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Infection in ChildhoodInfection in Childhood
Dr Maysara AbdelazizDr Maysara Abdelaziz
Consultant PaediatricianConsultant Paediatrician
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Infection in ChildhoodInfection in Childhood
• Cause:Cause:
ViralViral
BacterialBacterial
ParasiticParasitic
FungalFungal
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Infection in ChildhoodInfection in Childhood
• Presentation:Presentation:
AgeAge
Type of infection Type of infection
System involvedSystem involved
Immune systemImmune system
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Infection in ChildhoodInfection in Childhood
• Neonate(first 4 wk of life)Neonate(first 4 wk of life)
Inutro (congenital)Inutro (congenital)
During LabourDuring Labour
After birth.After birth.
• Infancy(first 12 months of life)Infancy(first 12 months of life)
• Childhood infectionChildhood infection
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Infection in ChildhoodInfection in Childhood
Neonate(first 4 wk of life)Inutro (congenital)Neonate(first 4 wk of life)Inutro (congenital)
•BacterialBacterialGp B streptocuccusGp B streptocuccus
Neisseria GonorrhoeoNeisseria GonorrhoeoChlamidiaChlamidia
ListeriaListeria
TreponemiaTreponemia
Pallidum(syphylis)Pallidum(syphylis)TBTB
•ViralViralCMVCMV
Hepatitis B and CHepatitis B and CHIVHIV
Herpes simplexHerpes simplex
RubellaRubella
Varicella (chickenpox)Varicella (chickenpox)
•ParasiticParasiticToxoplasmosisToxoplasmosis
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Erythema toxicum picErythema toxicum pic
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Erythema ToxicumErythema Toxicum
• Transient blotchy erythema seen in Transient blotchy erythema seen in
infants during first week to ten days of infants during first week to ten days of
lifelife
• Erythematous macules 2-3 cm inErythematous macules 2-3 cm in
diameter with 1-2mm pinpoint vesiclesdiameter with 1-2mm pinpoint vesicles
• Primarily on face but but occurs onPrimarily on face but but occurs ontrunk on trunk and extremitiestrunk on trunk and extremities
• Occur in approximately one-half of Occur in approximately one-half of
neonatesneonates
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Neonatal acne picNeonatal acne pic
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Neonatal AcneNeonatal Acne
• Defined as acne that occurs in theDefined as acne that occurs in thefirst 30 days after birthfirst 30 days after birth
• Common; has been estimated toCommon; has been estimated to
occur in up to 50% of all newbornsoccur in up to 50% of all newborns
• Rare in immediate neonatal period;Rare in immediate neonatal period;
generally first appears between 2generally first appears between 2
and 4 weeks of ageand 4 weeks of age
• Often has a pustular appearanceOften has a pustular appearance
• Resolves spontaneouslyResolves spontaneously
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Infection in ChildhoodInfection in Childhood
• Respiratory tract infectionRespiratory tract infection
URTIURTI
Upper airway obstruction(croup,Upper airway obstruction(croup,epiglottitis)epiglottitis)
BronchiolitisBronchiolitis
PneumoniaPneumonia
WCWC
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• neonate with severe respiratoryneonate with severe respiratory
distress.avidistress.avi
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• recession mildrecession mild severe.avisevere.avi
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• severesevere preterminalpreterminal respiratoryrespiratory
distress.avidistress.avi
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• respiratoryrespiratory distress.avidistress.avi
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Infection in ChildhoodInfection in Childhood
• UTIUTI
AgeAge
0 to 1 year0 to 1 year1year to 5 yrs1year to 5 yrs
Over 5 yearsOver 5 years
OrganismsOrganisms Treatment Treatment
InvestigationInvestigation
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Infection in ChildhoodInfection in Childhood
• FeverFever
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Infection in ChildhoodInfection in Childhood
• RashRash
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Childhood RashesChildhood Rashes
Change in the skinChange in the skin
• Appearance or texture.Appearance or texture.
• localized to one part of the body, orlocalized to one part of the body, oraffect all the skin.affect all the skin.
