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#Leishmaniasis@Clinicalpediatricround

🔴Leishmaniasis ▪︎It's A Protozoal Zoonotic Infection (Parasitic Infection Comes From Animals) Caused By Unicellular Flagellated Intracellular Leishmania Family 🔷Method Of Transmission 📍1. Infection Transmitted From Animals (Dogs Act As Reservoir) Through Phlebotomine SandFly Vectors To Humans (Humans Are Incidental Host) 📍2. Then From Those Infected Patients To Other Humans (Humans Also Act As Reservoir) 🔷Types Of Leishmaniasis 📍1. Visceral Leishmaniasis (VL/Kala-Azar) 📍2. Cutaneous Leishmaniasis (CL) 📍3. Mucosal Leishmaniasis (ML) 🔰Visceral Leishmaniasis (VL/Kala-Azar) ▪︎Caused By Leishmania.DonoVani Family (DonoVani/Infantum/Chagasi) ▪︎Affects Internal Body Organs (Spleen/Liver/BM/LN) & Results in Life Threatening Infection ▪︎Usually Affects Small Children & Infants & Immunocompromised Adults (HIV-Co Infection) 🔷Clinical Features & Dx Of VL 📍1. Asymptomatic Stage (Due To Long Incubation Period Weeks-Months-Years) 📍2. Starts As High Fever With Rigor & Chills (1st Sign) Then Starts To Decrease Gradually Over Time (With Episodes Of Fever Relapse But With Less Intensity) 📍3. Progressive SplenoMegaly Over Time Until Becomes Massive 📍4. Moderate HepatoMegaly 📍5. Lymph Nodes Enlargement (Occurs More in Africa) 📍6. Black Skin Discoloration (Advanced Disease) 📍7. Confirm Dx : 🔺I. CBC (PanCytoPenia) : ▪︎Severe Anemia ▪︎Leucopenia ▪︎Thrombocytopenia 🔺II. Elevated Liver Enzymes & Immunoglobulins (IgG Then IgM) & Decrease Albumin 🔺III. +Ve Serology (Stay +Ve Even After Tx/K39 Name Of Serology) 🔺IV. Tissue Biopsy Then Microscopic Examination (To See Amastigotes [Leishman Donovan Bodies]) Or Culture Or PCR ➡️ Best Method To Confirm Dx 🔷Complications Of VL 📍1. Heart Failure (Due To Severe Anemia) 📍2. Bleeding Episodes (Due To Thrombocytopenia) 📍3. Jaundice With Edema & Ascites (Due To Liver Inflammation Or Failure) 📍4. Secondary Bacterial Infections (Risk Of Death) 📍5. Post-Kala-Azar Dermal Leishmaniasis : ▪︎Diffuse HypoPigmented Erythematous Or Nodular Skin Lesions That Usually Affects Face (Around Chin) & Trunks ▪︎Develops Shortly After Tx Or Years Later (6m-3Years After Infection) 📍6. Death If Not Tx Given 🔷DDX Of VL 1. Malaria 2. Typhoid Fever 3. TB (Miliary) 4. Shistosomiasis 6. Brucellosis 7. Infectious Mononucleosis (CMV) 8. Malignancy (Leukaemia/Lymphoma) 9. Ameobic Liver Abscess 🔷Mx Of VL 📍1. Sodium StiboGluconate (Pentostam) & Meglumine Anti-Moniate ➡️ Both 20mg/Kg/Day IV Or IM For 28-30 Days (Repeated As Needed) 📍2. AmphoTericin B (0.75-1mg/Kg Every Day Or Every Other Day For 15-20 Dose) ➡️ Used in Resistant Cases & Recommended For Immunocompromised Patients 📍3. Other Drugs : ▪︎Pentamidine isethionate (4mg/Kg/Day For 2w) ▪︎ParoMoMycin (11-14mg/Kg/Day For 3-4w) ▪︎Miltefosin (Oral Drug 2.5mg/Kg For 28 Days) ▪︎Recombinant Human Interferon-Y ▪︎Drugs Combination (To Prevents Drug Resistant) 📍4. Patients Follow Up For 6-12m (Due To Risk Of Relapse)

