Human disease Summer 2020

20-2Respiratory Diseases

Respiratory illnesses are the most common childhood diseases seen by physicians. Infants are extremely susceptible to upper respiratory problems because their immune systems are not fully developed, and they have very small air passages, so even a minor amount of mucus can obstruct a passage and cause respiratory distress. Preschool and school-aged children are very vulnerable to the contagious respiratory diseases because they have a great deal of person-to-person and hand-to-mouth contacts. Several of the viral and bacterial respiratory diseases were covered previously in this chapter.

A relationship has been found between which of the following diseases and the use of aspirin for febrile illnesses in children?

Reyes syndrom

Which of the following is a malignancy of the blood-forming cells located in the bone marrow?

leukemia

infection caused by the Epstein-Barr Virus

mononucleosis

Infection affecting the paratid glands

mumps

What disease is caused by parasitic nematodes that infect the intestines and rectum?

pinworms

Which of the following is characterized by the alveolar air spaces in the lungs becoming filled with exudate, inflammatory cells, and fibrin?

pnemonia

Impetigo

Impetigo is a contagious superficial pyoderma (PYE-oh-DER-mah; inflammatory, purulent dermatitis) commonly found on the face and hands of children (Figure 20-7). It is caused by Staphylococcus aureus or group A streptococci. Good hand washing is the best preventive strategy. For more information, see Chapter 18.

A bone marrow biopsy will help diagnose which disease or condition?

LEukemia

The only symptom of which of the following is pain that increases with walking or running?

