PAEDIATRIC INFECTIOUS DISEASES
• + Vaccination Programs
• + Screening Programs
• + Illness and Injury Prevention Programs
URGENT NOTIFIABLE (PHONE) ROUTINE NOTIFIABLE (EMAIL)
• Avian Flu, • Acute rheumatic fever (GAS)
• Foodborne (≥2x linked cases) • Acute viral hep A/B/C
• Gastro (within institution) • Rheumatic heart disease - (< 35 yo)
• Coronavirus strains (SARS, MERS-CoV, SARS-CoV-2) • ADR to vaccinations
• Smallpox • CJD ® UK 1980 -1997 (bovine spongiform encephalopathy)
• Measles • HIV
• viral haemorrhagic fevers. • Pertussis
• Leprosy – mycobacterium leprae – affects skin, URT mucosa
and eyes ® red skin patch w/ NO sensation
• Syphilis
• TB
Describe global causes of childhood morbidity / mortality ® assess the impact of social determinants of
health on children.
Global causes for childhood morbidity and mortality Social determinants
• War and conflict • Low SES
o Drowning, road traffic injuries (lack of road safety programs and • Geographical location
adequate road infrastructure) • Unequal access to medical resources and expertise
• Unable to access clean drinking water o Higher rates of pre-term baby deaths (e.g. HIE – birth
o Increased risk of diarrhoea associated illnesses (e.g. cholera, ETEC asphyxia, aspiration pneumonia etc.)
– traveller’s diarrhoea) o Unable to manage congenital abnormalities
• Malnutritious diet (nil fortified foods – iodised salt in the making all breads)– effectively
increased risk of vitamin and nutrient deficiencies ® high risk of marasmus • Prioritisation of healthcare is non-existent in war-torn conflict
(def. in all nutrients) and kwashiorkor (mainly low protein) nations
• Poor health literacy • Low education – do not understand human rights to standard
• Ineffective or absent primary prevention programs (e.g. CST screening or HPV healthcare
vaccination in India not implemented unlike in Australia)
o Unprotected sex ® increased Tx of STIs, TORCH ® birth defects
o No vaccination plan
• Reliance on voluntary aid – MAFs (doctors without borders) – they come and
go (may pass on some knowledge but
, Vaccine Preventable Diseases
PP Sx Vaccine Route + Rx
Rotavirus Ø Replicated in mature significant childhood mortality è vomiting (1), diarrhoea (2), fever Oral live vaccine (before 6/12) to prevent ISS
enterocytes in GI lumen Ø Shed in large quantities during diarhoea Ø Rx and prevent dehydration (oral and IV fluids)
(non-enveloped RNA
virus) Ø Osmotic shifts Ø 5-7 days duration
Ø 95% asymptomatic IM 6 wks, 4 and 6 mths (eliminated in Aus.)
Ø 4% mild illness = GE + influenza-like illness (LRTi) Ø Inactivated poliomyelitis vaccine (need multiple
Polio Ø 1% aseptic meningitis (non-paralytic) – spasm of neck, back, doses to generate immunit
(faecal-oral)
(Poliovirus) lower limb
Ø <1% = paralytic poliomyelitis - spinal, bulbar, bulbospinal
(painful in back and lower limbs)
• Acute HBV = asymptomatic ® subclinical ® Sx ( Nausea, • Acute HBV infection = HbsAg +ve = no Rx
jaundice, liver fail)
Hepatitis B ® damage hepatocytes (vertical and • Chronic HBV infection = HbsAg +ve for 6/12 è
horizontal – bodily fluids) • 90% neonates acquire Hep B vertically transmitted develop antivirals or HBV Ig (pregnant)
(dsDNA virus) chronic = cirrhosis, HCC è fatigue, milkd RUQ discomfort, • Hep B vax within 12 hrs of birth
jaundice
• epiglottitis = stridor, drooling, tripoding, hot potato voice IM 6 wks, 4 and 6 mths (eliminated in Aus.)