• It leads to color change, itch, SkinIt leads to color change, itch, Skin
become warm, bumpy, dry, crackedbecome warm, bumpy, dry, crackedor blistered, swellor blistered, swell
• May be painful.May be painful.
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Type Type
• Macule-Flat & ImpalpableMacule-Flat & Impalpable
• Papule-Circumscribed elevated lesionPapule-Circumscribed elevated lesion
• Vesicle-Clear fluid <0.5 cmVesicle-Clear fluid <0.5 cm• Pustule-Elevated lesion containingPustule-Elevated lesion containing
puspus
• Petechaie –Spots that cant bePetechaie –Spots that cant beblanced if > 0.5 cm called purpurablanced if > 0.5 cm called purpura
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CausesCauses
• Allergies for example to foods, dyes, medicines,Allergies for example to foods, dyes, medicines,insect stings; such rashes are often called hivesinsect stings; such rashes are often called hivesMetals such as zinc or nickelMetals such as zinc or nickel
• skin contact with an irritantskin contact with an irritant
• Infection, e.g., by the bacteria ,virus and othersInfection, e.g., by the bacteria ,virus and others
• Reaction to vaccinationReaction to vaccination• skin diseases such as eczema or acneskin diseases such as eczema or acne
• Autoimmune disordersAutoimmune disorders
• Cancer or other diseaseCancer or other disease• Exposure to sun (sunburn) or heatExposure to sun (sunburn) or heat
• Irritation such as caused by abrasivesIrritation such as caused by abrasivesimpregnated in clothing rubbing the skinimpregnated in clothing rubbing the skin
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Maculopapular rashes of childhoodMaculopapular rashes of childhood
• The rashes associated with The rashes associated withsome of these viralsome of these viralinfections (fifth and sixthinfections (fifth and sixthdiseases) reflect immunediseases) reflect immuneresponses to the virus. Theresponses to the virus. Therash of second disease isrash of second disease iscaused by a bacterialcaused by a bacterialtoxin.toxin.
Exanthemsubitum(roseola
Sixth Disease
Erythemainfectiosum
Fifth Disease
Filatov-DukesFourthDisease
German
measles(rubella)
Third Disease
Scarlet feverSecondDisease
Measles(rubeola)First Disease
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MeaslesMeasles
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MeaslesMeasles
• Highly contagious, vaccine-preventable viral diseaseHighly contagious, vaccine-preventable viral disease• Characteristic prodrome: fever, gradually increasingCharacteristic prodrome: fever, gradually increasing
cough, runny nose, conjunctivitis with or withoutcough, runny nose, conjunctivitis with or without
photophobiaphotophobia
•Koplik’s spotsKoplik’s spots: silvery-white to erythematous pinpoint: silvery-white to erythematous pinpoint
macules that antedate the rashmacules that antedate the rash
• Exanthem: diffuse macular to maculopapular rash thatExanthem: diffuse macular to maculopapular rash that
begins on scalp and forehead and moves caudad;begins on scalp and forehead and moves caudad;
initially discrete lesions that rapidly coalesce; beginsinitially discrete lesions that rapidly coalesce; begins
to fade on third to fourth dayto fade on third to fourth day
• Complications:Complications:
– secondary bacterial infection; otitis media,secondary bacterial infection; otitis media,
pneumoniapneumonia
– laryngotracheitis, bronchitislaryngotracheitis, bronchitis
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RubellaRubella
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Rash in an eight month oldRash in an eight month oldunvaccinated child who has hadunvaccinated child who has had
generalized irritability, fever andgeneralized irritability, fever and
“knots” in the back of the head for“knots” in the back of the head forthe past 48 hours.the past 48 hours.