Legg-Calve'-Perthes

Influenza

Main content 20-1aViral Diseases Viral diseases in children are usually treated symptomatically. Most children have mild cases of the disease and recuperate quickly. However, for some children, especially those who have other medical disorders, even a mild viral infection can become a critical health problem. Some viruses invade the host and remain dormant for long periods of time and activate when triggered by something. Although this concept is not well understood, it is known that stress is a common trigger for initiating the replication of a dormant virus. Measles Description. Measles, also called rubeola, is one of the most serious childhood diseases due to major complications such as encephalitis and meningitis. 1 in 1,000 children die even with the best of care, and 1 in 1,000 children get brain swelling (encephalitis), which can lead to brain damage. Less extreme complications include croup, ear infection, and conjunctivitis. Since the development of immunization in 1963, measles has become rare in the United States. Outbreaks that do occur are usually a result of immigrants or travelers with measles bringing the disease into the United States. The majority of adults and children who get measles are unvaccinated. Etiology. Measles is an acute viral disease commonly spread by contaminated airborne droplets. It is highly contagious. If a child has the measles, 9 out of 10 unvaccinated children around them will become infected. Unprotected children can get measles from entering an empty room where a child with measles has recently been. With an incubation period of 7 to 14 days, the spread of measles may occur four days before the infected child is symptomatic and four days after that child has become ill. Symptoms. Symptoms include fever, inflammation of the respiratory mucous membranes, runny nose, and a generalized, dusky red maculopapular rash over the body trunk and extremities (Figure 20-1). Unique spots called Koplik's spots (Figure 20-2) appear in the mouth early in the disease. Diagnosis. Koplik's spots are rather unique to measles and are often the definitive symptom that confirms the diagnosis. Treatment. Treatment is usually directed at relief of symptoms and prevention of such complications as dehydration, pneumonia, or high fever. Having had one episode of the disease should provide lifetime immunity, but all children should be immunized to prevent measles (see the Healthy Highlight titled "Immunization Schedule for Children"). Prevention. This illness is effectively prevented with measles immunization. This immunization is often given in a combination vaccine called measles, mumps, and rubella (MMR). Figure 20-1 Maculopapular rash in rubeola. Courtesy of the Centers for Disease Control and Prevention Figure 20-2 Koplik's spots in the throat of a child with rubeola. Courtesy of the Centers for Disease Control and Prevention, Dr. Heinz F. Eichenwald Rubella Description. Rubella is a type of measles also known as German measles or 3-day measles. It is usually a very mild disease in children but can be quite serious in pregnant women. If it occurs during the first three months of pregnancy, serious consequences can result. These include miscarriage, fetal death/stillbirth and severe congenital anomalies (birth defects). Birth defects of the eyes, heart, and brain are common. Etiology. Rubella, like measles, is spread by contaminated airborne droplets. It is less contagious than rubeola, with an incubation period of 14 to 21 days. Symptoms. Symptoms of rubella include a classic rash similar to measles but lighter in color (Figure 20-3), lymph node enlargement, nasal discharge, joint pain, chills, and fever. Diagnosis. A blood test showing a significant rise in rubella antibodies is helpful in diagnosis. These antibodies can show whether there has been a recent or past infection with rubella. Treatment. Treatment is usually symptomatic with rest, good nutrition, and prevention of spread of the infection. Prevention. All children and women of childbearing age should be immunized to prevent rubella (see the Healthy Highlight titled "Immunization Schedule for Children"). Figure 20-3 Rubella rash. Courtesy of the Centers for Disease Control and Prevention Mumps Description. Mumps is an infection affecting the parotid glands, one of three pairs of salivary glands. These glands are located below and in front of the ears. This illness was quite common until 1906 when the vaccine was developed. Etiology. Mumps is a contagious viral infection that is spread by saliva. The infection can be spread by breathing infected airborne droplets from coughs and sneezes or by sharing eating or drinking utensils. The incubation period is usually 16 to 18 days but can be as long as 25 days. Symptoms. Symptoms include chills, fever, ear pain, and swelling of the parotid glands (one or both) (Figure 20-4). Diagnosis. Blood test showing the presence of mumps antibodies confirms diagnosis. Treatment. Treatment varies with the severity of the symptoms but is usually palliative (soothing or relieving symptoms). Complications of mumps include orchitis (or-KYE-tis; inflammation of a testis) in males and nerve conduction deafness. Although neither is common, they are a concern when mumps is diagnosed. Orchitis can result in sterility. Prevention. All children should be immunized to prevent mumps (see the Healthy Highlight titled "Immunization Schedule for Children"). Figure 20-4 Parotitis (mumps). Courtesy of the Centers for Disease Control and Prevention/NIP/Barbara Rice Varicella Description. Varicella, more commonly known as chicken pox, is one of the most common childhood infectious diseases and a highly contagious one. After an infection, the individual usually develops lifelong protective immunity from further bouts. Etiology. Chicken pox is the result of an infection with the herpes varicella-zoster virus. As discussed in Chapter 18, Integumentary System Diseases and Disorders, this virus causes both chicken pox (called varicella) and shingles (called herpes zoster). Varicella has an incubation period of 10 to 21 days, making it highly contagious. A person with chicken pox can be contagious up to five days before a rash appears. Varicella can be transmitted by airborne