Common Viral Infecions Measles Mumps Rubella Chicken pox Erythema infectiousum (Fifth Disease) Roseola infantum(Sixth Disease)

Rashes caused by childhood infections. Macular/papular /maculopapular: Macules-red/pink discrete flat areas,blanch on pressure ex rubella,measles..ect Papules –solid raised hemispherical lesions,usually tiny ,also blanch on perssure.ex scarlet fever,kawasaki disease. Purpuric/petechial: Non-blanching red/purple spots.ex meningococcal.

Vesicular: Raised hemispherical lesions,<0 Vesicular: Raised hemispherical lesions,<0.5 cm diameter,contain clear fluid.ex chicken pox Pustular/bullous: Raised hemispherical lesions,>0.5cm diameter,contain clear or purulent fluid. ex Imptigo Desquamation: Dry and flaky loss of surface epidermis, often peripheries. ex Kawasaki disease.

Measles RNA Virus Incubation Period: 6 – 12 days Clinical Features.fever,rash,coryza Complications: Respiratory: pneumonia,om Neurological:febrile conv.encephalitis,SSPE Others:diarrhoea,hepatitis Treatment;symptomatic Isolation & Infectivity: 2 days before till 6 days after rash

CLINICAL MANIFESTATIONS 1.Incubation period is approximately 6~18days,10days is the most common. (3-4weeks) 2 .predromal phase 3~4 days. 1. Fever. 2. Catarrhal inflammation of URT. 3. Koplik’s spots: white spots in the inner cheeks that appears after 24-48 hours of the infection. It’s the first to appear. 4. Transient prodromal rashes ( rash does not appear from the 1st day )

3. Eruption stage 4 . Convalescent stage brown staining. 1. Time: the 3~5 days after fever ; but the 4th day is most common; 2 . Shape: maculopapular 3. Sequence: behind the ear→along the hairline→face→neck→chest→back→abdomen→limbs→hand and feet(palm , sole) ( rash starts in the face then the trunk then on the periphery ) 4 . The temperature rise continuously and accompanied with the toxic symptoms . 4 . Convalescent stage brown staining. fine desquamation. course:10-14 days

COMPLICATIONS : the disease itself is not severe but its complications are serious. 1 .Bronchopneumonia. 2 .Myocarditis. 3 .Laryngitis. 4 .Neurologic complications: Encephalitis and SSPE . subacute sclerosing panencephalitis Persistent infection of the brain. Rare,psychologic.neuro deterioration. Personality changes,seziure,coma. It happens 7-10 years after the infection.

Measles vs. Scarlet fever Both measles and scarlet fever cause maculopapular rash but in scralet fever the rash appears from the 1st day and has a sand like appearance and occurs all over the body but not in the palms and soles. Scarlet comes with a strawberry tongue white cirumoral lesions and is caused by strep infection.

DIAGNOSIS. 1 .Epidemiologic data. 2 .Clinical manifestations. 3. Laboratory findings: 1 .Multinucleated giant cells are detected in nasopharyax mucosa secretions. 2 .Measles virus can be isolated in tissues culture. 3 . Antibody titer. specific antibody IgM. 4 . Other Ag and multinucleated giant cells

EPIDEMIOLOGY 1.Source of infection The patients are the only source of infection. 2 .Routes of transmission air-borne ( highly infectious ) by sneezing and cough. 3. Susceptibility of population 1 . All age person is susceptible; 90% of contact people acquire the disease. 2 .The permanent immunity acquire after disease. 4.Epidemic features season:winter and spring age:6 months to 5 years old ( seen in young age group )

DIFFERENTIAL DIAGNOSIS 1 .Rubella (German measles) 2. scarlet fever. 3 .Roseola infantum (infant subitum,exanthem subitum) 4. Drug rashes. In drug rash there will be no: fever, conjuctivitis, congestion or cough.

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

Clinical manifestation of mumps are: Parotid inflammation (or parotitis) in 60–70% of infections and 95% of patients with symptoms Parotitis causes swelling and local pain, particularly when chewing. It can occur on one side (unilateral) but is more common on both sides (bilateral) in about 90% of cases. Fever Headache Pancreatitis: inflammation of the affected pancreas. Orchitis: painful inflammation of the testicles might affect the future fertility (most important complication).

