Childhood Infectious Diseases Skimmia Japonica Rubella FAHAD AL ZAMIL Professor & Consultant Pediatric Infectious Diseases King Khalid University Hospital King Saud University, Riyadh

Measles RNA Virus RNA Virus Incubation Period: 8 – 12 days Incubation Period: 8 – 12 days Clinical Features Clinical Features Complications: Complications: Respiratory Respiratory Neurological Neurological Others Others Treatment Treatment Isolation & Infectivity: 2 days before till 5 days after rash Isolation & Infectivity: 2 days before till 5 days after rash Vaccine Vaccine

Measles (cont.) Koplik’s spots

Measles (Cont.)

Measles vs. Scarlet fever

Mumps RNA Virus RNA Virus Incubation Period: 14 – 21 days Incubation Period: 14 – 21 days Clinical Features Clinical Features Complications: Complications: Glandular Glandular Non glandular Non glandular Treatment Treatment Isolation & Infectivity: 9 days after onset of parotid swelling Isolation & Infectivity: 9 days after onset of parotid swelling Vaccine Vaccine

Rubella RNA Virus RNA Virus Incubation Period: 14 – 21 days Incubation Period: 14 – 21 days Clinical Features Clinical Features Complications: Complications: Acquired Acquired Congenital Congenital Treatment Treatment Isolation & Infectivity: 7 days from onset of rash Isolation & Infectivity: 7 days from onset of rash Congenital Rubella: until 1 year of age Congenital Rubella: until 1 year of age Vaccine Vaccine

Rubella (Cont.)

Rubella, Smallpox, Chickenpox

Congenital Rubella Syndrome

Chicken Pox (Varicella) DNA Virus DNA Virus Incubation Period: 10 – 21 days Incubation Period: 10 – 21 days Clinical Features Clinical Features Complications: Complications: 2 nd bacterial infection 2 nd bacterial infection Neurological Neurological Reye syndrome Reye syndrome Disseminated Disseminated Treatment (Acyclovir) Treatment (Acyclovir) Isolation & Infectivity: 2 days before rash till all skin lesions have crusted (6 th day of rash) Isolation & Infectivity: 2 days before rash till all skin lesions have crusted (6 th day of rash) Vaccine Vaccine

Cont. Chicken Pox

Diphtheria Corynebacterium diphtheriae Corynebacterium diphtheriae Incubation Period: 2 – 7 days Incubation Period: 2 – 7 days Clinical Features Clinical Features Complications: Complications: Thrombocytopenia Thrombocytopenia Myocarditis Myocarditis Vocal cord paralyses Vocal cord paralyses Treatment Treatment Isolation & Infectivity: up to 6 weeks, but with treatment communicable for fewer than 4 days Isolation & Infectivity: up to 6 weeks, but with treatment communicable for fewer than 4 days Vaccine Vaccine

Diphtheria (Cont.) Diphtheria (Cont.)

Pertusis (Whooping Cough) Bordetella Pertusis Bordetella Pertusis Incubation Period: 7 – 14 days Incubation Period: 7 – 14 days Clinical Features Clinical Features Complications: Complications: Pneumonia & Bronchiectasis Pneumonia & Bronchiectasis Haemorrhage Haemorrhage Hernia Hernia Hypoxia Hypoxia Treatment Treatment Isolation & Infectivity: up to 6 weeks, but with treatment => 5 days after starting therapy Isolation & Infectivity: up to 6 weeks, but with treatment => 5 days after starting therapy Vaccine Vaccine

Whooping Cough Video: Whooping Cough: Child Video: Whooping Cough: Child Video: Whooping Cough: Infant Video: Whooping Cough: Infant

Tetanus Clostridium tetani Clostridium tetani Incubation Period: 2 days to months, most within 14 days Incubation Period: 2 days to months, most within 14 days Clinical Features Clinical Features Complications: Complications: Lock jaw Lock jaw Neonatal mortality Neonatal mortality Generalized muscle spasm Generalized muscle spasm Treatment Treatment Isolation: no person to person transmission Isolation: no person to person transmission Vaccines Vaccines