particles or direct contact. A common complication of chicken pox is shingles, a reactivation of the virus in an adult. Symptoms. Symptoms of varicella include a classic dew drop on a rose petal macular rash. The rose petal is the development of an irregular red macular rash with the shape of a rose petal. The dew drops are thin-walled blisters or vesicles (VES-ih-kuls; blister-like eruptions on the skin) that form on the rash, appearing like a drop of dew on a rose petal. This rash develops over the face, trunk, and extremities (Figure 20-5). The rash usually develops over a period of several days with new lesions appearing every day for several days. This rash can be quite limited or very widespread and usually causes intense itching. The vesicles break, dry, and become crusty, often leaving a crater-like scar. Diagnosis. Diagnosis is by physical examination of symptoms including the classic rash. Treatment. Treatment is usually symptomatic with care taken to prevent a secondary skin infection at the sites of the lesions. Prevention. A vaccine has been available since 1995. Vaccine protection is recommended for children under age 13 and for adolescents and adults who have not been vaccinated and have not had chicken pox. Figure 20-5 Macular rash in varicella. Courtesy of Robert A. Silverman, MD, Pediatric Dermatology, Georgetown University Poliomyelitis Description. Poliomyelitis, also called polio, occurred in pandemics and crippled thousands of children and adults prior to the discovery of a vaccine by Jonas Salk in 1952 (Figure 20-6). Since the development of the vaccine, the number of polio cases has dropped dramatically. Beginning in 1988, a global effort to eradicate polio has been led by the World Health Organization (WHO). Due to this effort, the number of worldwide cases decreased 99%, from 350,000 cases in 1988 to only 74 in 2015! WHO reports that failure to eradicate all cases of polio could lead to a resurgence of the disease with an estimated 200,000 more new cases per year. If worldwide eradication of polio is accomplished, it will represent only the second time in history that man was able to eliminate a disease completely; the first was smallpox in 1979. Etiology. Polio is caused by the poliovirus (PV) and is spread through an oral route or fecal-oral route from an infected individual. Abortive poliomyelitis is a mild form of the disease that does not affect the central nervous system. The incubation period is 3 to 6 days for abortive poliomyelitis and 7 to 21 days for the more severe form of poliomyelitis. Symptoms. In the more severe form of polio, early symptoms include fever, headache, sore throat, and abdominal pain. This can progress to stiffness of the neck, trunk, and extremities. Although the disease might subside at this point, it can also progress to paralysis. If the respiratory center of the brain is affected, the disease is life-threatening. Diagnosis. The disease can be suspected in an individual with symptoms of weakness or paralysis in an arm or leg that has no other reason for such symptoms. Diagnosis is confirmed by a stool sample or throat swab showing poliovirus. Treatment. Treatment of polio is based on the symptoms and severity, but is usually only supportive. Physical therapy is important to prevent wasting of muscles. Ventilator support is necessary if the respiratory center is affected. Prevention. Sixty years of an aggressive immunization program in the United States has reduced the threat of polio. However, it could still recur as a major health problem, so all children should be vaccinated against polio (see the Healthy Highlight titled "Immunization Schedule for Children"). Figure 20-6 Crippling effects of poliomyelitis. Courtesy of the Centers for Disease Control and Prevention Influenza Description. Influenza, or the flu, is an acute infectious respiratory disease that occurs every year in the late fall through early spring. Etiology. Influenza is caused by viruses in the orthomyxoviridae family. Symptoms. The first symptom is commonly a sudden high fever of and a dry, hacking cough. These symptoms are immediately followed by chills, headache, joint or muscle aches, and runny nose. The flu often develops very quickly and in epidemic proportions in some communities. Very young children or children with other debilitating illnesses are at risk for severe illness. Diagnosis. Physical examination with evidence of symptoms during late fall and winter can lead to diagnosis of flu, confirmed by rapid assay blood testing. Treatment. Generally, treatment in children is symptomatic with rest, hydration, and antipyretics if needed. Antiviral drugs can be given for some types of influenza. A newly developed nasal spray flu vaccine is available for children 5 years of age or older. Prevention. Vaccination is the primary measure for preventing influenza for all ages six months and up. Common Cold Description. The common cold is appropriately named because it is the most frequently occurring disease. Etiology. Numerous strains of viruses can cause the common cold, but the rhinoviruses are usually the causative agent. It is transmitted by direct contact and droplet contact. Symptoms. Symptoms of the common cold include rhinitis (RYE-NIGH-tis; inflammation of the nasal mucous membrane), runny nose, coughing, sneezing, fever, and watery eyes. Diagnosis. There are no tests for the common cold. Diagnosis is made by physical examination of the individual's symptoms. Blood tests and throat cultures can be completed to rule out any other disease. Treatment. Treatment is directed at symptom relief and getting adequate rest, hydration, and good nutrition. Prevention. Good hand washing is the best preventive strategy for transmission of the cold virus. Respiratory Syncytial Virus (RSV) Description. RSV is a viral infection of the airways. It is the most common cause of bronchiolitis (inflammation of the small airways of the lungs) and pneumonia in children younger than 1 year of age. It is also the most common reason for hospitalization of an infant. Etiology. The cause is the respiratory syncytial virus. Symptoms. The infant or child has cold-like symptoms including a runny nose, coughing, congestion, sneezing, fever, irritability, and difficulty breathing, and may have