This document discusses the management of fever in infants and young children. It defines key terms like fever and serious bacterial infection. It provides guidelines for identifying febrile infants at low risk for serious bacterial infection. It discusses the approach to fever without a source and outlines testing and treatment recommendations based on a child's age. The document also reviews specific considerations for viral and bacterial causes of fever, appropriate use of antipyretics, and how to manage conditions like Kawasaki's disease and febrile seizures.
This presentation reviews some general fever related pearls before segueing into a review of fever workup in neonates, children 3-36 months, and then fever of unknown origin in older children.
The Febrile Neonate and Young Infant: An Evidence Based Reviewdpark419
Objectives:
1) Discuss the wide variation in management of this patient population
2) Review the low risk criteria for infants deemed safe to be discharged from the emergency room
3) Review the medical evaluation of the febrile neonate and young infant
4) Discuss several difficult clinical situations one may encounter when managing the febrile neonate/young infant (traumatic/dry LP, hyperpyrexia, neonatal mastitis, concomitant viral infection)
5) Answer the question: Can you safely withhold a lumbar puncture from a febrile young infant (4-8 week old)
Presentation on Prevention and Management of Infants With Suspected or Proven Neonatal Sepsis
References:
American Academy of Pediatrics. Prevention and Management of Infants With Suspected or Proven Neonatal Sepsis, 2013.
American Academy of Pediatrics. Management of Neonates With Suspected or Proven Early-Onset Bacterial Sepsis, 2012.
Basic concepts in neonatal ventilation - Safe ventilation of neonatemohamed osama hussein
Lecture by by dr Muhammad Ezzat Abdel-Shafy MB.BCh, M.Sc Pediatrics Neonatology Sp. , Benha Children Hospital, provided during our Doctors neonatology workshop, 20th of January 2017
A 100 years ago, when neonatal intensive care units (NICUs) started to be well established, the race never stopped trying to add new regimens to improve neonatal survival. On the other hand, long term sequelae of medications used at NICUs were usually not sufficiently studied and left mostly unnoticed for many years by neonatologists. Here we are trying to understand & & shed the light on some of these sequelae in a trial avoid those sequelae while working on NICU candidates.
Lecture given at the 6th Conference for Nile Basin Pediatrics 2-5 December 2015, Hurgada, Egypt
By dr Rabab Hashem, MRCPCH, pediatrician at El Nasr hospital Port said.
Cranial sonography is the most widely used neuroimaging procedure in premature infants. US helps in assessing the neurologic status of the child, since clinical examination and symptoms are often nonspecific. It gives information about immediate and long term prognosis.
jaundice in neonate, by Dr Nagwa Rizk, pediatric department, Nursing college, Port said University, Port said. Presented in the NICU nursing workshop, organized by Nursing syndicate in Suez canal & Sinai in cooperation with Port said university college of nursing & Port said neonatology society, December,2014 Port said
Care of neonate, by Dr Mona Abo zid, pediatric department Nursing college, Port said University, Port said. Presented in the NICU nursing workshop, organized by Nursing syndicate in Suez canal & Sinai in cooperation with Port said university college of nursing & Port said neonatology society, December,2014 Port said
Neonatal mechanical ventilation by dr Osama Hussein, president of Port said neonatology society. Presented in the NICU nursing workshop, organized by Nursing syndicate in Suez canal & Sinai in cooperation with Port said university college of nursing & Port said neonatology society, December,2014 Port said
Neonatal resuscitation, by Dr Osama Hussein, president of Port said neonatology society. Presented in the NICU nursing workshop, organized by Nursing syndicate in Suez canal & Sinai in cooperation with Port said university college of nursing & Port said neonatology society, December,2014 Port said
Normal newborn needs, by Dr Rehab Hany, pediatric department, Nursing college, Port said University, Port said. Presented in the NICU nursing workshop, organized by Nursing syndicate in Suez canal & Sinai in cooperation with Port said university college of nursing & Port said neonatology society, December,2014 Port said