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Diff i l Di iDiff ti l Di i
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Differential DiagnosisDifferential Diagnosis
1. Rubella1. Rubella
2. Measles2. Measles
3. Kawasaki’s Syndrome3. Kawasaki’s Syndrome
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RubellaRubella
• Vaccine-preventable acute exanthematousVaccine-preventable acute exanthematous
viral diseaseviral disease
• Incubation period: 14 - 21 daysIncubation period: 14 - 21 days
• Mild prodrome often antedates the fever andMild prodrome often antedates the fever and
rashrash
• Rash begins on face and moves cephaladRash begins on face and moves cephalad
over 48 - 72 hours; usually macular but mayover 48 - 72 hours; usually macular but may
be maculopapularbe maculopapular• Adenopathy is an invariable concomitant;Adenopathy is an invariable concomitant;
suboccipital lymph nodes are almost alwayssuboccipital lymph nodes are almost always
enlargedenlarged
• Resolves over 3-5 daysResolves over 3-5 days
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Erythema infectiosum-Parvo B19Erythema infectiosum-Parvo B19
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Erythema infectiosumErythema infectiosum
•When theWhen the
rashrashappears,appears,the child isthe child is
no longerno longerinfectious.infectious.
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Vesicular RashesVesicular Rashes
Coxsackie A16 Infection
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Coxsackie A16 Infection(Hand-Foot-Mouth Disease)
• Peak incidence in summer and fall
• No gender predilection• Full age spectrum
• Highly contagious (clinical disease in 52 % of family
contacts)
• Incubation Period: 3- 6 days
• Prodrome: 1-2 days
– low grade fever
– anorexia
– malaise
• Enanthem (90% of cases): – buccal mucosa - 61%
– tongue - 44%
– palate, uvula - 36%
• Exanthem: rapid progression from macule to vesicle to ulcer
• Resolves in 1- 6 days
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Scarlet fever-MaculopapularScarlet fever-Maculopapular
• Exotoxin-mediatedExotoxin-mediated
disease arisingdisease arising
from group A beta-from group A beta-
hemolytichemolytic
streptococcalstreptococcal
infectioninfection
• Exotoxin-mediatedExotoxin-mediatedstreptococcalstreptococcalinfections rangeinfections range
from localized skinfrom localized skindisorders (eg,disorders (eg,bullous impetigo)bullous impetigo)to the systemicto the systemic
rash of scarletrash of scarletfever to thefever to theuncommon butuncommon buthighly lethalhighly lethal
streptococcal toxicstreptococcal toxic
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• Features which predict poorFeatures which predict poorprognosis at the time of presentationprognosis at the time of presentationincludeinclude
• Presence of shockPresence of shock• Absence of meningismAbsence of meningism
• Rapidly progressive purpuric rashRapidly progressive purpuric rash
• Low peripheral white blood cell countLow peripheral white blood cell count• Thrombocytopenia Thrombocytopenia
• Markedly deranged coagulationMarkedly deranged coagulation
• Depressed conscious levelDepressed conscious level
Meningococcal Disease
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Respiratory Failure
Metabolic derangementCVS Dysfunction
Renal failure
Coagulopathy
CNS Dysfunction
Meningococcal Disease
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Respiratory failureRespiratory failure
((arterial POarterial PO22
<10kPa in air or PCO<10kPa in air or PCO22
>6)>6)
In shock. Capillary leak into lungIn shock. Capillary leak into lung
parenchyma acute pulmonary oedema.parenchyma acute pulmonary oedema.
Clinically: tachypnoea, chest wall retraction,Clinically: tachypnoea, chest wall retraction,hypoxia.hypoxia.
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• Metabolic derangementMetabolic derangement
Septicaemia causes profound acidosis andSepticaemia causes profound acidosis and
derangements in metabolism, which may affectderangements in metabolism, which may affect
myocardial function and need correcting.myocardial function and need correcting.Hypoglycaemia is common. Hypokalaemia,Hypoglycaemia is common. Hypokalaemia,
hypocalcaemia, hypomagnesaemia andhypocalcaemia, hypomagnesaemia and
hypophosphataemia all occurhypophosphataemia all occur
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CoagulopathyCoagulopathy
(purpuric rash)(purpuric rash) Coagulopathy occurs early inCoagulopathy occurs early in
patients with septicaemia. Thepatients with septicaemia. The
laboratory findings of disseminated intravascularlaboratory findings of disseminated intravascular(DIC) are common in such patients.(DIC) are common in such patients.
