Serious illness in newborns, infants and children

Fever

Fever

Body temperature exceeding 38°C (100.4°F), with varying thresholds based on age groups.

Pyrogens

Substances causing fever, entering the bloodstream and inducing prostaglandin E2 synthesis in the hypothalamus.

Hypothalamic Set Point

Raised by PGE2, leading to the body's response to increase temperature through vasoconstriction, muscle activity, and decreased heat loss.

Cytokines

Endogenous pyrogenic molecules like IL-1, IL-6, TNF, IF-alpha, inducing PGE2 synthesis and systemic effects during fever.

Benefits of Fever

Retarding bacterial and viral growth, enhancing immunologic function at moderately elevated temperatures.

Harms of Fever

Discomfort for the patient, increased metabolic rate, and potential offset of immunologic benefits in shock.

Hyperthermia

Abnormal elevation of body temperature without hypothalamic set point change, leading to adverse physiological effects.

Rash

Skin manifestations categorized into maculopapular, pustular, vesiculobullous, diffuse, petechial/purpureal types.

Type 1 Hypersensitivity

Immediate reaction mediated by IgE, causing mast-cell activation and histamine release.

Type 2 Hypersensitivity

Humoral cytotoxic reactions mediated by IgG and/or IgM, leading to cell lysis or phagocytosis.

Type 3 Hypersensitivity

Immune complex-mediated reactions mediated by IgG and/or IgM, causing tissue damage.

Type 4 Hypersensitivity

Cell-mediated immune reactions involving Th1, Th2, and CTL cells, leading to cell damage.

Viral Infection

Rash pathogenesis due to immune response or skin cell damage from viruses like measles, rubella, and varicella-zoster.

Inflammatory Dermatoses

Skin conditions like atopic dermatitis, psoriasis, and mastocytosis with various triggers and characteristics.

Local Bacterial/Fungal Infection

Skin damage from infections like impetigo, folliculitis, tinea corporis, scabies, and cutaneous candidiasis.

Drug Eruptions

Delayed hypersensitivity reactions to drugs, involving humoral and cell-mediated mechanisms.

Haematological Disorders

Rash due to hemorrhage from small blood vessels, seen in conditions like acute leukemia and immune thrombocytopenia.

Vasculitic/Rheumatological Diseases

Rash associated with inflamed or damaged cutaneous vessels in diseases like Kawasaki, lupus, and juvenile arthritis.

Systemic Bacterial Infections

Rash manifestations in diseases like meningococcal disease, syphilis, and gonorrhea infections.

Bacterial Endocarditis

Rare skin manifestations include Janeway lesions (painless maculopapular lesions on palms and soles) and Osler nodes (painful nodules on tips of fingers). Bacterial etiologies include S. aureus, Enterococcus, Streptococcus bovis, Streptococcus viridans, and HACEK organisms.

Toxin-mediated Infections

Staphylococcal scalded skin syndrome is caused by S. aureus toxin targeting the granular layer, leading to blister formation. Scarlet fever results from an erythrogenic toxin by group A beta-hemolytic streptococci, presenting with pharyngitis and a diffuse rash. Toxic shock syndrome involves toxins causing fever, low BP, and a diffuse erythematous rash.

Anaphylactic/Hypersensitivity Reactions

Urticaria manifests as transient wheals due to histamine release, commonly triggered by drug/food allergies or insect bites. Lesions last 24-48h, with recurrent crops extending the eruption.

Classic Rashes of Childhood

Measles, Scarlet Fever, Rubella, Duke’s Disease, Erythema Infectiosum, Roseola are common childhood rashes.

Maternal History

Maternal infections like HIV, CMV, HSV during pregnancy can increase fetal immunodeficiency risk. Risky behaviors like alcohol, smoking, and toxin exposure elevate risks.

Birth History

Premature birth, low birth weight, and mode of delivery impact immune system development and infection susceptibility.

Social History

Day care attendance, exposure to pets/farm animals, and environmental toxins influence infection risks in children.

Growth and Development

Metrics like weight, height, and chronic conditions can predispose children to infections.

Feeding History

Longer breastfeeding duration enhances immune function, reducing infection risks.

Immunization History

Incomplete vaccination schedules increase vulnerability to vaccine-preventable diseases.

Medications

Immunosuppressants like corticosteroids increase infection vulnerability by suppressing the immune system.

Family History

Autoimmune conditions and exposure to contagious diseases in family members increase infection risks in children.

Child Dosage for Antibiotics:

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7.5 mg/kg up to 320 mg

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7 mg/kg

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6 mg/kg up to 560 mg

Antibiotic Dosage for Amoxicillin or Ampicillin:

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Antibiotic Dosage for Cefotaxime:

For children with septic shock or requiring intensive care, 50 mg/kg up to 2 g IV, 8-hourly.