HiB • Adhere to resp. epithelium ® • bacterial meningitis = fever, photophobia • Acute = Anaesthetists consult + IV 1g ceftriaxone
• IgA proteases stop opsonization (or 400mg moxifloxacin / 10mg dex)
(Gram -ve anaerobic
coccobacilli) • disseminating into blood (mets) • Transitoin from IV to oral Abx
• Ix: Slide agglutination or PCR
• Mainly Men B+C (w/ rise in subtype W and Y) Ø Resus - ABCD ® Empirical Abx: BenzylPenicillin /
• Adhere ® colonise ® tissue
• Severe/life threatening sepsis - bacterial meningitis = fever, ceftriaxone - blood and CSF culture
damage via Lipoligosaccharide
Meningococcus (Il-1,6,8,,TNF-a) photophobia, neck stiff, non-blanching rash Vaccinate:
• rans-epithelial /endothelial RF: immunocompromised Ø MenACWY funded at 12 mths
(N. meningitidis) =
Gram -ve cocci transport • Usu. children < 2yo & adolescence Ø MenB is funded at 2, 4 and 12 months for ATSI
• Bacteraemia (infection of blood • Endemic (Middle East)
stream)
• Overcrowding
Strep. Adhere ® colonise ® tissue damage • RF: ATSI, young age, lack of BF, seasonal (spring/autumn) Vax 2, 4 and 12 months
(Il-1,6,8,,TNF-a)® trans-epithelial • AOM, meningitis, osteomyelitis, or pneumonia Ø Prevanar = 13 valent vaccine
Pneumococcus /endothelial transport ®
• Nephrotic syndrome – ascites – peritonitis Ø Pneumovax– 23 valent vaccine (ATSI)
Gram +ve cocci Bacteraemia (infection of blood
Ø Abx – amoxicillin
(respiratory droplets) stream)
Prodrome = fever + coryza + pharyngitis followed by Ø Vaccinate at 18 months
Varicella – • widespread vesicular rash Ø Notifiable disease
Ø Airborne droplets • after recovery it hides dormant in nerve root ® reactivated as Acute:
chicken pox Direct contact
Ø shingles at a later date Ø PPE + infection precautions (PPE + isolation)
(VZV (HHV3)) • pneumonia and neurological issues (transverse myelitis, Ø Simple analgesia + cool compresses
cerebral ataxia or encephalitis)
Ø 1-5 day Prodrome of Ø Live attenuated MMR at 1 and 4 years (as
German measles
Rubella o low grade fever + teratogenic)
Ø Airborne Ø Isolate ® notify ® test (nasopharyngeal/buccal
(togavirus) o LN of occipital and post-auricular
Ø Maternal to foetus (may be swab, urine and blood tests – serology IgG, IgM for
mild and self-limiting infectious for 7 days) Ø Pinpoint pink maculopapular rash (face ® trunk but does not
measles, mumps or rubella)
darken or coaelece like measles) +/- arthralgia, conjunctivitis
Ø Prodrome: cluster of fever, cough, coryza, conjunctivitis
Measles Ø Person-person contact Acute Mx:
Ø Koplik spots (white spots in the mouth) before maculopapular
(highly contagious Ø airborne rash (from face then downwards to chest – palms/soles spared) Ø ALL infection precaustions (PPE + ISOLATION)
paramyxovirus) Ø Late sign = pneumonia (LRTi signs = cough), meningitis Ø Rubella ® analgesia, warm/cold packs
Fever, respiratory and constitutional symptoms Ø Measles ® supportive (antipyretics, fluids), Vit A,
ribavirin (for measles pneumonia)
1. 1/3rd patients = asymptomatic
Mumps 2. parotitis in 70%, (uni or bilateral) – 10days swelling
Ø Mumps ® analgesia, warm/cold packs
Ø School- or college children
(highly contagious (respiratory droplets) Ø
3. orchitis in 15-30% of post pubertal males, oophoritis (5%)