Normal newborn care, by Dr Amal Khalil, Dean of Nursing college, Port said University, Port said. Presented in the NICU nursing workshop, organized by Nursing syndicate in Suez canal & Sinai in cooperation with Port said university college of nursing & Port said neonatology society, December,2014 Port said
One of lectures presented in our Port said fifth neonatology conference, 23-24 October 2014 by Prof Mohamed El Sawy, Prof in Pediatric department , faculty of medicine, Ain Shams university
One of lectures given during our Port said fifth neonatology conference, 23-24 October 2014 given by dr Dr El Sayed Khalaf MD Pediatrics,Consultant Pediatric and Neonatology
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
2. DEFINITIONS OF TERMS IN PRACTICE GUIDELINE ON THE MANAGEMENT
OF FEVER IN INFANTS AND YOUNG CHILDREN
Term Definition
Fever Rectal temperature of 38°C (100.4°F)*
Fever Acute febrile illness in which the etiology of the fever is not
without apparent after a careful history and physical examination
source
Serious Meningitis, sepsis, bone and joint infections, urinary tract
bacterial infections, pneumonia, enteritis
infection
Toxic Clinical presentation characterized by lethargy, evidence of poor
appearance perfusion, cyanosis, hypoventilation or hyperventilation
Lethargy Poor or absent eye contact; failure of child to recognize parents or
to interact with persons or objects in the environment
BY DR M OSAMA HUSSEIN MD
3. Infant appears generally well
ROCHESTER CRITERIA FOR
Infant has been previously healthy: IDENTIFYING FEBRILE INFANTS
AT LOW RISK FOR SERIOUS
Born at term (≥37 weeks of gestation) BACTERIAL INFECTION
No perinatal antimicrobial therapy
No treatment for unexplained hyperbilirubinemia
No previous antimicrobial therapy
No previous hospitalization
No chronic or underlying illness
Not hospitalized longer than mother
Infant has no evidence of skin, soft tissue, bone, joint or ear infection
Infant has these laboratory values:
White blood cell count of 5,000 to 15,000 per mm3 (5 to 15 × 109 per L)
Absolute band cell count of ≤1,500 per mm3 (≤1.5 × 109 per L)
Ten or fewer white blood cells / high-power field on microscopic examination of urine
Five or fewer white blood cells per high-power field on microscopic examination of
BY DR M OSAMA HUSSEIN MD
stool in infant with diarrhea
4. Why we pay special
attention to fever ?
• Parental concern
• “fever phobia”
• Clinician concern
• we don’t want to miss a life threatening infection
• Most common complaint in pediatric visits
• Some of these kids are sick
• most do well without intervention
• need an approach to sort them out
BY DR M OSAMA HUSSEIN MD
6. Fever Without a Source
• Fever without a source “FWS”= fever with no
apparent cause
• “Fever of Unknown Origin”= a febrile illness of
at least three weeks' duration, at least 38.3°C
on at least three occasions and failure to
establish a diagnosis in spite of intensive
evaluation.
BY DR M OSAMA HUSSEIN MD
7. Pediatric Fever Algorithm
Fever 38 C
Non toxic appearing, 28 – 90 days and “Low Risk”
No Yes
Outpatient Management
ADMIT
Blood Culture, Option 1 Option 2
Urine Culture, Blood Cx, Urine Cx, Blood Cx, Urine
CSF Cx, antibx CSF Cx, ceftriaxone Cx, Re-eval in 24
+/-CXR 50 mg/kg IV/IM, re- hours
eval in 24 hours
BY DR M OSAMA HUSSEIN MD
8. Child 3 to 36 months with FWS: Occult
Bacteremia
• S. pneumoniae>>H. influenzae>N. meningitidis
– conjugate vaccine for H influenzae virtually
eliminated this type of bacteremia
BY DR M OSAMA HUSSEIN MD
9. Child 3 to 36 months with FWS:
Practice Guidelines
• Toxic - Admit with full work up
• Non-toxic – Consider workup when fever is
39°C
BY DR M OSAMA HUSSEIN MD
10. Pediatric Fever Algorithm
Child 3 to 36 months with FWS
Appears toxic?
Yes No
Full sepsis work up and Temperature ≥ 39
antibiotics and admit
No Yes
No testing, Selective
assure follow up workup
in 48 hrs
BY DR M OSAMA HUSSEIN MD
11. Child 3 to 36 months with FWS:
Practice Guidelines
• Toxic - Admit with full work up
• Non-toxic – Consider workup when fever is
39°C (102.2°F)
BY DR M OSAMA HUSSEIN MD
12. Child 3 to 36 months with FWS:
Occult Pneumonia
• Children with high fever and leukocytosis are
more likely to have occult bacterial
pneumonia
– some suggest getting CXR with no resp symptoms
and WBC>20,000 and temp 39.5 C (103.1°F)
BY DR M OSAMA HUSSEIN MD
13. Pediatric Fever Algorithm
Child 3 to 36 months with FWS
Appears toxic?