Coagulopathy is generally associated with theCoagulopathy is generally associated with the
presence of a purpuric rash, but significantpresence of a purpuric rash, but significant
coagulopathy may infrequently occur in thecoagulopathy may infrequently occur in the
absence of purpura.absence of purpura.
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Neurological dysfunctionNeurological dysfunction
In septicaemia, patients may be alert until late inIn septicaemia, patients may be alert until late in
the illness. Falling conscious level results fromthe illness. Falling conscious level results from
impaired cerebral blood flow and disturbed brainimpaired cerebral blood flow and disturbed brainmetabolism due to hypotension, hypoxia andmetabolism due to hypotension, hypoxia and
acidosis.acidosis.
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Myocardial failureMyocardial failure
Depressed myocardial function is multifactorial,Depressed myocardial function is multifactorial,
including endotoxin, cytokines, multipleincluding endotoxin, cytokines, multiple
metabolic derangements, hypoxia, andmetabolic derangements, hypoxia, andhypovolaemia.hypovolaemia. Clinically: tachycardia, gallopClinically: tachycardia, gallop
rhythm, cool peripheries and eventuallyrhythm, cool peripheries and eventually
hypotension.hypotension.
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Renal failureRenal failure
Little or no urine output (<1ml/kg/hour) is a veryLittle or no urine output (<1ml/kg/hour) is a very
early sign in septic shock, initially due toearly sign in septic shock, initially due to
hypovolaemia. If shock persists then renal failurehypovolaemia. If shock persists then renal failuremay occur. Serum creatinine 2 times uppermay occur. Serum creatinine 2 times upper
limit of normal for age or 2-fold increase inlimit of normal for age or 2-fold increase in
baseline creatinine indicates renal dysfunction.baseline creatinine indicates renal dysfunction.
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• capillarycapillary refill.avirefill.avi
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• intraosseousintraosseous needleneedle insert.aviinsert.avi
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• 14Equinox.mpg14Equinox.mpg
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Diff i l Di i
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Differential DiagnosisDifferential Diagnosis
1. Suppurative thyroiditis
2. Infected thyroglossal duct cyst
3. Superficial abscess
4 Infected branchial cleft cyst
THYROGLOSSAL DUCT THYROGLOSSAL DUCTC S SCYSTS
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CYSTSCYSTS
• Thyroglossal duct is a remnant of the Thyroglossal duct is a remnant of theconnection between the Foramen Cecum andconnection between the Foramen Cecum and
the thyroidthe thyroid
• Cysts/infections are most common in theCysts/infections are most common in the
youngyoung
• 63% and 25% of cysts occur in the infrahyoid63% and 25% of cysts occur in the infrahyoid
and suprahyoid regions, respectively; areand suprahyoid regions, respectively; are
almost always midlinealmost always midline
• Infections are polymicrobial;aerobic andInfections are polymicrobial;aerobic and
anaerobic mouth organisms are most commonanaerobic mouth organisms are most common
• Treatment consists of antimicrobials Treatment consists of antimicrobials andand
surgery;during the operative procedure, it issurgery;during the operative procedure, it is
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Infection in ChildhoodInfection in Childhood
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Infection in ChildhoodInfection in Childhood
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ImpetigoImpetigo
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p g
• Superficial infection of skin caused bySuperficial infection of skin caused by
strains of strains of Staphylococcus aureusStaphylococcus aureus andandGroup A streptococciGroup A streptococci
• Three clinical forms: Three clinical forms:
– papulovesicular with honey-coloredpapulovesicular with honey-coloredcrusted lesionscrusted lesions
– bullous with thin-roofed bullae withbullous with thin-roofed bullae with
opalescent fluidopalescent fluid
– mixedmixed
• Epidemiology has changed from primarilyEpidemiology has changed from primarily
