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Lec.
4 4 :‫العدد‬
2022-3-17 ‫الخميس‬ ‫أطفال‬ ‫ رياض‬.‫د‬

Poliomyelitis2022
It is one of the of causes of : acute flaccid paralysis syndrome
causing paralysis of the muscles of the limbs caused by ;either
wild strain Polio Virus , or by oral vaccine virus .It is transmitted
from person to person via feco-oral route.
Poliovirus is a RNA enterovirus.
Patterns of polio -infection
• Basically three forms of infection
• A .Minor illness as flulike) abortive): 59%. not affecting

muscle power ,presented with fever ,sore throat, vomiting.
• B .Aseptic meningitis2-3% as headache ,neck stiffness ,

fever ,no paralysis
• C .Paralytic form 1% of infection cause acute flaccid paralysis

of the limbs, even bulbar or bulbospinal paralysis.
Diagnosis and differential diagnosis
• Acute flaccid paralysis syndrome defined as ;Any acute

limping less than 11 days onset with weakness and absent
reflexes ,should consider acute flaccid paralysis AFP
syndrome( polio, GB,TM ;)and requires collection of stool
sample to the preventive medical center =for polio virus
detection by ;culture , and further by PCR to detect the type
of strain of the polio virus.
• Guillain-Barre syndrome GB is another cause for AFP so it

should be excluded . In GB syndrome is acute ascending
bilateral symmetrical paralysis ,while in poliomyelitis ;it is
commonly unilateral paralysis.
• Transverse myelitis TM also should be excluded ;it usually
causes paraplegia.
1
Covid-19 in children
• Children of all ages even neonates ,can get the corona virus
and can experience its complications.
• Children are less likely to get covid-19 as adult and are less
likely to become severely ill.
• Upto 95% of cases may be without symptoms.
• Some may need hospitalization and intensive care.
Risk factors for severe Covid11-
• Obesity
• Diabetes
• Congenital heart disease
• Asthma
• Neurological conditions
• Babies <1yr.
Clinical features
• The most common are bouts of repetitive coughing ;each

attack may continue up to an hour and the attacks may be 3
and more in a day , may be productive.
• high fever.
• Sore throat.
• Nausea ,vomiting
• Muscle aches and fatigue.
• Nasal congestion and loss of smell and taste.
• Symptoms appear average 6 days after exposure to the

virus covid-19.
2
Multisystem inflammatory syndrome in children
• MIS-C is a serious complications following covid-19 infection

as a severe immunological response .Affect some parts like :
heart,lung,blood,vessels,kidneys,GIT,brain,eye and skin.
Possible signs and symptoms of MIS-C;
• Fever for >42 hrs
• Vomiting and diarrhea
• Skin rash ,enlarged lymph nodes.
• Red eyes ,swelling of lips and tongue.
• Redness and swelling of palms and soles
MIS-C definition and Criteria
• A child<21yr with fever for42 hr or more, with two or more of

organs involvement ( cardiac ,liver ,kidney ,brain ,
respiratory ,and dermatology), with severe condition
requiring hospitalization,having positive result for current
orrecent covid 95- infection by RT -PCR ,or serology IgM or
IgG ,and with one or more of positive inflammatory tests ;C -
reactive protein ,ESR ,ferritin ,D-dimer ,elevated
neutrophils ,reduced lymphocytes and low albumin.
• Some children may fulfill full or partial Kawasaki disease.
prevention
1. Good hygiene, hand washing ,face mask
2. USA FDA ; authorized Pfizer-Vaccine for children from 9

to 99 years of age .Lower doses two shots 3 , weeks a part.
3. Age 12-15yr higher dose of Pfizer .Two shots.
4. Third dose can be given after 6 weeks from first dose for
children with immune weakness in both age groups.
3
Infectious Mononucleosis
disease
EPSTIEN-BARR VIRUS INFECTION EBV INFECTION
Infectious Mononucleousis syndrome
1. IMN Diseases EB-virus infection (55 %).
2. Cytomegalovirus CMV infection.
3. Toxoplasmosis
4. Adenoviruses
EPSTEIN-BARR VIRUS INFECTION
• INFECTIOUS MONONUCLEOSIS syndrome is mostly

