Childhood Diseases and Disorders Pathophysiology

Infectious Diseases Viruses Bacterial Fungal Parasitic

Viral Diseases

Measles, Mumps, and Rubella (MMR) Measles (Rubeola) Highly contagious (incubation period is 7-14 days) Symptoms include fever, inflammation of respiratory mucous membranes, rash, and spots in mouth called Koplik’s spots Treatment is fluids, fever reducer, and rest May cause encephalitis or meningitis or ear infections and conjunctivitis (pink eye) Mumps Affects parotid glands (one of the three salivary glands) Spread by saliva with incubation period 16-18 but may be as long as 25 days Blood test determines presence and symptoms are chills, swelling of glands, fever Treatment is to treat symptoms May cause orchitis (inflammation of testis) or nerve conduction deafness Rubella (German Measles or three day measles) Incubation period of 14-21 days Symptoms like rubeola but lighter in color; also joint pain and lymph node involvement Diagnosis through a blood test May cause fetal problems or birth defects is pregnant women are exposed (80% chance in first 3 mos)

MMR

Varicella (Chicken Pox)/ Poliomyelitis Incubation of 10-21 days; caused by varicella-zoster May have shingles as an adult Symptoms include classic dew drop rose petal macular rash (vesicles) Poliomyelitis Incubation of 3-6 days for milder form, 7-21 for severe form Spread through oral fecal routes Headache, sore throat and then paralysis Stool sample or throat cultures confirms diagnosis Treatment is only supportive; physical therapy or respiratory ventilation may be needed

Chicken Pox Polio

Influenza/ Common Cold Symptoms are fever, headache, joint pain, runny nose, etc No treatment except rest, hydration, nasal sprays Common Cold (rhinovirus) Symptoms are rhinitis

Mononucleosis Caused by Epstein-Barr virus Spread through saliva Symptoms happen 4-7 days after exposure Diagnosis through blood test showing rise in WBC Takes 3-4 weeks to recover and sports should be avoided for one month after to protect the spleen

Acquired Immunodeficiency Syndrome (AIDS) Caused by HIV virus In 1980’s most children with the disease got it from infected blood because they were hemophiliacs and received transfusions. Today most get it from perinatal transmission Some sexually active teens have the disease 2.1 million live with HIV Time between HIV infection and AIDS is shorter in children and infants

Bacterial Diseases

Diphtheria / Pertussis Once had a fatality rate of 20% in 1920’s Caused by Corynebacterium diphtheriae Produces a membranous coating of pharynx, nose, and sometimes tracheobronchial tree called exudate with proteins and WBC that seep from tissue Diagnosis is gray membrane covering throat and positive culture Treatment is antibiotic and diphtheria antitoxin Pertussis (whooping cough) Caused by Bordetella pertussis Incubation is 6-10 days but can be as long as 21 days Symptoms are Catarrhal- increase in inflammation of mucous membranes Paroxysmal-spasm or convulsion with violent coughing, cyanosis, vomiting Convalescent stage-gradually reduced coughing Treatment is with antibiotics and supportive therapy but pneumonia can be a problem

Tuberculosis (TB) Affects respiratory system Currently on the rise Caused by Mycobacterium tuberculosis Also found in GI system and the bones, brain, and lymph nodes Incubation period is 4-12 weeks Symptoms include bloody sputum, fever, cough, lymph node enlargement Disease in children often stays dormant Diagnosis is by positive skin test, sputum culture and chest x-rays Treatment is rest, drug therapy There is a TB vaccine, bacille Calmette-Guesnn (BCG) for places with infection greater than 1% per year

Tularemia (Rabbit fever or deer fly fever) Caused by Francisella tularensis Symptoms include headaches, lymph node swelling, chills, vomiting Diagnosis is with blood test or chest x-ray to rule our pneumonia Treatment is with antibiotics Prevention is protection from ticks

Impetigo / Acute Tonsillitis / Otitis Media Caused by pyoderma commonly found on face and hands of children Caused by Staphylococcus aureus Acute Tonsillitis Infection of palatine tonsils caused by beta-hemolytic streptococci Symptoms are sore throat, cough, fever, trouble swallowing Diagnosis with throat culture Treatment is tonsillectomy Otitis Media Bacterial infection of middle ear If persistent, myringotomy with tympanopathy tubes might be treatment

Fungal Diseases

Candidiasis/ Tinea Candidiasis Tinea Also known as thrush, oral fungal infection Caused by Candida albicans White plaques on mucous membranes and tongue Treatment of choice is usually swabbing mouth with oral nystatin Tinea Also known as ringworm Usually affect scalp and between toes Males also get it in the groin area

Parasitic Diseases

Giardiasis / Pediculosis Infection with protozoa called giardia Caused by the Giardia lamblia and affects the digestive system Symptoms include watery diarrhea , nausea, flatulence Stool will float and be shiny May take many samples to identify parasite Treatment is furazolidone or similar drugs; clear fluids to prevent dehydration Pediculosis Lice acceptance Adult females produce 6 eggs/ 24 hours Nits (eggs) can be seen in hair Treated with permethrin 1% crème rinse