Diagnosis: Person infected with mumps is contagious from approximately 6 days before the onset of symptoms until about 9 days after symptoms start. Usually the disease is diagnosed on clinical grounds and no confirmatory laboratory testing is needed, you might ask for amylase.

Rubella RNA Virus Incubation Period: 14 – 21 days Clinical Features: fever ,rash. Complications: Acquired ;arthritis,encephalitis, Congenital:fetal damage. Isolation & Infectivity: 7 days from onset of rash Congenital Rubella: until 1 year of age

Rubella Symptoms include: low grade fever, swollen glands (sub occipital & posterior cervical lymphadenopathy), joint pains, headache and conjunctivitis. The swollen glands or lymph nodes can persist for up to a week and the fever rarely rises above 38 °C (100.4 °F) therefore no toxic appearance unlike measles. The rash (blueberry muffin rash) of German measles is typically pink or light red. The rash causes itching and often lasts for about three days. It starts severe and starts improving on the 3rd day on the face (unlike measles), but is still present on extremities. It’s seen in the face and trunk but more prominent in the peripheries. 1st patient to get infected has the best presentation, whereas the last has the worst presentation.

Congenital rubella syndrome Rubella can cause CRS in the newly born, whch is the most serious. The syndrome (CRS) follows intrauterine infection by the Rubella virus and comprises cardiac (PDA), cerebral (microcephaly), ophthalmic (cataract) and auditory defects. It may also cause prematurity, low birth weight, and neonatal thrombocytopenia, anaemia and hepatitis. The risk of major defects or organogenesis is highest for infection in the first trimester.

Chicken Pox (Varicella) DNA Virus(VZV). Incubation Period: 10 – 21 days very contagious especially in the first 48 hours from the rash. Almost 99%. Clinical Features: Generalized macules, Papules- vesicles- pusules-crust and then it scales. The rash has no specific sequence all present at the same time and do not differ from day to day as in rubella. The zoster rash has a dermatomal distribution. Complications: 2nd bacterial infection: staph.strep causing cellulitis Neurological: cerebellitis, encephalitis (a week after the infection) Reye syndrome Disseminated: immunocompromised Treatment: (Acyclovir- to decrease symptoms; in measles and rubella there is no need for treatment). ZIG (zoster immunoglobulin) given for 2 day to immuno-compromised patients who are exposed. Isolation & Infectivity: 2 days before rash till all skin lesions have crusted (6th day of rash)

Rubella, Smallpox, Chickenpox

Poliovirus Incubation Period: 7 – 21 days Clinical Features: <1% classical paralytic polio Complications: aseptic meningitis. Treatment Isolation & Infectivity: several weeks

What is Poliomyelitis? polio= gray matter Myelitis= inflammation of the spinal cord This disease result in the destruction of motor neurons caused by the poliovirus. Polio is causes by a virus that attacks the nerve cells of the brain & spinal cord although not all infections result in severe injuries and paralysis.

How is polio transmitted? Poliovirus is transmitted through both oral and fecal routes with implantation and replication occurring in either the oropharyngeal and/or in the intestine of mucosa ( highly contagious ) Polio cases are most infective for 7-10 days before and after clinical symptoms begin.

What are the symptoms? Many include fever, pharyngitis, headache, anorexia, nausea, and vomiting. Illness may progress to aseptic meningitis and menigoencephalitis in 1% to 4% of patients. These patients develop a higher fever, myalgia and severe headache with stiffness of the neck and back.

Can it cause paralytic disease? Paralytic disease occurs 0.1% to 1% of those who become infected with the polio virus. Paralysis of the respiratory muscles or from cardiac arrest if the neurons in the medulla oblongata are destroyed. Patients have some or full recovery from paralysis usually apparent with proximally 6 months Physical therapy is recommended for full recovery.

Vaccine Polio vaccine first appeared to be licensed in the United States in 1955. Advantages: Ease to administration Good local mucosal immunity Disadvantage: Strict cold shipping (it gets destroyed by heat) & storage requirements Multiple doses required to achieve high humeral conservation rates against all virus types

Vaccine (continuation) Babies are given 4 doses throughout their infancy. Adolescents and adults should get vaccinated as well. Adolescents younger than 18 should receive the routine four doses. You should get it if you travel outside places where polio is still an epidemic.