#TB

🔹Dx Of TB 📍1. Unexplained Cough For >2-3w 📍2. Chest Xray Changes : ▪︎Normal in Early Disease ▪︎Consolidation Or Cavitaion (Usually in Upper Lobe) ▪︎Hilar LN Enlargement ▪︎Ghon Focus (Small Rounded Well Defined Calcifications At The Periphery Indicates Healed Primary TB) ▪︎Miliary TB (1-2mm Nodules All Over The Lung Called Millet Seed) ▪︎Pleural Effusion Or Empyema ▪︎Lobar Collapse ▪︎Bronchiectasis & Pleural Scarring 📍3. Sputum Smear (At Least 3 Samples With One Taken At Early Morning) Then Do : ▪︎Ziehl-Neelsen Stain (Looking For Acid Fast Bacilli) ▪︎Lowenstein-Jensen Culture (Can Take 4-6w) ▪︎NAAT Tets ▪︎Fluorescent Microscopy 📍4. HistoPathological Dx Using Tissue Sample 📍5. Tuberculin Skin Test (Mantoux) Or Interferon Gamma Release Assay (IGRAs) ➡️ Can Used For Suspected Asymptomatic Patients (Detects Latent TB Infection) 🔹Mx Of TB ▪︎Patients Will Become Non-Infectious After 2w From The Tx 🪀Indications For TB Tx : 📍1. Smear +Ve Patients 📍2. Smear -Ve Patients But Has Typical Chest Xray Changes Not Respond To Usually Antibiotics 📍3. Strong Clinical Suspicious Of TB 🪀Duration Of Tx : 📍1. 6m For All Patients With New Onset Pulmonary & ExtraPulmonary TB 📍2. 12m For Patients With : ▪︎TB Meningitis ▪︎Spinal TB 🪀Drugs Regime : 📍1. Intensive Phase ➡️ 2m Of Isoniazid/Rifampicine/Pyrazinamide/Ethambutol 📍2. Continuation Phase ➡️ Then 4m Of Isoniazid/Rifampicine Only 📍3. Pyridoxine Alternative To Isoniazid Preferred in Pregnant Women & Malnourished Patients (Less Risk Of Peripheral Neuropathy) 📍4. Streptomycin Alternative To Ethambutol If Duration Of Tx Extended To 12m 📍5. Do Sputum Smear At 2m & 5m To Check Tx Efficacy 📍6. Tx Failure ➡️ If Sputum Smear +Ve At 5m Or Patient Has Mult-Drug Resistant TB 🪀Drugs Side Effects : 📍1. Rifampicine : ▪︎Changes Urine & Tear Colour To Orange ▪︎Reduce Efficacy Of Oral Contraceptives ▪︎Hepatitis & Rash & GIT Disturbances ▪︎Interstitial Nephritis ▪︎Haemolytic Anemia & Thrombocytopenia 📍2. Isoniazid : ▪︎Peripheral Neuropathy ▪︎Agranulocytosis ▪︎Hepatitis & Rash ▪︎Seizures & Psychosis 📍3. Ethambutol : ▪︎Optic Neuritis (RetroBulbar) ▪︎Arthralgia & Rash ▪︎Peripheral Neuropathy ▪︎Renal Impairment 📍4. Pyrazinamide : ▪︎HyperUricaemia & Gout ▪︎Myalgia & Hepatitis & Rash & GIT Disturbances & PhotoSensitivity 📍5. Streptomycin : ▪︎8th Cranial Nerve Damage (Vestibulo-Cochlear) ▪︎Renal Impairment ▪︎Agranulocytosis & Rash 🔹Prevention Of TB 📍1. Vaccination (BCG) 📍2. Detection Of Asymptomatic Carriers (Tuberculin Skin Test Or Interferon Gamma Release Assay) 📍3. ChemoProphylaxis For Contact Patients ➡️ 3m Of Isoniazid (Then Continue For 6m If Patient Confirmed Has TB)