caused by Epstein-Barr virus( EBV :)referred as the)
INFECTIOUS MONONUCLEOSIS DISEASE , )forms 90%)
of cases of the IMN syndrom ,it is also called glandular
fever .The virus is related to herpes virus group;( DNA)
• It is mainly disease of adolescent and adult but children

as young as 3-5 years old can be infected
• Othe 10% of the syndrom :is caused by CMV ,

Toxoplasmosis ,and adenovirus.
Clinical picture
• The virus is transmitted by saliva usually from asymptomatic

infected adult usually by kissing .Incubation period 1-2
months .Presentation as triad of fever for 1-2 weeks with
lymphadenopathy of the back of the neck ,axilla ,groin ,and
sore throat that exactly similar to follicular tonsillitis due to
streptococcal infection.
• Splenomegaly may be developed in the4 nd or 3 rd week of

illness in about 50% of cases. It may be prone to rupture
due to trauma .Liver also may enlarge in 30% .They regress
in a period of 2-3 weeks .Fever usually resolves in 4 week .
4
Most of the cases develops body maculopapular rash when
ampicillin or amoxicillin are received.
• Spontaneous improvement usually occurs within 2-4 weeks

without special treatment.
complications
• Splenic rupture if exposed to trauma ,in

0.5% of cases.
• Upper airway obstruction due to

pharyngeal oedema and swelling.
• Other complications are rare includes ;hepatitis and

jaundice ,encephalitis , Guaillain -barre syndrome ,hemolytic
anemia ,thrombocytopenia ,carditis , Burkett lymphoma.
diagnosis
• CBC shows high leukocytosis mainly due to absolute

lymphocytosis ;with 20-40% of lymphocyte count are of
atypical( reactive T-cell )lymphocytes seen in the blood film
Throat swab culture ; negative for streptococcal bact,
• Heterophiles antibodies detected by Monospot test .If it is

positive ,it is considered most likely diagnostic for EB virus
infection but with sensitivity, 70-90% it is less sensitive and
less specific than the serological virus antibody test .
Monospot test is usually negative in young children ; less than
5
2yr old .False positive test may be seen in leukemia ,
lymphoma and hepatitis.
• Definite diagnosis and convenient test for EBV infection is to

detect
EBV -IgM antibody in the serum ) EB virus serology TEST(in

all ages.
• Differential diagnosis of EBV infection are CMV ,adenovirus ,,

and toxoplasmosis ,all these shows lymphocytosis ,and can
even have atypical lymphocytes ,but with negative EBV -
specific antibody serology tests.
management
• Usually no need for specific treatment .It remits

spontaneously within 2-3 weeks .Just supportive like
antipyretic ,but in case of complications like upper
respiratory obstruction due to oropharyngeal or laryngeal
edema corticosteroids may be used.
Diphtheria
Definition
• It is a serious bacterial infection caused by Corynebacterium

Diphtheriae spread by airborne from droplets of sneezing
and cough or by direct contact from the lesion of skin .It
mainly infects the throat and cause white to gray membrane
on the tonsil or the palate and pharynx . Incubation period
about 7days. Main cause of the illness is due to toxins
produced by the bacteria that when once fix to the tissue
cannot be removed with treatment.
• Mortality rate reaches 5% and increase if not treated early.
Clinical features
• Fever and chills.
• Sore throat and pain on swallowing.
6
• Swelling of the neck (bull neck). Cervical lymphadenitis.
• True croup ;stridor ,brassy cough ,hoarseness of voice ,and

may need intubation or tracheostomy for respiratory difficulty.
• If not treated early ,it may leads to cardiac toxicity causing