Pinworms/ Roundworms Pinworms (seatworms or threadworms) are nematodes that infect intestines and rectum No harmful, just itchy Caused by Enterobius vermicularis Eggs can survive for 2-3 weeks; females lay 10,000-20,000 eggs at anus Symptoms are anal itching and look like white threads Diagnosis is by microscopic exam of stool Treatment is OTC or prescription drug therapy; may need to repeat in 2 weeks Roundworms Ascaris lumbricoides found in soil Symptoms are abdominal pain, excessive gas, weight loss, vomiting Diagnosis is through stool sample Treatment is same as for pinworms

Respiratory Diseases SIDS Croup Adenopid Hyperplasia Asthma Pneumonia

Respiratory Illness

Sudden Infant Death Syndrome (SIDS) / Croup Unexplainable death of an infant under age one; also known as crib death Cause unknown but suggested that infants be put in supine rather than prone position Only diagnosis is autopsy Croup Also known as laryngotracheobronchitis (URI) Caused by parainfluenza 1 and 2 viruses in children from 3 mos- 3 yrs old Symptoms are inspiratory stridor, difficulty breathing at night Diagnosis is physical exam Treatment is usually high humidity, fluids, rest, racemic epinephrine https://www.youtube.com/watch?v=Qbn1Zw5CTbA

Adenoid Hyperplasia/ Asthma Enlargement of the pharyngeal tonsils Symptoms are blockage of Eustachian tubes causing otitis media; difficulty breathing Diagnosis is exam/ throat culture Treatment is antibiotic therapy or adenoidectomy Asthma More than 5 million children under age 18 diagnosed (I out of every 4) #1 reason for school absences Cause unknown Symptoms are respiratory distress Diagnosis is by chest x-rays, allergy test, pulmonary function tests, physical exam Treatment is with medications like a bronchodilator and anti-inflammatory drugs Monitored with peak flow meter Prevention is knowing triggers https://www.youtube.com/watch?v=VA9C_aCH7F0

Pneumonia Infection of the lung parenchyma Can be viral or bacterial; alveolar air spaces become filled with fluid Symptoms are wheezing, coughing, fever, malaise Diagnosis is by chest x-ray and auscultation of the chest Treatment varies (antibiotics if bacterial)

Digestive Diseases / Cardiovascular Diseases Colic- in babies Fluid Imbalances Food Allergies Eating Disorders Cardiovascular Most are related to genetic or developmental disorders

Fluid Imbalances / Food Allergies/ Eating Disorders Children have higher exchange of fluids so diarrhea or vomiting can be serious Dehydration serious Treatment includes rehydration and electrolyte replacement Food Allergies Overreaction of immune system to a particular food Reaction may take seconds or even hours More common in children especially under age 1 After age three, if one develops it stays for adult life Testing can be done http://health.usnews.com/health-news/health-wellness/articles/2014/04/17/how-to-cope-with-food-allergies Eating Disorders Problem during adolescence Anorexia and bulimia most common

Musculoskeletal Diseases / Blood Diseases Legg-Calve-Perthes (LCP) Ewing’s Sarcoma Blood Diseases Leukemia

Musculoskeletal diseases Legg-Calve-Perthes (LCP) Avascular necrosis of the upper end of the femur Blood flow is reduced to the head of the femur Most common in boys age 4-8 Only symptom is pain when walking Cause unknown Diagnosis with x-ray Treatment is maintain position of femur, rest, ROM exercises, traction, etc. Ewing’s Sarcoma More common in males; found in long bones like femur Diagnosis with x-ray, CT scan, MRI Treatment is chemotherapy or amputation

Neurologic Diseases / Eye and Ear Diseases Reye’s Syndrome Eye and Ear Strabismus Deafness

Neurologic Diseases Reyes Syndrome Acute encephalopathy seen in children under age 15 Cause unknown but relationship with use of aspirin Symptoms are nausea and vomiting, liver enlargement, seizures Diagnosis should be suspected in a child who had a recent viral illness; blood testing of liver enzymes and lumbar puncture (spinal tap) Treatment is in ICU

Eye and Ear Diseases Strabismus Deafness Lazy eye or crossed Should not be present after age 4 mos Deafness Ranges from mild to complete Cause unknown but may be from trauma, infections, or exposure to ototoxic drugs Audiometric testing is needed for accurate diagnosis Treatment depends on extent of deafness Cochlear implants are now inserted surgically to stimulate 8th cranial nerve

Blood Diseases Leukemia Malignancy of the blood-forming cells located in bone marrow Most common cancer in children Cause is unknown Most common type in children is ALL (Acute Lymphoblastic Leukemia) Symptoms are pale skin, easy bleeding, bruising, abdominal pain, fever Diagnosed with blood tests and bone marrow biopsy Treatment is chemotherapy or radiation in some cases

Trauma Child Abuse Suicide Drug Abuse Poisoning

Child Abuse More common than any other pediatric illness Neglect vs. abuse Neglect is failing to provide basic needs Abuse is causing harm Diagnosed with physical exam and interview of child and care providers Cigarette and hands most common items of abuse Shaking Baby Syndrome common Types of abuse Sexual Physical Emotional Verbal

Suicide 3rd leading cause of death (15-24 years) Firearms used in 57% of male suicides Depression, alcohol and drug use are contributing factors Highest in incarcerated youths, gay or bisexual, and sexually abused Girls attempt more but males are more successful in suicide attempts

Poisoning Among top five causes of death under age 10; 75% under age 6 Household items and medications are common forms of poisoning Lead poisoning is chronic and blood can be tested to diagnose; caused neurological disorders Treatment MAY be medication to induce vomiting