Yes No
Full sepsis work up Temperature ≥ 39
and antibiotics and
admit
No Yes
No testing, Selective
assure follow workup
up in 48 hrs
BY DR M OSAMA HUSSEIN MD
14. Summary of Testing: 3 to 36 months and FWS,
non-toxic, temp ≥39 C
• Urine
– All females < 2 years
– Males
• Uncircumcised <12 months
• Circumcised < 6 months
• Stool culture
– If bloody diarrhea or >5 wbc’s/hpf
• CXR
– If respiratory symptoms or hypoxic
• LP
– Signs of meningitis
• Blood cultures and Antibiotics
– Option 1: All with fever ≥ 102.2
– Option2 : All with fever ≥ 102.2 and WBC ≥ 15,000
– Option3: Practitioner/immunization dependent
BY DR M OSAMA HUSSEIN MD
15. Fever with a Source
• More common than fever without a source
• Clinically identifiable viral or bacterial illnesses
BY DR M OSAMA HUSSEIN MD
16. Fever with a Source: Viral
– Varicella
– Measles (recent outbreaks)
– Mumps (recent Midwest
outbreaks)
– Adenovirus
(pharyngoconjunctival fever)
– Coxsackie infections
• Herpangina→
• Hand-foot-and-mouth
– Croup
– Bronchiolitis (as in our case)
– Influenzae
BY DR M OSAMA HUSSEIN MD
17. Fever with a Source: Viral
• Pediatric exanthems
– Roseola (HHV 6)
– Fifths disease (Parvo
B19)→
BY DR M OSAMA HUSSEIN MD
18. Fever with a Source: Bacterial
• Clinically evident bacterial infections
– Readily diagnosed from H&P
• Pneumonia
• Meningitis
• Septic arthritis
• Osteomyelitis
• Lymphadenitis
• Cellulitis/Abscess
• Bacterial enteritis
BY DR M OSAMA HUSSEIN MD
19. Antipyretics
• Triage protocols
– acetaminophen by protocol
• Acetaminophen dose
– 15 mg/kg q 4 hr prn
• Ibuprofen dose (for greater than 6 months
old)
– 10 mg/kg q 6 hr prn
BY DR M OSAMA HUSSEIN MD
20. Bug Drugs: <1 month
• Ampicillin and gentamycin
– covers GBBS, E. coli, Listeria monocytogenes
– ampicillin specifically for Listeria and provides
some synergy with gentamycin for GBBS
• Consider acyclovir
– Maternal history of Herpes (especially if primary
outbreak with vaginal delivery) or any noted skin
or mucosal lesions
BY DR M OSAMA HUSSEIN MD
21. Bug Drugs: 1-2 months
• Ampicillin and cefotaxime
– covers the < 1 month etiologic agents and also S.
pneumoniae
– with cefotaxime you don’t have to worry about
oto/renal toxicity associated with gentamycin
BY DR M OSAMA HUSSEIN MD
22. Bug Drugs: >2 months
• Ceftriaxone
– covers S. pneumoniae, H. influenzae, and N.
meningitidis
– theoretically shouldn’t give < 1 month because of
biliary sludging
• Add vancomycin if any concern for S.
pneumoniae on LP in any age range (resistant
strains have been appearing in CSF)
BY DR M OSAMA HUSSEIN MD
23. Kawasaki’s Disease
• Fever for at least 5 days' duration and the presence
of 4 of the following
– Extremities changes (erythema, edema, and
desquamation)
– Conjunctivitis (no exudate).
– Polymorphous rash (not vesicular) is usually generalized
– Cervical lymphadenopathy usually unilateral and greater
than 1.5 cm
– Lip or oral cavity changes (erythema, dry/fissured or
swollen lips, and strawberry tongue)
BY DR M OSAMA HUSSEIN MD
24. Febrile Seizures
• Simple Febrile Seizure
– 1 event in a 24 hour period
– Non-focal
• Complex
– Whenever it is not simple
– Consider larger work-up
• 30% chance of recurrence
BY DR M OSAMA HUSSEIN MD
25. Febrile Seizures
• Work up for the source of the fever
• “Strongly consider LP” for under 12 months –
AAP guidelines
• Brain imaging not often necessary
• Need to explain to parents why you aren’t
worried about the seizure
BY DR M OSAMA HUSSEIN MD
26. Pediatric Fever Summary: Golden
Rules
• A toxic appearance demands immediate
action
– Work-up/antibiotics and admit
• Know the age-specific algorithm for FWS
• Test the urine (most common SBI)
• Look for specific bacterial and viral etiologies
• Careful follow up must be assured
• Recommendations continue to evolve with
new immunizations
BY DR M OSAMA HUSSEIN MD
28. Clinical Manifestation
Incubation: 8-12 days, the average interval between appearance of
rash in the source case and subsequent cases is 14 days, with a range
of 7-18 days.