wheezing. Diagnosis. Diagnosis is based on symptoms. Treatment. Almost all children have had an RSV infection at some time, but many do not have serious symptoms. Most cases of RSV do not require treatment but medications may be given to treat any complications. It is dangerous in infants, so those who are under six months of age who have the virus are usually hospitalized for treatment. Prevention. Researchers are working to develop a vaccine. For infants and children who are at high risk, a preventive medication (Palivizumab) may be given. This medication can help prevent development of serious RSV, but cannot cure or treat children with RSV. Prevention involves avoiding those who are infected, avoiding kissing, not sharing eating utensils, and good handwashing. Fifth Disease Description. Fifth disease is a contagious viral disease more common in children than adults; it usually affects ages 5-15. School nurses frequently see this disease in school-aged children. It is also known as erythema infectiosum. It is called fifth disease because it is fifth in a list of historical classifications of common skin rash illnesses in children. Etiology. It is caused by a parvovirus (B19) that is spread by airborne droplets, usually by coughing or sneezing from an infected person. It can also be spread through the blood, by direct skin-to-skin contact, and by touching contaminated surfaces. Symptoms. Symptoms commonly occur 4 to 14 days after the infection and include a low-grade fever, runny nose, and swollen joints. A red rash called "slapped cheek rash" is commonly seen on the face. This classic rash is the most recognized feature of fifth disease. The rash may also spread down the trunk of the body. The child is usually no longer contagious once the rash appears. Diagnosis. Diagnosis is based on signs and symptoms. Treatment. Treatment is usually rest, along with medications if necessary for the fever and pain. In people with weakened immune systems, it can cause chronic anemia that requires medical attention. The rash usually fades after one to three weeks. Prevention. The only prevention is avoidance of those with the virus and good handwashing. Once a person recovers from the disease, they often develop immunity that protects them from being infected in the future. Mononucleosis Description. Infectious mononucleosis, sometimes called kissing disease (colloquially) or mono, is often joked about, but the disease can be quite serious. This infection primarily affects children and young adults. It is somewhat contagious and often will cause illness for several weeks. Etiology. This infection is caused by the Epstein-Barr virus (EBV), which is very common. Many people have been exposed and are lifetime carriers of the virus but might never develop the illness. The most common way to become infected with mononucleosis is by kissing someone who has been infected. Any activity involving direct contact with the saliva, such as sharing eating utensils or drinking straws, can spread the virus. Symptoms. Symptoms usually begin four to seven days after infection and include fatigue, sore throat, fever, swollen lymph glands, and splenomegaly (spleen enlargement). Diagnosis. Diagnosis is confirmed by history and physical examination and a WBC count showing a marked elevation in lymphocytes. Treatment. Treatment is symptomatic and includes rest, analgesics, and throat gargles. If there are no complications, symptoms of mononucleosis are usually resolved in three to four weeks. To prevent potential injury to the spleen, sports activities should be avoided for one month following the illness. Prevention. Slowing the spread of the virus can be accomplished by frequent hand washing, covering mouth and nose when sneezing or coughing, and not sharing drinks or eating utensils. Acquired Immunodeficiency Syndrome This disease is described in detail in Chapter 5, "Immune System Diseases and Disorders," but is addressed here in relation to its effect in children. Description. Acquired immunodeficiency syndrome, commonly known as AIDS, has now affected thousands of children in the United States. Etiology. AIDS is caused by the human immunodeficiency virus (HIV). During the 1980s, most children diagnosed with an HIV infection probably acquired it through a blood transfusion. Most children infected with HIV were hemophiliacs who had received transfusions or other blood products. Today, virtually all HIV infections in children are as a result of maternal-fetal transfer through blood, also called perinatal transmission. Children not only suffer the effects of infection with the disease but also are often orphaned as a result of both parents dying from the disease. As of 2015, more than 25 million children under 18 had lost one or both parents to AIDS (Avert, 2016). Increasing numbers of sexually active teens also are being diagnosed with HIV/AIDS. The period of time between the HIV infection and development of AIDS is much shorter in infants and toddlers than in infected older children or adults. Symptoms. Many children do not experience symptoms of the disease and live a normal life for years. However, in those with severely compromised immune systems, opportunistic infections can be overwhelming, necessitating repeated hospitalizations to sustain life. Diagnosis. As in adults, when T-cell count drops below 200 cells per microliter, the child has met the criteria set by the Centers for Disease Control and Prevention for a diagnosis of AIDS. Treatment. Treatment of pediatric HIV infection and AIDS varies with the child and the severity of the symptoms. Therapy focuses on prevention and treatment of opportunistic diseases, good nutrition, antiviral drugs, and other support therapies as needed. Prevention. In 2012, the United Nations Children's Fund (UNICEF) assisted in development of a Call to Action program to focus on ending preventable child deaths. The first step in the call to action is to increase efforts in the 24 countries that account for 80% of deaths in children under age 5 years. More recently in 2014, Save the Children organization reported helping over 11.8 million orphaned children with treatment and prevention of HIV/AIDS. Consider This... Every day, more than 500 children worldwide die of AIDS (Avert, 2016).