🔴Tuberculosis (TB) ▪︎It's A Bacterial infection Caused By Mycobacterium Species (Mostly M.TB) That Results in Granulomatous Inflammation (Granuloma Formation) in Different Body Systems ▪︎More Common in The Developing Countries الفقرة ▪︎Usually Droplet Transmission (Respiratory Route) 🔹Features Of M.TB Bacteria ▪︎Curved Rod Shape ▪︎Aerobic تحب المناطق الهوائية العالية ▪︎Non-Motile ▪︎Non-Spore Forming ▪︎Weakly Gram +Ve ▪︎Acid Fastness 🔹Risk Factors For TB Infection 1. Children & Recent Measle Infection 2. Close Contact With Infected Person & Overcrowding 3. Smoking & Alcohol & Immunocompromised (Diabetes/Steroids/HIV) 4. Malignancy & Chronic Kidney Disease 5. Malnutrition & Vitamin Deficiency (A-D) 6. Silicosis 7. Hx Of Previous TB 8. Live in Endemic Region 🔹Clinical Features Of TB 🔸A. Pulmonary TB 📍1. Primary TB Usually Asymptomatic (Only Chest Xray Findings) & Occurs More in Children 📍2. Non Specific Flu Like Symptoms 📍3. Chronic Productive Cough With Haemoptysis 📍4. Pyrexia Of Unknown Origin & Night Sweats 📍5. Weight Loss & General Malaise 📍6. Spontaneous Pneumothorax 📍7. Exudative Pleural Effusion 📍8. Unresolved Pneumonia 📍9. Miliary TB : ▪︎Pulmonary TB Dissemination Through The Blood To Other Body Organs ▪︎Present As Acute Or 2-3w Symptoms Of : I. Fever/Night Sweats/Anorexia/Weight Loss/Dry Cough II. ExtraPulmonary Features (HepatoSplenoMegly/Headache/Anemia/Leucopenia/Choroidal Spots On The Eye) 📍10. Post-Primary TB : ▪︎Gradual Slow Onset Of TB Symptoms in Patient Previously Dx With TB ▪︎Due To Reactivation Of Latent TB Or Due To Acquisition Of New TB Infection ▪︎More in Adults & Usually Present As Pulmonary Symptoms Only & Xray Changes More in Upper Lobes ▪︎More Risk Of Pulmonary Complications 🔸B. ExtraPulmonary TB (Common in HIV Patients) 📍1. Painless LN Enlargement : ▪︎1st Seen At Cervical Then Mediastinal Then Axillary Then Inguinal Then SupraClavicular LN ▪︎Start As Mobile LN Then Become Matted Together & Fluctuant طرية ▪︎Nodes May Discharge into The Skin (Collar-Stud Abscess & Sinus Formation) 📍2. GIT TB : ▪︎Usually Affects Ileo-Caecal Loop Of The Bowel ▪︎Present As : I. Palpable Right iliac Fossa Mass II. Acute Abdomen (30%) III. Bowel Wall Or Mesenteric Thickening IV. Bowel Narrowing & Shortening & Distortion (Increase Risk Of Bowel Obstruction) V. Ascites VI. Abdominal LN Enlargement & Mesenteric Adenitis VII. TB Peritonitis (Abdominal Pain & Distention With Fever) VIII. Jaundice 📍3. Pericardial Diseases Present As : ▪︎Pericardial Effusion ▪︎Constrictive Pericarditis ▪︎Pericardial Calcifications 📍4. TB Meningitis : ▪︎High Risk Of Mortality (30%) ▪︎Risk Of Neurological Dysfunction 📍5. Bone & Joint TB (Pott's Disease) : ▪︎Usually Affects Lower Thoracic & Lumbar Spine ▪︎Present As : I. Chronic Back Pain (Cord Compression) II. Kyphosis III. Para-Vertebral & Psoas Abscess IV. Large (Cold) Inguinal Abscess V. Hip Or Knee Joint Inflammation (Poncet's Arthropathy) 📍6. Genito-Urinary TB Present As : ▪︎Hematruia/Frequency/DysUria ▪︎Sterile PyUria ▪︎Women Infertility (Due To EndoMetritis) ▪︎Women Pelvic Pain & Swelling (Salpingitis) ▪︎Women Tubo-Ovarian Abscess ▪︎Men Epididymitis Or Prostatitis 🔹Complications Of TB 1. Permanent Lung Damage (Fibrosis/Bronchiectasis/Emphysema/Calcification) 2. Cor Pulmonale (Right Heart Failure Due To Lung Disease) 3. Massive Haemoptysis 4. Bronchopleural Fistula 5. Pleural Calcification 6. TB Meningitis (More in Children Younger Than 5 Years & Usually Develops 6m After Primary TB)

