COMMON COMMUNICABLE DISEASES IN CHILDREN.pptx

COMMON COMMUNICABLE DISEASE IN CHILDREN FOR NURSING STUDENTS

1. COMMON COMMUNICABLE DISEASES IN CHILDREN

2. MEASLES

3. INRODUCTION Measles is an acute viral illness caused by a virus in the family paramyxovirus, genus Morbillivirus. It is characterized by a prodrome of fever ( upto 105º F) and malaise, cough, coryza and conjunctivitis, followed by a maculopapular rash. MODE OF TRANSMISSION Droplet infection

4. INCUBATION PERIOD 10 days from exposure to onset of fever or 14 days to appearance of rash CLINICAL FEATURES Prodromal stage Fever, coryza, conjunctival congestion, dry hacking cough, koplik spots Eruptive phase Dusky red macular or maculopapular rash appearing on 4 th day with rise of fever initially behind the ears, which rapidly spreads over face, neck, trunk and extremities in next 2-3 days

5. KOPLIK SPOTS

6. Post measles phase Weight loss, severe malaise There may be growth retardation, diarrhoea and candidiasis COMPLICATIONS Respiratory- otitis media, bacterial bronchopneumonia, reactivation of latent tuberculosis Gastro intestinal – persistent diarrhoea , appendicitis, malnutrition, coma or gangrene of cheeks

7. RISK FACTORS Unvaccinated children Children with immune deficiency due to HIV Leukemia Corticosteroid therapy Malnutrition Vitamin A deficiency

8. DIAGNOSIS Clinical examination Serum IgM antimeasles antibody seen 3 days after the rash upto 1 month TREATMENT No specific treatment is required Supportive management such as antipyretics, fluid and calorie intake, vitamin A administration may be advised Antibiotics for secondary infection, Ibuprofen or acetaminophen for pain Bronchodilators & Antiemetic

9. NURSING MANAGEMENT Bed rest in febrile stage Isolation upto 4-5 days after rashes appear. Oral hygiene every 4 hourly Skin hygiene and eye care Nutrition: prevent PEM Control of fever by PCM and sponging Severe cough relieved by saline nebulization

10. Vitamin A, 2 lakh IU given orally to the children above 1 yr for 2 consecutive days PREVENTION - Vaccination Passive immunization with g amma glo bulin I M 0.25m l /kg for children less than 1 yr

11. CHICKEN POX

12. INTRODUCTION Chicken pox is highly infectious disease caused by varicella zoster virus characterized by vesicular rash accompanied by a short prodromal illness More common during spring and winter season. MODE OF TRANSMISSION Transmitted by direct contact with the infectious person or by airborne spread It can be spread from mother to foetus crossing the placental barrier and cause congenital varicella

13. INCUBATION PERIOD 10-21 days approximately CLINICAL FEATURES Pre eruptive phase Mild to moderate fever, back ache, headache, shivering and malaise This prodromal symptoms last for about 24 hrs Eruptive phase The rash appears within 24-48 hrs first on the trunk and spreads rapidly in-

14. -centripetal distribution to face and extremities Vesicles also appears in oral mucosa, pharynx, larynx, conjunctiva and genitals Rash appears as pruritic erythematous macule and evolves into papules, clear fluid filled vesicles, clouded vesicles and scab Pleomorphism is the unique characteristic of rashes in chicken pox. There may be 250-300 lesions in most children. Scaring may occur due to scratching or secondary infection

15. COMPLICATIONS Bacterial skin infection Meningoencephalitis, acute cerebellar ataxia, Pneumonia Thrombocytopenic purpura DIAGNOSIS Clinical examinations Scrapping of the vesicles and Tzanck smear of lesion is done to diagnose

16. TREATMENT Symptomatic treatment done with antipyretics, antipruritic drugs, good nutrition and hygiene Isolation is needed Administration of oral acyclovir in healthy children within 24 hrs of appearance of rash reduces the duration of rash and number lesions by 25% PREVENTION Varicella zoster immunoglobulin within 72 hours of exposure to infected person is recommended as post exposure prophylaxis for neonates

17. Live attenuated varicella vaccine is advised for any healthy children after 12 months of age

18. DIPHTHERIA

19. INTRODUCTION Diphtheria is an acute bacterial infection caused by toxigenic strains of Corynebacterium diphtheriae. Diphtheria can be 3 types- nasal, tonsillar pharyngeal, and laryngeal diphtheria. The gram positive bacilli multiply and produce exotoxin, which leads to the formation of greyish white pseudo membrane over the tonsils, pharynx or larynx which can not be wiped off and bleeds if tried to remove it.