paramyxovirus)
*Brain damage, deafness and male infertility are rare complications
> check IgM, IgG serology
muscle spasms beginning: Ø 5xDPT at 6 wks, 4, 6, 18/12 and 4 years
Tetanus Ø Tetanus spores from faeces of
1) at jaw (trismis)
domestic animasl ® toxin
Clostridium tetani (tetanospasm) ® carried in 2) generalised muscle spasms (hyperreflexia)
(gram + ve rod) PNS to CNS (BLOCK inhibitory 3) seizures
From dirty wounds neurotransmitter)
4) difficulties with SOB and swallowing
Diphtheria toxin causes: Ø 5xDPT at 6 wks, 4, 6, 18/12 and 4 years ;
Diptheria Ø Life threatening Sore throat + fever Respiratory swab:
(Corynebacterium Colonise in pharynx ® Diphteria Ø Progresses to swollen bull neck (tonsillar pseudomembranous) Ø ABCD (ensure patent away)
diphtheriae (gram +ve exotoxin ® exudate ® coagulates to Ø Parenteral benzylpenicillin or erythromycin (as
rod) via respiratory form grey pseudo-membrane patient cannot swallow properly)
droplets) Ø Vax after recovery (inc. close contacts who also
may need ABx)
Colonise brush border of bronchial (1) Catarrhal stage = coryza (URTI) – like illness Ø 5xDPT at 6 wks, 4, 6, 18/12 and 4 years
Pertussis (2) Paroxysmal stage = persistent whoop cough >2 wks ® may Ø Vax antenatally at 28 weeks GA
epitheliuam ® pertussis toxin ®
(Bordetella pertussis inhibit neutrophils/macrophage ® develop apnoea and cyanosis Ø Exclude from school and social distance
gram—ve bacteria) – paralyse cilia + apoptosis of (3) Post-tussive vomits ® beware of severe pneumoniia and Ø Macrolides (azithromycin) to reduce Tx (but not
airborne macrophage (via ↑cAMP) apnoea the disease severity)
*TORCH = benign for mother, but congenital infection will be teratogenic for foetus who is imm unocompromised
**Other viruses that cause issues: Parvovirus (slapped cheek, erythema infectiosum ® foetal BMF and subsequent hydrops),
*** vaccination CI: previous reaction (anaphylaxis), immunocompromised, concurrent NSAID usage (COVID)
• + Vaccination Programs
• + Screening Programs
• + Illness and Injury Prevention Programs
URGENT NOTIFIABLE (PHONE) ROUTINE NOTIFIABLE (EMAIL)
• Avian Flu, • Acute rheumatic fever (GAS)
• Foodborne (≥2x linked cases) • Acute viral hep A/B/C
• Gastro (within institution) • Rheumatic heart disease - (< 35 yo)
• Coronavirus strains (SARS, MERS-CoV, SARS-CoV-2) • ADR to vaccinations
• Smallpox • CJD ® UK 1980 -1997 (bovine spongiform encephalopathy)
• Measles • HIV
• viral haemorrhagic fevers. • Pertussis
• Leprosy – mycobacterium leprae – affects skin, URT mucosa
and eyes ® red skin patch w/ NO sensation
• Syphilis
• TB
Describe global causes of childhood morbidity / mortality ® assess the impact of social determinants of
health on children.
Global causes for childhood morbidity and mortality Social determinants
• War and conflict • Low SES
o Drowning, road traffic injuries (lack of road safety programs and • Geographical location
adequate road infrastructure) • Unequal access to medical resources and expertise
• Unable to access clean drinking water o Higher rates of pre-term baby deaths (e.g. HIE – birth
o Increased risk of diarrhoea associated illnesses (e.g. cholera, ETEC asphyxia, aspiration pneumonia etc.)