Pediculosis

Pediculosis is infestation with lice. Lice infestations reach epidemic levels in many school systems throughout the United States. Lice are transmitted from human to human by direct contact and reproduce rapidly with the adult female parasite producing about six eggs every 24 hours. Lice on the head and lice eggs (nits) attached to hair are easy to see (Figure 20-11). The most effective treatment is permethrin 1% crème rinse. In addition, vinegar and water can loosen the nits prior to combing with a delousing comb. This treatment should be performed every day until all nits are removed. For more information, see Chapter 18.

Which of the following infectious diseases in also known as whooping cough?

Pertusis

Which of the following in infants can be prevented by breastfeeding rather than bottle feeding?

Thrush

Symptoms of which of the following childhood diseases include a classic dew drop on a rose petal macular rash?

Varicella

20-1aViral Diseases

Viral diseases in children are usually treated symptomatically. Most children have mild cases of the disease and recuperate quickly. However, for some children, especially those who have other medical disorders, even a mild viral infection can become a critical health problem. Some viruses invade the host and remain dormant for long periods of time and activate when triggered by something. Although this concept is not well understood, it is known that stress is a common trigger for initiating the replication of a dormant virus.

contagious viraldisease more common in children than adults

5th disease

Pertussis

Description. Pertussis is also known as whooping cough. Etiology. Pertussis is an acute respiratory infection caused by Bordetella pertussis. The incubation period is 6 to 10 days but can be as long as 21 days. Pertussis is transmitted by direct contact with respiratory droplets.

Reye's syndrome has been linked to which of the following?

. Ingestion of aspirin by a child

20-1bBacterial Diseases

Bacterial diseases of childhood are caused by pathogens. There are millions of bacteria in the world, but not all bacteria are pathogenic. (See Chapter 4, "Inflammation and Infection," for more information.) Some of the common infection-causing bacteria include Staphylococcus, Clostridium, Haemophilus, Escherichia coli, and Streptococcus. Symptoms of bacterial infections can include coughing, fever, headache, difficulty breathing, and sore throat. Treatment is based on the causative agent along with relief of symptoms. Some bacterial diseases can be prevented by immunizations.

What are the most prominent symptoms of laryngotracheobronchitis?

Barking cough and high-pitched sound during inspiration

Which of the following is characterized by binge eating followed by purging the food?

Bulimia

What is another name for diaper rash caused by yeast and thrush of the mouth?

Candidiasis

What type of treatment is instituted to remove the lead from the blood?

Chelation Therapy

Figure 20-13 Roundworm.

Consider This... Every year, children spend approximately one-half billion dollars on chewing gum.

Check My Work Which of the following is life-threatening in very young children and infants?