Prodromal period: fever 2-4 day + 3C
cough
coryza
conjunctivitis
Koplik spot
Rash: erythematous maculopapular rash
facesole in 72 hr.
face and trunk: mostly distributed
pneumonia
Convalescence
cough may persist for 1 week
BY DR M OSAMA HUSSEIN MD
31. Complication
Pneumonia
Otitis media
Diarrhea
Meningoencephalitis
Croup
Subacute sclerosing panencephalitis (SSPE)
BY DR M OSAMA HUSSEIN MD
32. Treatment and Care
Supportive and Symptomatic
Vit A supplementation
6 mo-2 yr hospitalized with measles and complication
> 6 mo who have risk for severe measles and vit A
deficiency:
immunodef, vitamin A def, impaired intestinal absorption,
malnutrition, recent immigration from high mortality rated due
to measles
Antibiotic for superimposed bacterial infection
BY DR M OSAMA HUSSEIN MD
33. Treatment and Care
Isolation: Airborne Precaution
1-2 day before onset of symptom or 3-5 days
before onset of rash
4 days after onset of rash in healthy children
For the duration of illness in immunocompromised
pt.
Isolated room (negative pressure ventilation)
Prevention: immunization
9-15 months
4-6 years
BY DR M OSAMA HUSSEIN MD
34. Rubella
RNA virus: Family Togaviridae, genus Rubivirus
IP: 14-21 days
Infectivity: 7 days before – 5 days after onset of
rash
BY DR M OSAMA HUSSEIN MD
35. Clinical Manifestation
Prodromal period 1-5 days
MP rash for < 3 days
LN at postauricular and cervical area
CBC: normal range
Dx: viral isolation
Serologic test: CF, HI, IgM ELISA
BY DR M OSAMA HUSSEIN MD
37. Rubella
Complication
arthritis
thrombocytopenia
meningoencephalitis
Treatment: supportive
Isolation:
droplet precaution for 7 days after onset of rash,
contact precaution for congenital rubella until > 1 yr-
old
Prevention: immunization
BY DR M OSAMA HUSSEIN MD
38. Chickenpox
VZV, HHV-3:
Transmission
airborne
contact vesicular fluid
vertical transmission
Incubation period:
14-16 days, (10-21days)
Infectivity: winter season
Most contagious: 1-2 days before onset of rash until
crusting of lesion.
BY DR M OSAMA HUSSEIN MD
39. Clinical Manifestation
Prodromal period: 2-3 days
Generalized, pruritic, vesicular rash 250-500 lesions
involving skin and oral mucosa
Complication
Herpes Zoster, Shingles
Congenital varicella: Scar, limb, ocular, CNS defect
Bacterial infection
Severe chickenpox
CNS: encephalitis, cerebellar ataxia, Reye’s
Syndrome
BY DR M OSAMA HUSSEIN MD
43. Treatment and care
Supportive and symptomatic
antipruritic drug
for severe case: ACV, famciclovir, valacyclovir
Isolation:
Airborne and contact isolation 1-2 days before
rash until crusting of all lesion.
Prevention
Immunization
BY DR M OSAMA HUSSEIN MD
44. Child Care and School
Children may return to school when all lesion are
crusted.
For compromised children with prolonged course
should excluded for the duration of the vesicular
eruption.
Older children and staff members with zoster should
be instructed to wash their hands if they touch
potentially infectious lesion
BY DR M OSAMA HUSSEIN MD
45. Hand-foot-mouth Disease
coxackie virus type 16 (A 16) most common,
other include A5, A7, A9, A10, B2, B5(31)
and enterovirus 71
Fever, sore throat, drooling
DDx from Herpes gingivostomatitis
Self-limited, symptomatic treatment
BY DR M OSAMA HUSSEIN MD
48. Roseola Infantum
Exanthem subitum
3 mo- 3 yr. (6 mo-1 yr)
HHV-6,7: DNA virus, Herpesviridae
Uncertain incubation period (9-10 days)
BY DR M OSAMA HUSSEIN MD
49. Clinical Manifestation
High fever 39-41 c for 3-4 days
nonspecific symptom
bulging AF
febrile convulsion
MP Rash after defervescence
CBC: normal range of WBC, lymphocyte
predominated
BY DR M OSAMA HUSSEIN MD
56. Scarlet fever
GAS or S aureus: pyrogenic exotoxin (SPE)
Acute febrile illness with:
Sore throat
Gooseflesh or coarse sand-paper rash within 12-
48 hr.
Most intense at pressure area: axilla, groin
Pastia’s line
Strawberry tongue
Pustule (Staph scarlet)
Desquamation begins toward the end of the 1st week
BY DR M OSAMA HUSSEIN MD
61. Staphylococcal scalded
skin syndrome (SSSS/4S)
Staphylococcus toxigenic strain phage group
2 with epidemolylic toxin A and B
Start with local infection e.g. purulent
conjunctivitis, otitis media, nasopharyngeal
infection
Fever, MP rash or erythroderma with
periorificial and flexural accentuation with
Nikolski sign
BY DR M OSAMA HUSSEIN MD