Treatment Supportive treatment: bed rest with close monitoring of respiratory and cardiovascular functioning is essential during the acute stage of poliomyelitis along with fever control and pain relievers for muscle spasms. No antiviral medications. If respiratory failure: must be hospitalized for mechanical ventilation, respiratory therapy may be needed depending of the severity of patients.

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

Croup (or laryngotracheobronchitis) Is a respiratory condition that is usually triggered by an acute viral infection of the upper airway. The infection leads to swelling inside the throat, which interferes with normal breathing and produces the classical symptoms of a "barking" cough, stridor, and hoarseness

croup Croup is characterized by a "barking" cough, stridor, hoarseness, and difficult breathing which usually worsens at night. The "barking" cough is often described as resembling the call of a seal or sea lion. The stridor is worsened by agitation or crying, and if it can be heard at rest, it may indicate critical narrowing of the airways. As croup worsens, stridor may decrease considerably

Diagnosis The first step is to exclude other obstructive conditions of the upper airway, especially epiglottitis (it’s a more serious infection than croup, once suspected you can’t examine the patient, you do x-ray (thumb sign) and intubate), an airway foreign body, subglottic stenosis, angioedema, retropharyngeal abscess, and bacterial tracheitis.

Diagnosis A frontal X-ray of the neck is not routinely performed, but if it is done, it may show a characteristic narrowing of the trachea, called the steeple sign, because of the subglottic stenosis, which is similar to a steeple in shape

Croup treatment: Corticosteroids (inhaled or nebulized), such as dexamethasone and budesonide, have been shown to improve outcomes in children with all severities of croup, single dose is usually all that is required. Moderate to severe croup may be improved temporarily with nebulized epinephrine

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

Bronchiolitis most often affects infants and young children because their small airways can become blocked more easily than those of older kids or adults ( in older group children and adults it causes URTI) typically occurs during the first 2 years of life, with peak occurrence at about 3 to 6 months of age is more common in males, children who have not been breastfed, and those who live in crowded conditions. Its more common in premature babies.

Signs & Symptoms Sudden breathing difficulty, usually preceded by fever and a mild common cold and cough, and characterized by the following: Wheezing. Rapid, shallow breathing (60 to 80 times a minute). Retractions (seesaw movements) of the chest and abdomen, and nasal flaring. Fever (occasionally). Blue discoloration of skin or nails (severe cases).

Treatment General Measures Keep the humidity in the child's room as high as possible, preferably with an ultrasonic cool-mist humidifier. Clean humidifier daily. If you don't have a humidifier, run cold or hot water in the shower with windows and doors closed to produce a high-humidity room. Hold the child in this room for 20 minutes several times a day, especially at bedtime. If the child awakens at night with wheezing or shortness of breath, repeat the process. Sometimes they give ventolin but its not very effective.

Erythema Infectiosum (Fifth Disease) might come as a picture in the exam Parvovirus B19 (imp MCQ) Incubation Period: 4 – 21 days Clinical Features :fever, slapped cheek rash. They’re not that sick. Complications: aplastic crises especially in SCA and other hemoglobinopathies by shutting down the BM. No Treatment Isolation & Infectivity: droplet precautions for 7 days

Fifth disease symptoms Bright red cheeks are a defining symptom of the infection in children (hence the name "slapped cheek disease"). Occasionally the rash will extend over the bridge of the nose or around the mouth. In addition to red cheeks, children often develop a red, lacy rash on the rest of the body, with the upper arms and legs being the most common locations.

Roseola (Sixth Disease) HHV-6 Incubation Period: 9 – 10 days Clinical Features: fever followed by macular rash as fever wanes. Complications; associate e febrile convulsion Treatment

Roseola Typically the disease affects a child between six months and two years of age, and begins with a sudden high fever (39–40 °C; 102.2-104 °F) that persists up to 5 days. This can cause, in rare cases, febrile convulsions (also known as febrile seizures or "fever fits") due to the sudden rise in body temperature, but in many cases the child appears normal. To prevent this, we need to give regular antipyretics. After a few days, the fever subsides, and just as the child appears to be recovering, a red rash appears. This usually begins on the trunk, spreading to the legs and neck. The rash is not itchy and may last 1 to 2 days