– traveller’s diarrhoea) o Unable to manage congenital abnormalities
• Malnutritious diet (nil fortified foods – iodised salt in the making all breads)– effectively
increased risk of vitamin and nutrient deficiencies ® high risk of marasmus • Prioritisation of healthcare is non-existent in war-torn conflict
(def. in all nutrients) and kwashiorkor (mainly low protein) nations
• Poor health literacy • Low education – do not understand human rights to standard
• Ineffective or absent primary prevention programs (e.g. CST screening or HPV healthcare
vaccination in India not implemented unlike in Australia)
o Unprotected sex ® increased Tx of STIs, TORCH ® birth defects
o No vaccination plan
• Reliance on voluntary aid – MAFs (doctors without borders) – they come and
go (may pass on some knowledge but
, Vaccine Preventable Diseases
PP Sx Vaccine Route + Rx
Rotavirus Ø Replicated in mature significant childhood mortality è vomiting (1), diarrhoea (2), fever Oral live vaccine (before 6/12) to prevent ISS
enterocytes in GI lumen Ø Shed in large quantities during diarhoea Ø Rx and prevent dehydration (oral and IV fluids)
(non-enveloped RNA
virus) Ø Osmotic shifts Ø 5-7 days duration
Ø 95% asymptomatic IM 6 wks, 4 and 6 mths (eliminated in Aus.)
Ø 4% mild illness = GE + influenza-like illness (LRTi) Ø Inactivated poliomyelitis vaccine (need multiple
Polio Ø 1% aseptic meningitis (non-paralytic) – spasm of neck, back, doses to generate immunit
(faecal-oral)
(Poliovirus) lower limb
Ø <1% = paralytic poliomyelitis - spinal, bulbar, bulbospinal
(painful in back and lower limbs)
• Acute HBV = asymptomatic ® subclinical ® Sx ( Nausea, • Acute HBV infection = HbsAg +ve = no Rx
jaundice, liver fail)
Hepatitis B ® damage hepatocytes (vertical and • Chronic HBV infection = HbsAg +ve for 6/12 è
horizontal – bodily fluids) • 90% neonates acquire Hep B vertically transmitted develop antivirals or HBV Ig (pregnant)
(dsDNA virus) chronic = cirrhosis, HCC è fatigue, milkd RUQ discomfort, • Hep B vax within 12 hrs of birth
jaundice
• epiglottitis = stridor, drooling, tripoding, hot potato voice IM 6 wks, 4 and 6 mths (eliminated in Aus.)
HiB • Adhere to resp. epithelium ® • bacterial meningitis = fever, photophobia • Acute = Anaesthetists consult + IV 1g ceftriaxone
• IgA proteases stop opsonization (or 400mg moxifloxacin / 10mg dex)
(Gram -ve anaerobic
coccobacilli) • disseminating into blood (mets) • Transitoin from IV to oral Abx
• Ix: Slide agglutination or PCR
• Mainly Men B+C (w/ rise in subtype W and Y) Ø Resus - ABCD ® Empirical Abx: BenzylPenicillin /
• Adhere ® colonise ® tissue
• Severe/life threatening sepsis - bacterial meningitis = fever, ceftriaxone - blood and CSF culture
damage via Lipoligosaccharide
Meningococcus (Il-1,6,8,,TNF-a) photophobia, neck stiff, non-blanching rash Vaccinate:
• rans-epithelial /endothelial RF: immunocompromised Ø MenACWY funded at 12 mths
(N. meningitidis) =
Gram -ve cocci transport • Usu. children < 2yo & adolescence Ø MenB is funded at 2, 4 and 12 months for ATSI
• Bacteraemia (infection of blood • Endemic (Middle East)
stream)
• Overcrowding
Strep. Adhere ® colonise ® tissue damage • RF: ATSI, young age, lack of BF, seasonal (spring/autumn) Vax 2, 4 and 12 months
(Il-1,6,8,,TNF-a)® trans-epithelial • AOM, meningitis, osteomyelitis, or pneumonia Ø Prevanar = 13 valent vaccine
Pneumococcus /endothelial transport ®
• Nephrotic syndrome – ascites – peritonitis Ø Pneumovax– 23 valent vaccine (ATSI)
Gram +ve cocci Bacteraemia (infection of blood
Ø Abx – amoxicillin
(respiratory droplets) stream)
Prodrome = fever + coryza + pharyngitis followed by Ø Vaccinate at 18 months
