purpura fulminans,Reye's syndrome.

D/D Coxsackie virus infection ,impetigo,papular urticaria and scabies. Rx Fluids Paracetamol calamine lotion

Diphenhydramine syp. Perednisone (over 1 yr)0.05 to 2 mg/kg/day divided 1 to 4 times/day Aciclovir 500mg I/vT.i.Dx7D Calamine lotion Erythrocin

Malaria: Causes:P.falciparum(Most virulent),P.Vivax(Most common),P.malariae,and P.ovale. C/F -Episodes of chills foloowed by Hi-feverheadche ,nausea vomiting,myalgia and delirium. -splenomegally. -orthostatic hypotension,dehydration,jaudice,herpes labialis, and pallor due to anemia. svere malaria:hypoglycemia,jaundice,elevated aminotrannsferases and paracitemia 15%. Dx Blood MP or ICT Malaria

D/D : Meningitis,Appendicitis,gastroentritis,hepatitis,enteric fever,TB and septicemia. complications of Falciparum malaria: cerebral malaria,black water fever,hi output CHF,dehydration,adult respiratory distress syndrome,jaundice,sever anemia,DIC,hypoglycemia,circulatoryu collkapse,Tropical splenomegally syndrome,nephrotic syndrome. Rx Paracetamol

Brufen syp. Chloroquine For uncomplicated P-Falciparum: coartem 1 tab crushed in two TSF water Bidx4d for complicated P-falciparum: or quinine plus pyrimethamine-sulphaoxine Gravinate Mefenemic acid syp. or Brufen syp. N.B. Blood transfusion for anemia.

Typhoid fever(Enteric Fever): Cause:Typhoid bacillus. C/F Infants:severe gastroentitis or sever sepsis.vomiting,diarrhea and abd.distension common. Older child:Hi-grade continuous fever,headache ,anorexia,lethargy,myalgia,abd.pain and tenderness. -toxic look,log dran face and furred tongue central. -soft spleen may be palpable. Dx Typhidot test or widal test D/D: Gastroentritis,bronchpneumonia,spesis,malaria,Tb,hepatitis,amebic liver abscess,miliary Tb,bacterial endocarditis,infect.mononucleosis and leukemia or lymphoma.

Complications: Intestinal perforation,intestinal hemorrhage,toxic encephalopathy,acute

cholecystitis or hepatitis,pneumonia,pyelonehritis,meningitis,septic arthritis,sepsis and toxic myocarditis.

Rx Ciprofloxacin syp or tab. or cefspan syp. paracetamol 6 plus Lilac syp

TB: Cause:Mycobacterium tuberculosis. C/F Fever ,anorexia,irritabibility,malase ,easy fatigability,weight loss and night sweats. Dx Ghon focus on vhest cxr. Rx Myrin -P Vita 6 Vialyn M Deltacortril 1-2mg/kg/d for 4-6wks

Rheumatic Fever: Cause:Group A beta hemolytic streptococci. -polyarthritis,carditis and chorea,afebrile and minor complaints of limb pain. Dx clinical ESR raised in acute stage. C-reactive protein increased in acute phase

ASO titre-raised in 85% Throat swab culture Aneia-HB Reduced. ECG-Myocarditis=prolong pR interval Prolong QT interval St wave and T-wave changes

Rx Benzylpenicillin 6-12 lac u I/M od x10d or erythrocin 250-500mgx4tyimes x10d Aspirin(above 12yr) Prednisone Haloperidol Frusimide

Dengue Fever: Cause :Aedes Mosquito. C/F -Flu-like illness,fever,rash,headache,pain behind eyes,muscle and joint pain. -mild bleeding from the mucous membranes of the mouth and nose. Rx -Intravenous fluids -Ribavirin -Paracetamol -Blood transfusion -Fresh frozen plasma -Platelet transfusion