Infectious Mononucleosis Epstein-Barr Virus Incubation Period: 30 – 50 days Clinical Features : fever ,tonsillopharngitis. exudative membrane, cervical lymphadenopathy, generalized maculopapular rash. Complications: Hepatitis Hemolytic Anemia GBS Splenic rapture Myocarditis Malignacy Treatment no treatment might get complicated with a secondary strept infection

COMMON BACTERIAL INFECTIONS Staphylococcal and Group A streptoccocal infections. By direct effect –abscess, celluitis, imptigo, orbital celluitis. Toxin mediated: toxic shock syndrome Toxic epidermial necrolysis.

Continue…. Group A streptococcus: Direct effect: tonsillitis, osteomyelitis, otitis media, cellulitis Toxin mediated: toxic shock like syndrome, scarlet fever Post infectious: rheumatic fever, glomerulonephritis.

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

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

Diagnosis Isolation by culture Polymerase Chain Reaction PCR Media: Regan-Lowe, Bordet-Gengou, or charcoal agar Polymerase Chain Reaction PCR Kids & Children Direct fluorescent antibody (DFA) NO Freezer or Refrigeration of samples Isolation of B. pertussis in a culture is the standard and preferred method of diagnosis. B. pertussis is difficult to isolate and does have particular growth requirements. Specimens should be collected from the posterior nasopharynx (not the throat) with a Dacron or calcium alginate (not cotton) swab and plated directly on selective media. Selective media for B. pertussis includes Regan-Lowe, Bordet-Gengou, or charcoal agar (Steele, 2004). These cultures usually have a general turnaround time of 7 days however some cultures may require an incubation period as long as two weeks, so more rapid diagnosis techniques are preferred for initial diagnosis (Steele, 2004). Successful isolation declines in specimens that are collected beyond the first two weeks of illness. Isolation is also difficult for vaccinated patients. Ploymerase Chain Reaction or PCR testing of nasopharyngeal swabs can also be done to obtain a rapid, sensitive, and specific pertussis diagnosis usually within 24 hours. This technique is currently only available in some laboratories. PCR should be done in addition to culture, for the culture may be necessary for further case analysis including evaluation for antibiotic resistance and molecular This lab testing method is most common with children. typing. Direct fluorescent antibody or DFA tests can also be performed on nasopharyngeal samples and is another pertussis screening method. It uses fluorescent antibodies to detect antigen in the sample. These can not be refrigerated or frozen, all samples must stay at room temp. This method has been shown to have low sensitivity and is not very specific with nasopharyngeal samples, so it should not be relied upon for laboratory confirmation. This low specificity leads to a high percentage of false positive results (Steele, 2004).

Route of Transmission Spread through direct contact of respiratory secretions. Most contagious during first few stages of infection Resides in upper airway pathways, mostly the trachea and bronchi. Very contagious Bordetella pertussis has no known reservoir other than humans and is thought to be unable to survive in the environment for prolonged periods of time. B. pertussis invades its human host through entry into the respiratory tract where it colonizes to cause whooping cough, also known as pertussis, which was at one time a very common and potentially life threatening infection for children (Steele, 2004). Pertussis is highly contagious, with an 80% secondary attack rate among susceptible people. Pertussis is generally transmitted from person to person via respiratory droplets, but direct contact with respiratory secretions from infected individuals may also lead to the disease. Freshly contaminated articles (such as clothing) from the infected person can also contain infectious respiratory secretions, allowing pertussis to be passed indirectly from the infected person to a susceptible host who comes in direct contact with these items. While the most serious infections occur in young children, with most pertussis related deaths occurring in infants too young to be vaccinated, adolescents and adults also experience a health burden from the disease (Forsyth et al., 2004). Pertussis is on the rise in adolescent and adult populations, and while the health of these age groups are important, they also provide a potential source of major pediatric infections (Forsyth et al., 2004). Parents are a common source of B. pertussis infections for infants, while other relatives such as grandparents, uncles and aunts also provide another potential source of infection (Forsyth et al., 2004).