Mentzer Index: differentiate iron deficiency anemia and thalassemia.

#Diphtheria@Clinicalpediatricround

🔴Diphtheria ▪︎Bacterial Infection Of URT Mucus Membranes & Skin By Toxin Producing Corynebacterium Diphtheria (Gram +Ve/Club Shape Rods With Beaded) ▪︎Respiratory & Direct Contact Transmission ▪︎Psuedomembrane Formation ▪︎Mostly Affect Tonsils/Pharynx/Nose & Larynx 🔹Clinical Features 📍1. Pharyngeal Diphtheria ▪︎Sore Throat & Mild Fever ▪︎Serosanguineous Rhinitis ▪︎Ulcerations Of Upper Lip & External Nares ▪︎Dysphagia & Hoarseness ▪︎Gray Adherent Psuedomembrane Formation On Tonsils/Pharynx/Nasopharynx/Trachea ➡️ Bleed On Removal ▪︎Cervical LN Enlargement With Neck Edema ➡️ Produce Bull Neck Appearance ▪︎Stridor & Upper Airway Obstruction ➡️ If Diphtheria Reach Larynx 📍2. Skin Diphtheria ➡️ Superficial Ecthyma Like NonHealing Ulcer With Gray-Brown Psuedomembrane Formation With Pain & Tenderness & Erythema 🔹Dx ➡️ Clinical + Culture On Loeffler-Tellurite Agar For 16-48h 🔹Complications 1. Myocarditis (Most Common Cause Of Death) ➡️ Present After 2-3w As Tachycardia/PR Prolongation/ST Changes/Arrhythmia/HF/Cardiomyopathy 2. Polyneuritis ➡️ Paralysis Of Soft Palate & Pharyngeal & Laryngeal & Facial Muscles ➡️ Produce Nasal Speech/Difficult Swallowing/Regurgitation & Aspiration/Diplopia & Strabismus 3. Secondary Pneumonia 🔹Mx 📍1. Diphtheria AntiToxin Within 48h (Single Dose 20k-100k Unit) 📍2. Penicillin G (150k Unit/Kg/Day IV Or IM Every 6h) For 10 Days ▪︎Alternative AB •Erythromycin (40mg/Kg/Day Orall Or IV Every 6h) •Oral Penicillin V (250mg 4x) 📍3. Carriers Tx ➡️ Erythromycin (40mg/Kg/D Orally)/Penicillin V (50mg/Kg/D For 10D)/Penicillin G (600k-1200k IM) 📍4. Prevention ➡️ DTAP Vaccination

