Pediatria

Pediatrics

Small Pox
- viral infection
- high mortality rate
- it’s a skin dz
- dz only in humans, no animal reservoir
- more contagious than chicken pox
- virus remains in the air for few mths (not sun light)
- here the virus doesn’t die as the vesicles dries up and fall off
- virus produces necrosis of the tissue
- the virus leaves an scar (d/t scratching), it goes downto the dermis
- vesicles have a concave shape
- gives you more vesicles in the face

the incubation period of the smallpox is 10 days. This was the first disease that had a vaccine created in london.



Vaccine:
- is the 1st dz that have a vaccine:
- in 1967 began a world wide campaign to irradicate it
- in 1983 small pox was declared irradicated
- cowpox and human pox have cross immunity
o this was an observation done by epedimiology where the vaccine was first created.
- 10 days after vaccination the pt must have a primary rxn, for the vaccine to be effective
- if not you must shot again
- vaccine is not free of comlplications
- 1/100 000 get encephalitis
- Roseola vacinatum: this is the side effect ofvaccination.
- occurs usually few days later
- benign
- last only few days

Measles
- Childhood disease
- contagious
- caused by virus
- not a benign dz any more
- High mortality rate:
- 11% due to hemorrhage in lungs, especially in undernourished children
- serous dz ⋄ mortality rate 25%
- affects mucous membranes
- Transmission:
- Is by inhaled virus
- thevirus is in the nasopharyngeal area before the rash appear
- 10-14 days of incubation

S+S:
- prodromal period the incubation period is 2 weeks. The rash starts in the face and around the hair line. In about 3 days will cover the whole body.
- fever, fotophobia, cough
- Kopliks spots
- in the mucosa of the mouth near pre-molars
- precedes rash by 48hrs
-Rash:
- Begins in the face and the hair line behind the ears, and the mouth, then comes down
- Maculopapular rash
- you can see completely healthy skin between the rashes, (non homogenius rash)
- no inflammation!!

Complications are bronchopneumonia and ecephalitis.
There are 2 shots of this measles vaccines. It comes now mixed with MMR measels and rubella. And yougive them a seccond shot 2-3 years later.
- Disease last about 1 week, then symptoms disappear, beginning in the face and going down

DDx:
- Rashes produced by GI virus – echovirus and coxsackie virus
- Allergic reaction
- Meningococcemia (sometimes)
- Rashes by streptococci

Complications:
1. Acute complications:
- Otitis media
- Gastroenteritis
- Encephalitis (2/1,000)- benign and well recover
- d/t direct invasion to the brain
- hemorrhagic measles
- very fatal
- lung hemoptysis
- red stools
2. Late complications:
- TB may exacerbated due to decrease immune defenses
- Bacterial bronchopneumonia (MC)
- d/t the decrease in the immunity
3. Years later:
-Very late complication
- SPE – SubacutePansclerotic Encephalitis (1/1,000,000)
- Autoimmune suppressive dz that simply deteriorates the brain
- slow progressive disroder

Tx: avoid dehydration, PCN, Gamma globulins

Management of measles
-Vitamin A and antipyretics
- Vitamin A
– 2 doses of 200,000 units, IM 48hours apart
- During the disease
- Mortality comes down

- Antibiotics – acutephase
- Not routine
- Bacterial bronchopneumonia - penicillin
Prevention:
Vaccine:
- life attenuated viral vaccines
- youngest case here 3 months
- Most cases of measles are 15 month
- Or as a single mumps vaccine

NOTE: after infection you have Immunity for life

Diphteria
- Not very frequent
- comes in the air (Inhaled bacteria)
-...