Progression of Whooping Cough Incubation period 4-21 days 3 Stages 1st Stage- Catarrhal Stage 1-2 weeks runny nose, sneezing, low fever, and a mild cough (common mistaken for cold) 2nd Stage- Paroxysmal Stage 1-6 weeks whooping cough, which consists of bursts or paroxysms of numerous, rapid coughs, severity of the infection is at its greatest. The is a contagious phase. 3rd Stage- Covalescent Stage weeks-months gradual recovery starts After transmission of B. pertussis to a new host, there is an incubation period that averages 7-10 days, with a range of 4-21 days. In rare cases, incubation periods have been found to occur for as long as 42 days. After the incubation period, an infected person can expect the illness to progress through three stages: the catarrhal stage, the paroxysmal stage, and the covalescent stage. The first stage is the catarrhal stage, which is characterized by a runny nose, sneezing, low fever, and a mild cough. These beginning symptoms are similar to a common cold and gradually become more severe. At this point the body is beginning its immune response. This is the stage where it is very easy for the bacteria to spread due to the fact that the patient is unaware of what they have and may continue with their day-to-day activities. After 1-2 weeks, the paroxysmal stage begins. It is at this point that a diagnosis of pertussis is usually suspected and the severity of the infection is at its greatest. The cough usually progresses to the characteristic whooping cough, which consists of bursts or paroxysms of numerous, rapid coughs. These coughing episodes seem to be due to a difficulty in expelling mucus from the tracheobronchial tree. These attacks usually end with a long inspiratory effort which is usually accompanied by the high pitched whoop from which the disease gets its name. These attacks may also cause the patient to turn blue and appear very ill and distressed, especially when young children and infants are effected. Vomiting may also accompany these attacks, but the patient generally appears normal between such episodes. Paroxsymal attacks are more frequent at night and these attacks will increase in frequency during the first two weeks of this stage and then begin to decline after week three. This stage lasts from 1-6 weeks, but may effect the patient for up to 10 weeks. The characteristic whoop may not be observed in young infants due to a lack of strength, though these coughing episodes occur. Individuals with pertussis are most infectious during the catarrhal stage and the first two weeks after cough onset, with this highly infectious period lasting an approximately 21 days. The third and final stage of the disease involves the gradual recovery of the patient from the paroxysmal stage. During this convalescent stage, these coughing attacks continue to gradually decrease and usually disappear within 2-3 weeks, though these episodes may recur following subsequent respiratory infections for many months after the onset of the disease. Adults and adolescents usually have milder symptoms that may be indistinguishable from other respiratory infections and the characteristic whoop is uncommon. B. pertussis is estimated to cause up to 7% of coughing illnesses each year in the less susceptible, older population.

Complications Adults Children Pneumonia Hypoxia Rib Fracture Apnea Weight Loss Hernias Urinary Incontinence Children Hypoxia Apnea Pneumonia Seizures Complications: Major complications are most common among infants and young children and include hypoxia, apnea, pneumonia, seizures, encephalopathy, and malnutrition. Young children can die from pertussis and 10 children died in the United States in 2007. Most deaths occur among unvaccinated children or children too young to be vaccinated. Younger patients have a greater chance of complications from pertussis than older patients. The most common complication is secondary bacterial infection, which is the cause of most pertussis-related deaths. Pneumonia occurs in one out of 20 cases; this percentage is higher for infants younger than age 6 months. Infants are also more likely to suffer from such neurologic complications such as seizures and encephalopathy, probably due to the reduction of oxygen supply to the brain. Other less serious complications include ear infection, loss of appetite, and dehydration. Adults with pertussis can have complications such as pneumonia and rib fracture from coughing. Other reported side effects include (among others), loss of consciousness, female urinary incontinence, hernias, and weight loss.

Treatment Antibiotic Therapy- Macrolides Erythromycin Azithromycin Clarithromycin Pertussis is a significant economic burden in the US. The direct costs of pertussis in infants is estimated at $2822, with hospitalization accounting for two thirds of infant medical costs. For children, this cost drops to $308 while the direct cost for adolescents is $254 and $181 for adults (Forsyth et al., 2004). For children, adolescents, and adults, these costs reflect doctors visits, but antibiotics and hospitalization could also contribute. Erythromycin is highly effective at removing B. pertussis in infected patients, but does not effect the duration or severity of the clinical disease (Steele, 2004). The drug should be administered in four doses per day for 14 days with 40-50 mg/kg total per day. Erythromycin should not be given to newborns less than 13 days old because it produces increased gastric motility and can lead to hypertrophic pyloric stenosis. Azithromycin and clarithromycin are equally effective when the patient is given azithromycin at 10-12 mg/kg per day for five days followed by clarithromycin in two doses at 15-20 mg/kg total per day for seven days (Steele, 2004). Azithromycin and clarithromycin do not produce this change in the GI tract and should be used instead of erythromycin (Steel et al., 2004).