Dehydration

20-2cAdenoid Hyperplasia

Description. Adenoid hyperplasia is the enlargement of the pharyngeal tonsils, lymphoid tissues located on the posterior wall of the nasopharynx above the palatine tonsils. Hyperplasia of the adenoids is a very common occurrence in children. Etiology. Adenoid hyperplasia can be caused by infection or a congenital defect. Symptoms. The enlarged adenoids can block the Eustachian tubes, causing ear problems such as otitis media. Because of the location of the adenoids, enlargement also can cause some obstruction of the airway, resulting in breathing difficulty. Diagnosis. Physical examination revealing enlarged, infected tonsils that might have deep pockets or crypts is indicative of the condition. Children with recurring middle ear infections may well have adenoid hyperplasia. A throat culture also can be performed. Treatment. Treatment focuses on correcting the cause of the hyperplasia. If repeated infections are the cause, antibiotic therapy is instituted. If the enlargement cannot be corrected, an adenoidectomy (AD-eh-noy-DECK-toh-me; ectomy = removal; removal of the adenoids) might be necessary. Prevention. Prompt and effective diagnosis and treatment of sore throats usually prevent the condition. Avoiding children with respiratory infections will help reduce the spread of these illnesses.

Fifth Disease

Description. Fifth disease is a contagious viral disease more common in children than adults; it usually affects ages 5-15. School nurses frequently see this disease in school-aged children. It is also known as erythema infectiosum. It is called fifth disease because it is fifth in a list of historical classifications of common skin rash illnesses in children. Etiology. It is caused by a parvovirus (B19) that is spread by airborne droplets, usually by coughing or sneezing from an infected person. It can also be spread through the blood, by direct skin-to-skin contact, and by touching contaminated surfaces. Symptoms. Symptoms commonly occur 4 to 14 days after the infection and include a low-grade fever, runny nose, and swollen joints. A red rash called "slapped cheek rash" is commonly seen on the face. This classic rash is the most recognized feature of fifth disease. The rash may also spread down the trunk of the body. The child is usually no longer contagious once the rash appears. Diagnosis. Diagnosis is based on signs and symptoms. Treatment. Treatment is usually rest, along with medications if necessary for the fever and pain. In people with weakened immune systems, it can cause chronic anemia that requires medical attention. The rash usually fades after one to three weeks. Prevention. The only prevention is avoidance of those with the virus and good handwashing. Once a person recovers from the disease, they often develop immunity that protects them from being infected in the future.

Giardiasis

Description. Giardiasis is infection with a parasite called Giardia. Young children are affected three times more often than adults, leading some to believe that as we age, we develop some immunity to the parasite. An entire family can be affected with symptoms varying from mild to severe. As many as two-thirds of infected individuals are asymptomatic. Etiology. Giardiasis is caused by the Giardia lamblia protozoan, which affects the digestive system. These protozoa lodge in the lining of the small intestines and absorb nutrients from the host. Symptoms. Symptoms of giardiasis include watery diarrhea, nausea, cramping, flatulence (excessive gas), fever, and anorexia (loss of appetite). This condition affects the body's ability to absorb fat, so the stool will float and be shiny and quite foul-smelling. Chronic giardiasis often leads to weight loss and signs of poor nutrition in children. Diagnosis. Diagnosis is by laboratory stool examination. It might take as many as three samples to detect the presence of the protozoan. Treatment. Treatment usually includes furazolidone or similar drugs and symptom relief as needed. Clear liquids are given to prevent dehydration, a dangerous complication of the disease. Prevention. Guidelines for prevention include: Drinking only clean water approved by the local health authorities. Drinking bottled water if the quality of the local water is questionable. Washing hands before preparing meals. Encouraging children to wash their hands after they use the bathroom and especially before eating. Washing raw fruits and vegetables thoroughly before eating them.