carditis and arrhythmia .and may cause kidney damage.
• Palatal paralysis and other cranial nerve paralysis or
peripheral nerve paralysis due to the effect of the toxin.
Laboratory investigations
Diagnosis depend upon the clinical suggestion followed

by confirmation by lab tests.
Diagnostic test is to take swab from the throat and

isolation of m.o by gram stain or
by culture of the bacteria from the swab.
prevention
• Infection does not lead to permanent immunity ,

and vaccine DTaP in children <6yr or dT in
>6years old ,gives 95 yrs protective immunity
from diphthria.
• For contact ; give booster by DTaP for age <6yr.
• And dT vaccine booster for age above 6 yr
TREATMENT
• PENICILLIN G injections for 92 days or erythromycin oral for

92days.
• Antitoxin should be given to inactivate toxins that still not

combine with tissue yet .given IM or IV injection.

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Lec.

2022-3-17 ‫الخميس‬ ‫أطفال‬ ‫ رياض‬.‫د‬

Poliovirus is a RNA enterovirus.

Patterns of polio -infection

• Basically three forms of infection

• A .Minor illness as flulike) abortive): 59%. not affecting

• B .Aseptic meningitis2-3% as headache ,neck stiffness ,

• C .Paralytic form 1% of infection cause acute flaccid paralysis

Diagnosis and differential diagnosis

• Acute flaccid paralysis syndrome defined as ;Any acute

• Guillain-Barre syndrome GB is another cause for AFP so it

• Transverse myelitis TM also should be excluded ;it usually

• Upto 95% of cases may be without symptoms.

• Some may need hospitalization and intensive care.

Risk factors for severe Covid11-

• Congenital heart disease

• The most common are bouts of repetitive coughing ;each

• Muscle aches and fatigue.

• Nasal congestion and loss of smell and taste.

• Symptoms appear average 6 days after exposure to the

• MIS-C is a serious complications following covid-19 infection

Possible signs and symptoms of MIS-C;

• Fever for >42 hrs

• Vomiting and diarrhea

• Skin rash ,enlarged lymph nodes.

• Red eyes ,swelling of lips and tongue.

• Redness and swelling of palms and soles

MIS-C definition and Criteria

• A child<21yr with fever for42 hr or more, with two or more of

• Some children may fulfill full or partial Kawasaki disease.

1. Good hygiene, hand washing ,face mask

2. USA FDA ; authorized Pfizer-Vaccine for children from 9

3. Age 12-15yr higher dose of Pfizer .Two shots.

EPSTIEN-BARR VIRUS INFECTION EBV INFECTION

Infectious Mononucleousis syndrome

1. IMN Diseases EB-virus infection (55 %).

2. Cytomegalovirus CMV infection.

EPSTEIN-BARR VIRUS INFECTION

• INFECTIOUS MONONUCLEOSIS syndrome is mostly

• It is mainly disease of adolescent and adult but children

• Othe 10% of the syndrom :is caused by CMV ,

• The virus is transmitted by saliva usually from asymptomatic

• Splenomegaly may be developed in the4 nd or 3 rd week of

• Spontaneous improvement usually occurs within 2-4 weeks

• Splenic rupture if exposed to trauma ,in

• Upper airway obstruction due to

• Other complications are rare includes ;hepatitis and

• CBC shows high leukocytosis mainly due to absolute

• Heterophiles antibodies detected by Monospot test .If it is

• Definite diagnosis and convenient test for EBV infection is to

EBV -IgM antibody in the serum ) EB virus serology TEST(in

• Differential diagnosis of EBV infection are CMV ,adenovirus ,,

• Usually no need for specific treatment .It remits

• It is a serious bacterial infection caused by Corynebacterium

• Mortality rate reaches 5% and increase if not treated early.

• Fever and chills.

• Sore throat and pain on swallowing.

• True croup ;stridor ,brassy cough ,hoarseness of voice ,and

• If not treated early ,it may leads to cardiac toxicity causing