20. Edema and inflammation of respiratory passages occur and may result in toxemia affecting heart, kidney and myocardium. MODE OF TRASMISION Droplet infection INCUBATION PERIOD 2-6 days CLINICAL FEATURES Fever, headache, malaise in general

21. In nasal diphtheria, serosanguinous foul smelling nasal discharge, epistaxis, respiratory difficulty can occur In case of tonsillar pharyngeal diphtheria redness and swelling over the fauces , cervical lymph node enlargement with bullneck appearances, sore throat and dysphagia. Laryngeal diphtheria is characterized by noisy breathing, brassy barking cough, stridor, hoarse voice and retractions COMPLICATIONS Respiratory- respiratory failure

22. BULLNECK APPEARANCES

23. Cardiac- myocarditis, arrhythmias, congestive cardiac failure Neurological- palatal palsy, ocular palsy, peripheral neuritis Renal- oliguria, proteinuria, nephritis DIAGNOSIS Albert stain swab from oropharynx and larynx Schick test to check susceptibility of contacts TREATMENT Administration of diphtheria antitoxin IV/IM

24. MANAGEMENT Anti diphtheria serum (ADS) IM/IV if infection with diphtheria bacilli is suspected Doses: n asal d i phth eria: 20 , 000 un i t s Tonsillar and pharyngeal diphtheria: 40,000-80,000 units Laryngeal lesions: 80,000-1,20,000 units Diphtheria immunoglobulin 0.6ml/kg body weight in place of ADS Antibiotics

25. P r ocai n e p e ni cillin is th e d r u g o f c h oice Alternatively erythromycin (40mg/kg/day) can be used It should be given for 7-10 days or until the throat culture is negative NURSING MANAGEMENT Isolate the child Strict bed rest for 2 weeks Maintain proper hydration and nutrition Regulate humidity and provide steam inhalation

26. Use suctioning as needed Observe vital signs, especially respiration Gargles with normal saline Nutrition: soft liquid diet PREVENTION Isolation until the course of antibiotics is complete or until two cultures from throat and nose are negative People in close contact should be immunized immunization

27. PERTUSSIS

28. INTRODUCTION Pertussis is an acute highly communicable respiratory infection caused by Bordetella pertussis characterized by paroxysmal or spasmodic cough ending with ‘whoop’ . It is most common in children below 5 years of age. MODE OF TRANSMISSION Droplet infection INCUBATION PERIOD 7-14 days

29. CLINICAL FEATURES Catarrhal phase Lasts for 10 days with insidious onset, sneezing. Coryza, hacking cough at night, which becomes diurnal later and malaise Paroxysmal phase It lasts for 2-4 weeks, characterized by episodic paroxysmal cough with increasing intensity ending with high pitch inspiration ( whoop) followed by vomiting. Infants may become apneic or cyanotic

30. Convalescent phase Severity of cough decreases over 1-2 weeks COMPLICATIONS Respiratory- bronchitis, bronchopneumonia, emphysema, atelectasis, otitis media and flare up of tuberculosis. Neurological- convulsions, encephalopathy, cerebral hemorrhage, subconjunctival hemorrhage Malnutrition, hernia

31. DIAGNOSIS Culture of nasopharyngeal swab on Bordet Gengou medium Chest x-ray Routine blood studies: elevated leukocytosis and low ESR TREATMENT Antibiotic- Erythromycin 40-50mg/kg/day in 3 divided doses for 14 days Nebulization with salbutamol Good nutrition and fluid intake

32. Salbutamol orally 0.3-0.5mg//kg/day in 3 divided doses, if nebulization is not possible PREVENTION Immunization Chemoprophylaxis for children or close family contacts with erythromycin

33. TETANUS

34. INTRODUCTION It is an acute disease caused by neurotoxin of Clostridium tetani characterized by muscular rigidity and painful paroxysmal spasms of voluntary muscles. Bacillus is present in soil, human and animal feces. MODE OF TRANSMISSION Transmitted through the contamination of wounds with spores in presence of foreign body, trauma, burn injury or suppurative infection. During delivery unclean cord tie and unhygienic practices may cause neonatal tetanus

35. INCUBATION PERIOD 6- 10 days to several months TYPES Neonatal tetanus- occur due to birth of a new born from unimmunized mother during pregnancy, unhygienic birth practices and contaminated umbilical cord. Manifestations can seen by 3 rd day of life, excessive crying and refusal of feed Paralysis, painful muscular spasms and opisthotonic posture develops progressively

36. OPISTHOTONIC POSTURE

37. Localized tetanus Characterized by rigidity and pain localized to muscles adjacent to the site of injury. It is less severe but cephalic tetanus affecting bulbar muscle has poor prognosis Generalized tetanus Characterized by generalized spasms involving initially in jaw muscles, descending paralysis It can cause severe complications and death

38. PATHOGENESIS Entry of organisms through abraded skin, puncture wound, burn injury etc Transform into vegetative form under favorable conditions Multiply and produce 2 types of toxin- tetanolysin & tetanospasmin Toxins mainly tetanospasmin binds to neuromuscular junction at the injured site Reaches presynaptic nerve terminal via retrograde axonal transport Prevents release of inhibitory neurotransmitters(glycine & GABA)