#Mumps@Clinicalpediatricround

🔴Mumps النكاف ▪︎Viral Infection (RNA Paramyxo Virus) Affecting The Salivary Glands ▪︎Mostly Affect Unimmunized Children ▪︎Gives Life Long Immunity ▪︎Respiratory Transmission & Infectivity Period 1-2 Days Before & 5 Days After Onset Of Symptoms 🔹Clinical Features & Complications 📍1. Prodromal Symptoms Of Mild Fever & Myalgia & Malaise 📍2. Tender Swelling Of Salivary Glands ▪︎Usually Starts As Unilateral Then Becomes Bilateral Parotid Swelling With Ear Protruding & Stensen Duct Swelling ▪︎Pain Increase By Eating Sour Food & Mouth Opening Then Disappears After 1w 📍3. Mumps MeningoEncephalitis ▪︎Most Common Cause Of Aseptic Meningitis in Unimmunized Children ▪︎Present As Mild Headache/Fever/Nausea & Vomiting/Neck Stiffness/Convulsions/Or Asymptomatic ▪︎Present 5 Days After Parotid Swelling 📍4. Epidydimo-Orchitis ▪︎More in Postpubertal Men (Adolescents & Adults) ▪︎Present As Testicular Pain & Swelling & Erythema ▪︎Mostly Unilateral & Resolve in 1-2w ▪︎Risk Of Testicular Atrophy & Infertility (Rare) 📍5. Oophoritis (Girls) ➡️ Pelvic Pain & Tenderness Confused With Appendicitis 📍6. Acute Hemorrhagic Pancreatitis ➡️ Acute Epigastric Pain & Tenderness With Fever & Vomiting & Increase Pancreatic Enzymes (Amylase & Lipase) 📍7. CSF Lymphocytosis & Elevated Proteins 📍8. Long Term Complications ➡️ Deafness/Aqueductal Stenosis & Hydrocephalus/Myocarditis/Transverse Myelitis/Facial Paralysis 🔹DDX 1. Cervical Adenitis ➡️ Leukocytosis & Neutrophilia/Normal Ear Position & Normal Stensen Duct 2. Bacterial Parotitis ➡️ Pus & Systemic Toxicity With High Fever Due To Staph.Aureus 3. Recurrent Parotitis ➡️ Intermittent Swelling & Pain Increase By Chewing Due To Parotid Stones 4. Endemic Parotitis ➡️ Bilateral Painless Swelling Due To Malnutrition & Chronic Anemia 5. HIV Parotitis ➡️ Bilateral & Chronic & Less Painful 🔹Mx (Supportive) 📍1. 5 Days Patient Isolation 📍2. IV Fluids & Analgesia 📍3. Prevention By MMR Vaccine

Status epileptics

Status epilepticus

🔰Erythema Infectiosum (5th Disease)

▪︎Viral Infection Caused By DNA ParvoVirus B19

🔹Clinical Features & Dx

📍1. Start As Mild Fever/Headache/Malaise/Myalgia/Pharyngitis/Conjunctivitis 📍2. Then Rash After 7-10 Days :

▪︎Start As Slapped Check Rash With Circumoral Pallor (Like Lupus) ▪︎Then Rash On Trunk ▪︎Then Central Clearing Of Rash ➡️ Giving Appearance Of Lacy Reticulated Rash على شكل شبكة من الخطوط

📍3. Hematological Abnormalities (Aplastic Crisis)

🔹Complications

📍1. Transient Aplastic Crisis For 7-10 Days 📍2. Congenital Fetal Infection ➡️ Results in Severe Anemia/Heart Failure/Hydrop Fetalis & Fetal Death 📍3. Arthritis/Hepatitis/Myocarditis/Purpuric Gloves & Stocks Syndrome

🔹Mx (Supportive)

📍1. Blood Transfusion For Transient Aplastic Crisis 📍2. IVIG For Immunocompromised Patients

🔰Scarlet Fever الحمى القرمزية

▪︎Bacterial Infection Caused By GA Beta Hemolytic Streptococcus (GAS) ▪︎Primary Focus Of Infection ➡️ Pharyngitis/Skin Infections

🔹Clinical Features & Dx

📍1. Sudden Onset Of Fever & Sore Throat/Vomiting/Headache/Systemic Toxicity 📍2. Tonsils & Pharynx Swelling & Covered With Patches Of Exudates 📍3. Tongue Change Colour ➡️ White Strawberry (1st Two Days) Then Red Strawberry (At 5th Day) 📍4. Skin Rash (Scarlatiniform) At Same Time With The Fever :