Definition of Bacteraemia:

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Definition of Septicaemia:

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Pathophysiology of Sepsis:

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Classification of Sepsis:

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Suspected or proven infection plus systemic inflammatory response syndrome (SIRS).

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Sepsis with organ dysfunction.

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Severe sepsis with hypotension unresponsive to fluid resuscitation.

Neonatal Sepsis:

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Common Pathogens in Children:

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Meningitis Overview:

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Types of Meningitis:

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Commonly caused by enteroviruses, herpes simplex virus, and mumps.

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Serious infections caused by Streptococcus pneumoniae, Haemophilus influenzae type b, and Neisseria meningitidis.

Meningitis Pathophysiology:

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Clinical Features of Meningitis:

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Management of Meningitis:

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Risk Factors for Pneumonia:

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Prolonged Rupture of Membranes (PROM)

Refers to the rupture of the amniotic sac and leakage of amniotic fluid before labor, lasting more than 18 hours before delivery.

Neonatal Community-Acquired Pneumonia (CAP)

Infection of the lower respiratory tract and lung parenchyma in neonates, commonly caused by Group B Streptococcus, Escherichia coli, Klebsiella species, Staphylococcus aureus, and Haemophilus influenzae.

Viral Causes of CAP in Children

Influenza A, respiratory syncytial virus (RSV), parainfluenza virus, human metapneumovirus (hMPV), and adenovirus are common viral causes in children older than 2 months.

Delayed Clearance of Fetal Lung Fluid

Condition where fetal lung fluid absorption is delayed, leading to fluid retention in the lungs, seen in transient tachypnea of the newborn (TTN).

Surfactant Deficiency

Surfactant reduces lung surface tension, preventing alveolar collapse; deficiency leads to atelectasis and impaired gas exchange.

Osteomyelitis Spread of Infection

Infections spread hematogenously from primary sites, direct inoculation, local extension, or transphyseal vessels in infants.

Common Pathogens in Osteomyelitis

Staphylococcus aureus, Group B Streptococcus, Gram-negative bacilli, Candida albicans are common pathogens in different age groups.

Juvenile Idiopathic Arthritis (JIA)

Autoimmune/autoinflammatory disease causing chronic synovial inflammation, leading to arthritis, fever, rash, and joint function loss in children.

Marfan Syndrome

Autosomal dominant mutation affecting fibrillin-1 gene, leading to connective tissue abnormalities like aortic aneurysm, mitral valve prolapse, and skeletal features.

Meningococcal Sepsis

Caused by Neisseria meningitidis, leading to systemic effects like vascular permeability, DIC, myocarditis, and neurological complications in children and adolescents.

Pallor

Paleness of the skin often associated with reduced blood flow or anemia.

Tachypnea

Abnormally rapid breathing rate.

Meningitis

Inflammation of the protective membranes covering the brain and spinal cord.

Septic Shock

Life-threatening condition resulting from an infection, causing a severe drop in blood pressure.

Kernig and Brudzinski signs

Physical exam maneuvers indicative of meningeal irritation in meningitis.

Purpuric Lesions

Skin rash characterized by purple spots resulting from bleeding under the skin.

Lumbar Puncture

Medical procedure to collect cerebrospinal fluid for diagnostic purposes.

Ceftriaxone

Antibiotic used in the treatment of bacterial infections.

Disseminated Intravascular Coagulation (DIC)

Condition where blood clots form throughout the body's small blood vessels.

Measles

Highly contagious viral infection characterized by fever, cough, and a distinctive rash.

Rubella

Viral infection causing a distinctive red rash and mild fever.

Roseola

Viral illness common in young children, marked by high fever and a rash.

Pathogen

Human Herpesvirus 6 (HHV-6) primarily causes Roseola, with rare cases due to Human Herpesvirus 7 (HHV-7).

Route of Transmission

Roseola spreads through respiratory secretions from asymptomatic carriers.

Incubation Period

Roseola has an incubation period of 5 to 15 days.

Viral Characteristics

HHV-6 and HHV-7 are double-stranded DNA viruses that infect CD4+ T lymphocytes.

Latency and Reactivation

HHV-6B can remain latent in tissues and reactivate during immunosuppression.

Clinical Course

Roseola presents with a febrile phase and an exanthem phase.

Febrile Phase

Characterized by sudden high fever and lymphadenopathy.

Exanthem Phase

Follows fever resolution with a rose-pink rash starting on the neck and trunk.

Nagayama Spots

Papular enanthem on the uvula and soft palate seen in Roseola.

Asymptomatic Shedding

HHV-6 and HHV-7 DNA can be found in saliva post-infection.