20-8bDeafness

Description. Hearing losses in children range from mild to complete. Etiology. The cause of deafness can be unknown, genetic, as a result of trauma, infections, or exposure to ototoxic drugs. Symptoms. The primary symptom is a loss of hearing. Diagnosis. Audiometric testing is needed for an accurate diagnosis of the extent of hearing loss. Treatment. Treatment depends on the cause and severity of the loss. If the hearing loss is the nonconductive type, some medications or surgical interventions can be helpful in restoring all or part of the lost hearing. Several types of hearing aids are designed especially for children for use in the ear, over the ear, and attached to the eyepieces of glasses, which can be fitted by professional hearing specialists. Cochlear implants are now being inserted surgically. They stimulate the eighth cranial nerve (vestibulocochlear nerve) and send out electrical impulses to the inner ear. Prevention. Reduction in noise levels and avoiding ototoxic medications are preventive measures.

Diptheria

Description. In 1920, there were an estimated 200,000 cases of diphtheria in the United States. With a fatality rate as high as 20% in young children, it was one of the leading causes of death among children. Since the development of a vaccine, diphtheria has almost been eradicated. There have been fewer than five cases reported in the United States in the last decade. Worldwide, diphtheria is still a health concern, with approximately 7,000 cases reported annually (WHO, 2016). Etiology. Diphtheria is an infectious disease caused by Corynebacterium diphtheriae and characterized by severe inflammation of the respiratory system. It is transmitted by direct contact with droplets from an infected person. The incubation period is two to five days. Symptoms. It produces a membranous coating of the pharynx, nose, and sometimes the tracheobronchial tree. This membrane becomes a thick fibrinous exudate (ECKS-you-dayt; fluid composed of protein and white blood cells that seeps from tissue), causing extreme difficulty in breathing. The toxin also can produce degeneration in peripheral nerves, heart muscle, and other tissues. Diagnosis. Physical examination revealing a thick gray membrane covering the throat and tonsils, along with a positive culture of the membrane revealing diphtheria, confirms diagnosis. Treatment. Treatment includes antibiotic therapy and diphtheria antitoxin. Prevention. Immunization of children with the diphtheria/tetanus/pertussis (DTP) combination vaccine prevents this disease.

Mononucleosis

Description. Infectious mononucleosis, sometimes called kissing disease (colloquially) or mono, is often joked about, but the disease can be quite serious. This infection primarily affects children and young adults. It is somewhat contagious and often will cause illness for several weeks. Etiology. This infection is caused by the Epstein-Barr virus (EBV), which is very common. Many people have been exposed and are lifetime carriers of the virus but might never develop the illness. The most common way to become infected with mononucleosis is by kissing someone who has been infected. Any activity involving direct contact with the saliva, such as sharing eating utensils or drinking straws, can spread the virus. Symptoms. Symptoms usually begin four to seven days after infection and include fatigue, sore throat, fever, swollen lymph glands, and splenomegaly (spleen enlargement). Diagnosis. Diagnosis is confirmed by history and physical examination and a WBC count showing a marked elevation in lymphocytes. Treatment. Treatment is symptomatic and includes rest, analgesics, and throat gargles. If there are no complications, symptoms of mononucleosis are usually resolved in three to four weeks. To prevent potential injury to the spleen, sports activities should be avoided for one month following the illness. Prevention. Slowing the spread of the virus can be accomplished by frequent hand washing, covering mouth and nose when sneezing or coughing, and not sharing drinks or eating utensils.

Measles

Description. Measles, also called rubeola, is one of the most serious childhood diseases due to major complications such as encephalitis and meningitis. 1 in 1,000 children die even with the best of care, and 1 in 1,000 children get brain swelling (encephalitis), which can lead to brain damage. Less extreme complications include croup, ear infection, and conjunctivitis. Since the development of immunization in 1963, measles has become rare in the United States. Outbreaks that do occur are usually a result of immigrants or travelers with measles bringing the disease into the United States. The majority of adults and children who get measles are unvaccinated. Etiology. Measles is an acute viral disease commonly spread by contaminated airborne droplets. It is highly contagious. If a child has the measles, 9 out of 10 unvaccinated children around them will become infected. Unprotected children can get measles from entering an empty room where a child with measles has recently been. With an incubation period of 7 to 14 days, the spread of measles may occur four days before the infected child is symptomatic and four days after that child has become ill. Symptoms. Symptoms include fever, inflammation of the respiratory mucous membranes, runny nose, and a generalized, dusky red maculopapular rash over the body trunk and extremities (Figure 20-1). Unique spots called Koplik's spots (Figure 20-2) appear in the mouth early in the disease. Diagnosis. Koplik's spots are rather unique to measles and are often the definitive symptom that confirms the diagnosis. Treatment. Treatment is usually directed at relief of symptoms and prevention of such complications as dehydration, pneumonia, or high fever. Having had one episode of the disease should provide lifetime immunity, but all children should be immunized to prevent measles (see the Healthy Highlight titled "Immunization Schedule for Children"). Prevention. This illness is effectively prevented with measles immunization. This immunization is often given in a combination vaccine called measles, mumps, and rubella (MMR).