Varicella – • widespread vesicular rash Ø Notifiable disease
Ø Airborne droplets • after recovery it hides dormant in nerve root ® reactivated as Acute:
chicken pox Direct contact
Ø shingles at a later date Ø PPE + infection precautions (PPE + isolation)
(VZV (HHV3)) • pneumonia and neurological issues (transverse myelitis, Ø Simple analgesia + cool compresses
cerebral ataxia or encephalitis)
Ø 1-5 day Prodrome of Ø Live attenuated MMR at 1 and 4 years (as
German measles
Rubella o low grade fever + teratogenic)
Ø Airborne Ø Isolate ® notify ® test (nasopharyngeal/buccal
(togavirus) o LN of occipital and post-auricular
Ø Maternal to foetus (may be swab, urine and blood tests – serology IgG, IgM for
mild and self-limiting infectious for 7 days) Ø Pinpoint pink maculopapular rash (face ® trunk but does not
measles, mumps or rubella)
darken or coaelece like measles) +/- arthralgia, conjunctivitis
Ø Prodrome: cluster of fever, cough, coryza, conjunctivitis
Measles Ø Person-person contact Acute Mx:
Ø Koplik spots (white spots in the mouth) before maculopapular
(highly contagious Ø airborne rash (from face then downwards to chest – palms/soles spared) Ø ALL infection precaustions (PPE + ISOLATION)
paramyxovirus) Ø Late sign = pneumonia (LRTi signs = cough), meningitis Ø Rubella ® analgesia, warm/cold packs
Fever, respiratory and constitutional symptoms Ø Measles ® supportive (antipyretics, fluids), Vit A,
ribavirin (for measles pneumonia)
1. 1/3rd patients = asymptomatic
Mumps 2. parotitis in 70%, (uni or bilateral) – 10days swelling
Ø Mumps ® analgesia, warm/cold packs
Ø School- or college children
(highly contagious (respiratory droplets) Ø
3. orchitis in 15-30% of post pubertal males, oophoritis (5%)
paramyxovirus)
*Brain damage, deafness and male infertility are rare complications
> check IgM, IgG serology
muscle spasms beginning: Ø 5xDPT at 6 wks, 4, 6, 18/12 and 4 years
Tetanus Ø Tetanus spores from faeces of
1) at jaw (trismis)
domestic animasl ® toxin
Clostridium tetani (tetanospasm) ® carried in 2) generalised muscle spasms (hyperreflexia)
(gram + ve rod) PNS to CNS (BLOCK inhibitory 3) seizures
From dirty wounds neurotransmitter)
4) difficulties with SOB and swallowing
Diphtheria toxin causes: Ø 5xDPT at 6 wks, 4, 6, 18/12 and 4 years ;
Diptheria Ø Life threatening Sore throat + fever Respiratory swab:
(Corynebacterium Colonise in pharynx ® Diphteria Ø Progresses to swollen bull neck (tonsillar pseudomembranous) Ø ABCD (ensure patent away)
diphtheriae (gram +ve exotoxin ® exudate ® coagulates to Ø Parenteral benzylpenicillin or erythromycin (as
rod) via respiratory form grey pseudo-membrane patient cannot swallow properly)
droplets) Ø Vax after recovery (inc. close contacts who also
may need ABx)
Colonise brush border of bronchial (1) Catarrhal stage = coryza (URTI) – like illness Ø 5xDPT at 6 wks, 4, 6, 18/12 and 4 years
Pertussis (2) Paroxysmal stage = persistent whoop cough >2 wks ® may Ø Vax antenatally at 28 weeks GA
epitheliuam ® pertussis toxin ®
(Bordetella pertussis inhibit neutrophils/macrophage ® develop apnoea and cyanosis Ø Exclude from school and social distance
gram—ve bacteria) – paralyse cilia + apoptosis of (3) Post-tussive vomits ® beware of severe pneumoniia and Ø Macrolides (azithromycin) to reduce Tx (but not
airborne macrophage (via ↑cAMP) apnoea the disease severity)
*TORCH = benign for mother, but congenital infection will be teratogenic for foetus who is imm unocompromised
**Other viruses that cause issues: Parvovirus (slapped cheek, erythema infectiosum ® foetal BMF and subsequent hydrops),
*** vaccination CI: previous reaction (anaphylaxis), immunocompromised, concurrent NSAID usage (COVID)