streptococcal to staphylococcal; mixedstreptococcal to staphylococcal; mixed
forms commonforms common
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Differential DiagnosisDifferential Diagnosis
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Differential DiagnosisDifferential Diagnosis
1. Scarlet Fever1. Scarlet Fever
2. Stevens Johnson Syndrome2. Stevens Johnson Syndrome
3. Staphylococcal Scalded Skin3. Staphylococcal Scalded Skin
SyndromeSyndrome
Staphylococcal ScaldedStaphylococcal Scalded
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Skin SyndromeSkin Syndrome
• Acute generalized exanthem caused by toxin-Acute generalized exanthem caused by toxin-producing strains of producing strains of Staphylococcus aureusStaphylococcus aureus
• Acute onset; diffuse bright red exanthemAcute onset; diffuse bright red exanthem
associated with high fever; skin is tenderassociated with high fever; skin is tender
• Mucopurulent conjunctivitis and/or rhinitis areMucopurulent conjunctivitis and/or rhinitis arealmost always present and generally antedatealmost always present and generally antedate
the exanthemthe exanthem
• May have fragile thin- roofed bullae that easilyMay have fragile thin- roofed bullae that easily
rupture; Nikolsky’s sign is presentrupture; Nikolsky’s sign is present
• Follows characteristic course; exfoliation of Follows characteristic course; exfoliation of
skin on second to third day of illnessskin on second to third day of illness
• Rarely, if ever, have positive blood culturesRarely, if ever, have positive blood cultures
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Infantile ScabiesInfantile Scabies
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Infantile Scabiesa e Scab es
• Generalized skin involvement is commonGeneralized skin involvement is common• Face and scalp are often involvedFace and scalp are often involved
• Large incidence of involvement of palms andLarge incidence of involvement of palms and
solessoles
• Burrows are infrequentBurrows are infrequent
• Vesicular lesions are commonVesicular lesions are common
• Marked pruritis and secondary excoriationMarked pruritis and secondary excoriation• Large incidence of eczematization andLarge incidence of eczematization and
secondary infectionsecondary infection
• Nodular lesions are more common than inNodular lesions are more common than in
adultsadults
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Thrush Thrush
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• Superficial infection of mucous membranesSuperficial infection of mucous membranescaused by strains of caused by strains of Candida albicansCandida albicans
• CandidaCandida is considered as normal flora inis considered as normal flora in
newborns; present in oropharyngx of 80%newborns; present in oropharyngx of 80%
of infants at 3 monthsof infants at 3 months
• Superficial pseudomembrane consisting of Superficial pseudomembrane consisting of
white , curdish-appearing material that iswhite , curdish-appearing material that is
adherent to mucous membraneadherent to mucous membrane• Generally occurs in neonatal period butGenerally occurs in neonatal period but
can be transmitted from nipples duringcan be transmitted from nipples during
breast or bottle feedingbreast or bottle feeding
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Primary Irritant Diaper DermPrimary Irritant Diaper Derm
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Primary Irritant Diaper DermPrimary Irritant Diaper Derm
picpic
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Molluscum ContagiosumMolluscum Contagiosum
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• Benign viral infection of skin and,Benign viral infection of skin and,
sometimes, mucous membranessometimes, mucous membranes
• Lesions are:Lesions are:
– discretediscrete
– umbilicated papulesumbilicated papules– pearly graypearly gray
– 1-5 mm1-5 mm
• Trunk, face and genitalia are most Trunk, face and genitalia are mostcommon sitescommon sites
• Generally asymptomaticGenerally asymptomatic
• Resolve without therapy within 6 mo’sResolve without therapy within 6 mo’s
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Case History 80Case History 80
Ten year old who had diagnosis of Ten year old who had diagnosis of
impetigo of external auditory canalimpetigo of external auditory canal
