Pediatric infectious
diseases. Vaccination
programs
Prof. Dr. György Fekete
Localizing symptoms









Skin
Upper respiratory
Lower respiratory
Genitourinary
Gastrointestinal
CNS
Skeletal
Cardiovascular
Hepatic
Characteristics in infants and
children




Neonates, infants: non-specific initial
symptoms (irritability, lethargy, poor
feeding)
Specific rashes
Sites of infection
Prevention: vaccination/
immunization
Erysipelas



Superficial inflammation of the skin
Streptococcus pyogenes,
Staphylococcus aureus
Complication/ infants: sepsis
Erysipelas
(Group A Streptococcus, acute cellulitis and
lymphangitis)
Cellulitis (phlegmone)
Inflammation of the
subcutaneous connective
tissue – may lead to abscess
 Streptococcus pyogenes,
Staphylococcus aureus,
Haemophilus influenzae (<2 yrs)
 Therapy: penicillin+ clindamycin

Infectious diseases with rash
Stadium incubationis: in generalno symptom
 Stadium prodromum: non-specific
symptoms
 Stadium floritionis :characteristic
symptoms

Measles (Rubeola, Morbilli, NineDay Measles)







Paramyxovirus, RNA virus
7-14 days incubation, prodromal fever
Coryza, hacking cough, conjunctivitis
Koplik’s spots 2-4 days later
Rash: retroauricular, temporal region, then
on the face - maculo-papulous
exanthemes
Photophobia, high fever
Complications: bacterial superinfections,encephalitis, cerebellitis,
subacute sclerotizing panencephalitis
Measles
(RNA virus, macular rash,
Koplik’s spots)
Koplik’s spots


Resembling tiny grains of white sand
surrounded by inflammatory areolae
Buccal mucosa opposite the 1st and
2nd upper molars
Rubella (German Measles, ThreeDay Measles)





Togavirus, RNA
14-21 days incubation
Painful lymphadenopathy:
retroauricular, cervical, occipital
region: Theodor- Klatsch symptom
Peeling
Congenital rubella syndrome
Rubella
(RNA virus, maculopapular rash, occipital
lymphadenopathy)
Congenital rubella syndrome


Infection of seronegative mother during
pregnancy
Risk of fetal infection
•
•
•
•
I. trimenon: 75-90%
II. trimenon: 20-40%
III.trimenon: 25-50%
Fetal lesion



1-8.
gest. week: 80%
9-12. gest. week: 30%
13-20. gest. week: 10%
Congenital rubella syndrome

Gestation
• 14- 60. days: embryopathy – cataracta,
microphthalmia, hearing loss, congenital
heart disease, microcephalia, thymus
hypoplasia
Rubella vaccination is prohibited during
pregnancy!
Roseola infantum (exanthema
subitum)
(Human Herpesvirus-6, high fever,maculopapular rash)
Chickenpox


Extremely contagious
14-16 days incubation,
communicability is possible from 10
to 21 days after exposure
Varicella (chickenpox)
Varicella (chickenpox)
(Varicella-Zoster virus, vesicles,
crusting)
Varicella (toxic)
Infectious mononucleosis
(Epstein- Barr virus infection)
Infectious mononucleosis
(Epstein-Barr virus, enanthema=pharyngeal
petechiae)
Infectious mononucleosis
Scarlat fever
(Group A Streptococcus, erythrogenic toxin,
fine papular exanthem, palmar/ plantar
peeling)
Kawasaki disease
(Multisystem vasculitis)
Mumps (Epidemic Parotitis)






Paramyxovirus, infected saliva
14-21 days incubation
Headache, anorexia, malaise, fever
Pain on chewing or swallowing acidic
liquids
Parotid and other salivary glands are
tender, tissue edema
The oral duct openings of the glands
are „pouting” and inflamed
Mumps
Tonsillopharyngitis
streptococcica