39. Uncontrolled contraction of muscles occur CLINICAL FEATURES Spasm of massaters causing lock jaw, inability to open mouth (trismus) Rigidity of facial muscles creating a sardonic grin Opisthotonus posturing Laryngeal spasms causing respiratory distress and cyanosis Autonomic instability Hypertension or hypotension

40. Arrythmias Hyperpyrexia TREATMENT Human tetanus immunoglobulin (TIG) 3000- 6000 units IM Antitetanus serum (ATS) 50,000 units IV if TIG not available Antibiotics : pencillin 1 lakh units/kg body weight IV in 4 divided doses for 10 days, Metronidazole Diazepam: IV in a dose of 0.5- 5mg/kg every 2-4 hours

41. Avoid stimulation to prevent spasms Benzodiazepines for relief of spasms Oral feeding is avoided and intravenous fluid and nutrition is preferred in severe cases Alpha and beta adrenergic blockers for autonomic instability Complete course of tetanus toxoid immunization after recovery Tracheostomy and ventilation

42. NURSING MANAGEMENT Complete bed rest Keep the child in dim lighted, quiet and well ventilated room, as spasm can be precipitated by bright lights, noise or even touch Minimize external stimuli Prompt suctioning and administration of oxygen Maintenance of fluid and electrolyte balance Change position of child 2-3 hours to prevent bed sore and complications Maintenance of general hygiene

43. POLIOMYLEITIS

44. INTRODUCTION Poliomyelitis is the combination of two words ‘polio’ and ‘myelitis’ where polio means gray matter and myelitis means inflammation of spinal cord Agent: polio virus with 3 distinct serotypes- type I, II , and III. It is a picorna virus Mode of infection : feco -oral route Transmission: food and water borne Incubation period : 5-35 days Reservoir and host: hu man

45. TYPES OF POLIOMYELITIS Abortive illness Non paralytic illness Paralytic illness

46. Abortive illness : minor nonspecific illness without clinical or laboratory evidence of CNS invasion illness lasts for 1-14 days Fever Headache Sore throat Nausea & vomiting Loss of appetite Vague abdominal pain

47. Non-paralytic illness : Minor febrile illness for several days is followed by signs of meningeal irritation Symptoms include headache, nausea& vomiting are common, pain & stiffness of back and legs, neck rigidity Other signs include Tripod sign : on asking the child to sit up unassisted, flexes the knees, examiner then passively extends one knee. The child places his hands behind him for sitting and extends trunk to relieve tension

48. Kiss the knee test : knees are kept down and child is asked to kiss his knees. He cannot do the maneuver due to stiffness of spine Head drop sign : the hand is placed under patient’s shoulder and trunk is raised. The head lags behind Neck rigidity is present Paralytic illness: occurs in 0.1% cases several forms of paralytic polio

49. Spinal form Bulbar bulbo -spinal form Polio encephalitis

50. Spinal Form Paralysis of spinal muscles occur suddenly Muscle pain, hyperesthesia (excessive physical sensitivity), tremors and diminished tendon reflexes Involvement of diaphragm and intercostal muscles may cause respiratory difficulty Transient urinary retention and constipation due to autonomic involvement

51. Bulbar: life threatening Weakness of soft palate, pharynx & vocal cord Hoarse voice, Breathing & swallowing difficulty Fluid regurgitate through nose Secretions accumulate in pharynx, which may be aspirated into lungs causing atelectasis and pneumonia Skin becomes dusky, red & mottled Patient is restless and anxious, may be confused, delirious and comatose

52. bulbo -spinal form – combination of spinal & bulbar Polio encephalitis Rare form and i nvolves higher brain center Symptoms are i rritability, d isorientation Fits, tremors Loss of consciousness Spastic paralysis

53. COMPLICATIONS Gastric dilatation Hypertension Acute pulmonary edema Melena Hypercalcemia Life long disability

54. DIAGNOSIS Stool specimen culture for virus culture (virus found in feces from 72 hours prior to onset of paralysis upto 6 weeks or after infection) It should be suspected in incomplete or unimmunized child with paralysis, if occurs 7-14 days following OPV administration Confirmation through ELISA and PCR on stool

55. MANAGEMENT-symptomatic & supportive Mild sedation for relieving anxiety Analgesics for pain Hot moist pack for relieving muscle pain and spasm Laxatives for constipation Penicillin for secondary infection Ventilatory support for respiratory paralysis P hysiotherapy

56. Nursing management Bed rest Isolation of child Immobilization of painful limb Vital signs Oxygen therapy if cyanosis Hot packs Antipyretics Personal hygiene Ventilator care

57. PREVENTION I mmunization with polio vaccine Injectable polio vaccine Oral polio vaccine OPV should be given, minimum 5 doses starting from birth upto 5 years