▪︎Diffuse Red Punctate Feels Like SandPaper (Goose Skin Rash نقاط ناعمة) ▪︎Flushed Face & CircumOral Pallor (Like Lupus) ▪︎Blanch On Pressure ▪︎More Intense At Skin Folds (Axilla/Groin/Neck) ➡️ Here Don't Blanch ▪︎Residual Petechial Rash in The AnteCubital Fossa May Be Seen (Pastia’s sign) 📍5. Confirm Dx :

▪︎Typical Clinical Features ▪︎Neutrophilia ▪︎+Ve Throat Culture ▪︎ASO Titer >250

🔹Mx Of Scarlet Fever

📍1. Oral Penicillin V For 10 Days 📍2. Amoxicillin (50mg/Kg) For 10 Days 📍3. Single IM Benzathine Penicillin G 📍4. Erythromycin Or Azithromycin (For Penicillin Allergic Patients) 📍5. Clindamycin Or Rifampin ➡️ For Eradication Of Chronic Carrier State

🔹Complications

📍1. PostStrept Glomerulonephritis 📍2. Acute Rheumatic Fever 📍3. Strept Toxic Shock Syndrome 📍4. Reactive Arthritis 📍5. Chronic Carrier State

🔰ChickenPox

▪︎Primary Viral Infection Caused By Varicella Zoster (VZV) Member Of Herpes Family Transmitted By Droplets & Skin Contact

▪︎Gives Life Long Immunity & Latent Infection 🔹Clinical Features

📍1. Start As Fever With Malaise & Anorexia (Prodromal Stage) 📍2. After 24-48h Very Itchy Rash (Start On Scalp & Face & Trunk Then Descend To Limbs) :

▪︎About 200-500 Lesions ▪︎Rash Start As Erythematous Macules Then Papules Then Vesicles Then Crusts ▪︎Different Stages Of Rash Present At Same Time ▪︎Vesicles in Mouth Mucus Membrane May Ulcerate

📍3. Patient is Infective 2 Days Before Rash Onset Until Rash Crusted

🔹Complications Of ChickenPox 1. Permanent Scars If Lesions Scratched 2. Secondary Bacterial Infection (Staphylococci/GA Streptococcus) ➡️ Risk Of Toxic Shock Syndrome & Necrotizing Fasciitis 3. Encephalitis ➡️ Week After Onset Of Rash & Associated With Cerebellar Signs (Cerebellitis) 4. Purpura Fulminas ➡️ Large Area Of Skin & Subcutaneous Tissue Inflammation After VZV Infection 5. in Immunocompromised ➡️ Severe Vesicular & Hemorrhagic Eruption/Pneumonitis/DIC 6. Congenital Varicella Syndrome ➡️ Risk Of LBW/Mental Retardation & Congenital Anomalies 7. Rye's Syndrome If Aspirin Used 8. Shingles (Secondary Herpes Zoster) ➡️ ReActivation Of Latent VZV Causing Vesicular Eruption in Specific Dermatomes (Mostly At Thorax) & Risk Of Chronic Neuralgic Pain

🔹Mx Of ChickenPox

📍1. Acyclovir (20mg/Kg 4x Per Day For 5 Days) 📍2. Anti-Pruritics (Anti-Histamines/Calamine Lotion) 📍3. Anti-Pyretics (Paracetamol/Never Use Aspirin) 📍4. Antibiotics (If Secondary Bacterial Infection Developed) 📍5. Prevention & Prophylaxis :

▪︎ChickenPox Vaccine At 12-18m Age (Also Given 3-5 Days After Exposure As Prophylaxis) ▪︎Anti-VZV IVIG (IM 1 Vial For Each 10Kg Of Body Weight) ➡️ Post Exposure Prophylaxis For Immunocompromised & Pregnants & Newborns