two days ago. Has had increasingtwo days ago. Has had increasing
pain of ear and awoke this morningpain of ear and awoke this morning
and couldn’t close one of her eyesand couldn’t close one of her eyes
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Differential DiagnosisDifferential Diagnosis
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Differential DiagnosisDifferential Diagnosis
1. Ramsay-Hunt Syndrome1. Ramsay-Hunt Syndrome
2. Brain stem glioma2. Brain stem glioma
3. Idiopathic Bell’s palsy3. Idiopathic Bell’s palsy
4.4. CNS Herpes SimplexCNS Herpes Simplex
Differential Diagnosis
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Differential Diagnosis
1. Ramsay-Hunt Syndrome
2. Brain stem glioma
3. Idiopathic Bell’s palsy
4. CNS Herpes Simplex
Ramsay-Hunt SyndromeRamsay-Hunt Syndrome
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y yy y
• Old term for Herpes Zoster involvementOld term for Herpes Zoster involvementof external auditory canal and/orof external auditory canal and/or
tympanic membrane and concomitanttympanic membrane and concomitant
Bell’s palsyBell’s palsy
• Involvement of facial and auditoryInvolvement of facial and auditory
nervesnerves
• May have associated tinnitus, vertigo,May have associated tinnitus, vertigo,
hyperacusis and deafnesshyperacusis and deafness
• Cutaneous or tympanic lesions may beCutaneous or tympanic lesions may be
sublimesublime
Herpes ZosterHerpes Zoster
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• Clinical syndrome that occurs withClinical syndrome that occurs with
reactivation of Varicella-zoster virusreactivation of Varicella-zoster virus
• Grouped vesicles in specific dermatomeGrouped vesicles in specific dermatome
patternpattern
• Generally, do not cross the midline inGenerally, do not cross the midline in
uncomplicated diseaseuncomplicated disease
• Rarely, if ever, painful in childrenRarely, if ever, painful in children << 1010years of ageyears of age
• Can disseminate and cause generalizedCan disseminate and cause generalized
disease in immunocom romised atientsdisease in immunocompromised patients
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Herpes GingivostomatitisHerpes Gingivostomatitis
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• Infection of oral mucosa caused by HerpesInfection of oral mucosa caused by Herpes
simplex virussimplex virus
• Almost always Type I strainsAlmost always Type I strains
• Occurs at younger age in infants of lowOccurs at younger age in infants of low
socioeconomic status; in higher socioeconomicsocioeconomic status; in higher socioeconomic
groups, approximately 50% of infections occurgroups, approximately 50% of infections occur
in older childrenin older children
• Characterized by vesicles, ulcers on theCharacterized by vesicles, ulcers on the
gingiva and oral mucous membranes; friablegingiva and oral mucous membranes; friable
interdenticular pegsinterdenticular pegs
•
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Differential DiagnosisDifferential Diagnosis
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Differential DiagnosisDifferential Diagnosis
1. Juvenile Rheumatoid Arthritis1. Juvenile Rheumatoid Arthritis
2. Serum Sickness2. Serum Sickness
3. Scarlet Fever3. Scarlet Fever
4. Kawasaki’s Syndrome4. Kawasaki’s Syndrome
Differential Diagnosis
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Differential Diagnosis
1. Juvenile Rheumatoid Arthritis
2. Serum Sickness
3. Scarlet Fever
4. Kawasaki’s Syndrome
Kawasaki’s SyndromeKawasaki’s Syndrome
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• Acute febrile multisystem illness of unknown etiology thatAcute febrile multisystem illness of unknown etiology that
primarily affects children who areprimarily affects children who are << 6 years of age6 years of age
• Prolonged fever unresponsive to antimicrobial therapyProlonged fever unresponsive to antimicrobial therapy
• Enanthem:Enanthem:
– strawberry tongue; conjunctival injectionstrawberry tongue; conjunctival injection
– red, cracked lipsred, cracked lips– diffuse intraoral erythemadiffuse intraoral erythema
• Exanthem:Exanthem:
– Polymorphic rashPolymorphic rash
– Desquamation of tips of fingers and toesDesquamation of tips of fingers and toes
– Induration and erythema of palms and solesInduration and erythema of palms and soles
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