Other bacteria: S. aureus,
H. influenzae positive in throat
microbiological cultures are not
pathogenic. Antibiotic treatment is
not necessary!
Aminopenicillin antibiotics are not
recommended –possible infectious
mononucleosis
Complications




Abscess of the cervical lymphnodes
Peritonsillar abscess
Sepsis
Late: rheumatic fever, acute diffuse
glomerulonephritis
Lyme disease
(Borrelia Burgdorferi, erythema chronicum
migrans)
Tetanus
(Clostridium tetani exotoxins)
Tetanus





Neonatal: contamination of the
umbilical cord
Muscle stiffness
Difficulty in swallowing
Pain
Trismus associated with tooth,
peritonsillar, retropharyngeal abscess
Influenza Viral Infection





RNA orthomyxoviruses, types A, B, C
Young children: bronchiolitis,
pneumonia, myositis
Secondary bacterial infection of the
respiratory tract
Salicylates should be avoided (risk of
Reye syndrome)
Th: oral oseltamivir (Tamiflu)
Human Immunodeficiency Virus
Infection (AIDS)




RNA retroviruses
Occurrence is rare in children
80% intrauterine, intra partum,
breast feeding, 10- 15% blood and
blood products, 5% unknown origin
Risk of children of HIV infected
mother: 20-40%
AIDS/ clinical forms




Slowly progressing form: intra
partum, post partum infection
Frequent and severe infections after
latency (1-2 yrs)
Lymphoid interstitial pneumonitis,
hypergammaglobulinemia
Death before the age of 6 yrs in 60%
AIDS / prevention




Antiviral treatment of infected
mother during pregnancy
Isolation of newborn baby from
infected mother
No breast feeding
BCG vaccination is prohibited!
AIDS / clinical forms




Rapidly progressing: intrauterine infection
Repeated,severe infections with classical
and opportunistic pathogens
(Pneumocystis carinii, Cryptosporidium,
Candida, HSV, EBV, CMV)
Failure to thrive,enlargement of parotid
gland, lymphadenopathy, cortical atropy,
demyelinisation of the brain, death at the
age of 3 yrs
BCG sepsis!
Immunization schedule







BCG
Birth
Hepatitis B1 Birth to 2 mo
2 1 to 4 mo
3 6 to 18 mo
H.infl. Typ b 2,4,6 mo
DTP+IPV
3 mo
DTP+OPV
4,5 mo
MMR
15 mo, 6 yr (12 yr)
Recommended: varicella, hepatitis A,
pneumococcal conjugate vaccine
Types of vaccines



Live attenuated viruses (measles,
mumps, rubella, varicella, polio)
Inactivated viruses (polio, hepatitis
B, influenza)
Inactivated bacteria (pertussis,
diphtheria, tetanus, H. influenzae
type b, pneumococcus)
Non- mandatory vaccines

Polysaccharid vaccines
• Meningococcus A, C, W-135, Y serotypes
• Pneumococcus, 23 serotypes, 7 serotypes







Hepatitis- A, A+B
Human papillomavirus (HPV)
Influenza
Tick - borne encephalitis
Rotavirus
Chickenpox (varicella)
RSV
Endocarditis prophylaxis

Antibiotic prophylaxis for dental
procedures is now recommended only in
patients with a prosthetic heart valve;
previous IE; cyanotic congenital heart
disease that is unrepaired, within 6
months of a repair procedure, or repaired
but with residual defect at or near the
location of prosthetic material; or in
cardiac transplant recipients with cardiac
valvulopathy
Antibiotic prophylaxis to prevent
endocarditis


During dental / respiratory
procedures : oral amoxicillin, 50
mg/kg 1 hr before
For patients allergic to penicillin:
clindamycin, 20 mg/kg
Oral-dental procedures requiring
endocarditis prophylaxis







Extractions
Periodontal procedures
Dental implant placement
Root canal surgery beyond the apex
Subgingival placement of orthodontic
bands but not brackets
Prophylactic cleaning of teeth / bleeding is
anticipated
Intraligamentary local anesthetic
injections