Prevention Good hygiene CDC recoomends children be given the Diphtheria, Tetanus, and Pertussis (DTaP) vaccine as early as 6 weeks but no later than 6 y/o. Cover mouth/nose when coughing and sneezing.

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

Diphtheria Is an upper respiratory tract illness caused by Corynebacterium diphtheriae, a facultative anaerobic, Gram-positive bacterium. It is characterized by sore throat, low fever, and an adherent membrane (a pseudomembrane) on the tonsils, pharynx, and/or nasal cavity.

Case classification Probable: a clinically compatible case that is not laboratory-confirmed and is not epidemiologically linked to a laboratory-confirmed case Confirmed: a clinically compatible case that is either laboratory-confirmed or epidemiologically linked to a laboratory-confirmed case Empirical treatment should generally be started in a patient in whom suspicion of diphtheria is high.

Treatment Antibiotics are used in patients or carriers to eradicate C. diphtheriae and prevent its transmission to others. The CDC recommends either: Metronidazole Erythromycin (orally or by injection) for 14 days (40 mg/kg/day with a maximum of 2 g/d), or Procaine penicillin G given intramuscularly for 14 days (300,000 U/d for patients weighing <10 kg and 600,000 U/d for those weighing >10 kg). Patients with allergies to penicillin G or erythromycin can use rifampin or clindamycin.

Tetanus Clostridium tetani Incubation Period: 2 days to months, most within 14 days Clinical Features: very sick, they come with arched back due to spasm Complications: Lock jaw Neonatal mortality Generalized muscle spasm Treatment Isolation: no person to person transmission Vaccines

Tetanus Medical condition characterized by a prolonged contraction of skeletal muscle fibers. The primary symptoms are caused by tetanospasmin, a neurotoxin produced by the Gram-positive, rod-shaped, obligate anaerobic bacterium Clostridium tetani. Infection generally occurs through wound contamination and often involves a cut or deep puncture wound. As the infection progresses, muscle spasms develop in the jaw (thus the name "lockjaw") and elsewhere in the body. Neonates may develop it by using infected instruments to cut the umbilical cord after delivery.

The wound must be cleaned The wound must be cleaned. Dead and infected tissue should be removed by surgical debridement. Administration of the antibiotic metronidazole decreases the number of bacteria but has no effect on the bacterial toxin. Penicillin was once used to treat tetanus, but is no longer the treatment of choice, owing to a theoretical risk of increased spasms.

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

Tetanus can be prevented by vaccination with tetanus toxoid. The CDC recommends that adults receive a booster vaccine every ten years, and standard care practice in many places is to give the booster to any patient with a puncture wound who is uncertain of when he or she was last vaccinated, or if he or she has had fewer than three lifetime doses of the vaccine

Thrush Candida Albicans Clinical Features: cheesy like material. Don’t stop feeding the child. Complications: if the baby is healthy its not complicated, if the baby is immunocompromised it might cause throat infection. Treatment: nystatin

Kawasaki disease Affect infant and young children Clinical criteria Fever >5days and 4 of the following Conjunctival injection Red mucous membrane Cervical lymphadenopathy Rash Oedema of palms & soles with peeling

Feature Hepatitis A Hepatitis B Hepatitis C Hepatitis D Hepatitis E Virus HAV HBV HCV HDV HEV Genome RNA DNA Incubation 15-50 days 45-160 days 7-9 weeks 2-8 weeks 15-60 days Onset Acute Insidious Transmission Oral Parenteral Perinatal Sequelae: Fulminant liver failure Carrier Chronic hepatitis Rare No Uncommon Yes Mortality 0.1-0.2 % 0.5-2 % 1-2 % 2-20 %

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