Guide to Tetanus Prophylaxis in Routine Wound Management History of Adsorbed Tetanus Toxoid (Doses) Clean, Minor WoundAll Other Wounds* TdTIGTdTIG Unknown or <3YesNoYesNo ≥3§No"NoNo¶No " yes if more than 10 years since last dose ¶ yes if more than 5 years since last dose

Haemophilus influenzae type b (Hib) Clinical Features Clinical Features Complications Complications Treatment Treatment Isolation & Infectivity: droplet precautions for 24 hours after starting antimicrobial therapy Isolation & Infectivity: droplet precautions for 24 hours after starting antimicrobial therapy Vaccine Vaccine Cerebrospinal fluid culture positive for Hib (Gram stain)

Hib (Cont.)

Poliovirus Incubation Period: 7 – 21 days Incubation Period: 7 – 21 days Clinical Features Clinical Features Complications Complications Treatment Treatment Isolation & Infectivity: several weeks Isolation & Infectivity: several weeks Vaccines: Vaccines:

Polio Vaccines OPV IPV

Thrush Candida Albicans Candida Albicans Clinical Features Clinical Features Complications Complications Treatment Treatment

Croup Parainfluenza Parainfluenza Incubation Period: 2 – 6 days Incubation Period: 2 – 6 days Clinical Features Clinical Features Complications Complications Treatment Treatment Isolation & Infectivity: contact precaution in hospital, infective up to 3 weeks Isolation & Infectivity: contact precaution in hospital, infective up to 3 weeks Video: A Child with Croup

Bronchiolitis Respiratory Syncytial Virus Respiratory Syncytial Virus Incubation Period: 2 – 8 days Incubation Period: 2 – 8 days Clinical Features Clinical Features Complications Complications Treatment Treatment Isolation & Infectivity: 3 – 8 days (up to 4 weeks in infants) Isolation & Infectivity: 3 – 8 days (up to 4 weeks in infants)

Erythema Infectiosum (Fifth Disease) Parvovirus B19 Parvovirus B19 Incubation Period: 4 – 21 days Incubation Period: 4 – 21 days Clinical Features Clinical Features Complications Complications Treatment Treatment Isolation & Infectivity: droplet precautions for 7 days Isolation & Infectivity: droplet precautions for 7 days

Roseola (Sixth Disease) HHV-6 HHV-6 Incubation Period: 9 – 10 days Incubation Period: 9 – 10 days Clinical Features Clinical Features Complications Complications Treatment Treatment

Infectious Mononucleosis Epstein-Barr Virus Epstein-Barr Virus Incubation Period: 30 – 50 days Incubation Period: 30 – 50 days Clinical Features Clinical Features Complications: Complications: Hepatitis Hepatitis Hemolytic Anemia Hemolytic Anemia GBS GBS Splenic rapture Splenic rapture Myocarditis Myocarditis Malignacy Malignacy Treatment Treatment Isolation & Infectivity: patients with recent infection should not donate blood Isolation & Infectivity: patients with recent infection should not donate blood

Viral Hepatitis

Feature Hepatitis A Hepatitis B Hepatitis C Hepatitis D Hepatitis E VirusHAVHBVHCVHDVHEV GenomeRNADNARNARNARNA Incubation days days 7-9 weeks 2-8 weeks days OnsetAcuteInsidiousInsidiousAcuteAcute TransmissionOralParenteralPerinatalParenteralParenteralOral Sequelae: Fulminant liver failure Carrier Chronic hepatitis RareNoNoUncommonYesYesUncommonYesYesYesYesYesYesNoNo Mortality % % 1-2 % 2-20 % 1-2 %

Further Reading RED BOOK by Report of the committee on Infectious Diseases. RED BOOK by Report of the committee on Infectious Diseases.