mumps

Description. Mumps is an infection affecting the parotid glands, one of three pairs of salivary glands. These glands are located below and in front of the ears. This illness was quite common until 1906 when the vaccine was developed. Etiology. Mumps is a contagious viral infection that is spread by saliva. The infection can be spread by breathing infected airborne droplets from coughs and sneezes or by sharing eating or drinking utensils. The incubation period is usually 16 to 18 days but can be as long as 25 days. Symptoms. Symptoms include chills, fever, ear pain, and swelling of the parotid glands (one or both) (Figure 20-4). Diagnosis. Blood test showing the presence of mumps antibodies confirms diagnosis. Treatment. Treatment varies with the severity of the symptoms but is usually palliative (soothing or relieving symptoms). Complications of mumps include orchitis (or-KYE-tis; inflammation of a testis) in males and nerve conduction deafness. Although neither is common, they are a concern when mumps is diagnosed. Orchitis can result in sterility. Prevention. All children should be immunized to prevent mumps (see the Healthy Highlight titled "Immunization Schedule for Children").

Otitis

Description. Otitis media is an acute bacterial infection of the middle ear and is one of the most common diseases of children. Symptoms. Symptoms include pain (in the infant, this symptom might be indicated by the child pulling on the ear); fever; drainage; and, on otoscopic examination, a bulging, reddish tympanic membrane. Treatment includes antibiotic therapy and acetaminophen for fever and pain. If the condition persists, a myringotomy with tympanoplasty tubes might be the treatment of choice. (See Chapter 16, "Eye and Ear Diseases and Disorders," for more information.) Consider This... Children grow faster in the spring than in any other season.

Pin Worms

Description. Pinworms, also known as seatworms or threadworms, are parasitic nematodes (specific type of helminthes or worms) that infect the intestines and rectum. They do not cause physical harm, other than itching, and never infect the blood. Pinworms can infect anyone because they live on objects and are easily transmitted. Etiology. The causative organism is Enterobius vermicularis. Pinworms are transmitted by ingestion or inhalation of the eggs, usually by hand-to-mouth contact. These eggs can survive on most surfaces for two to three weeks. Individuals become infected by touching any infected surface, such as towels, doorknobs, toilet seats, toys, or drinking glasses, to name a few. Pets do not give humans pinworms, but these eggs can be picked up off the fur if an infected individual recently touched the animal. When the eggs are on the hands, touching the mouth or food that is placed in the mouth moves these eggs to the digestive system. The ingested eggs pass through the digestive system and attach to the inside wall of the large intestine. A few weeks later, the female pinworm leaves the intestine to move to the rectum. They often come out of the rectum at night and lay 10,000 to 20,000 eggs around the anus, causing intense itching. Scratching around the anus during sleep is common and moves the eggs to the fingers and fingernails. Contaminated fingers then move the eggs to any surface the infected individual touches, and the cycle starts over. Symptoms. Usually, the only symptom is anal itching. Pinworms can be seen as tiny white threads about the size of a staple, noticeable in the commode after a bowel movement or in the child's underwear in the morning. Diagnosis. Diagnosis is by microscopic examination of stool revealing pinworms. Pinworm eggs can be obtained for microscopic examination by pressing a piece of clear adhesive tape to the child's anus early in the morning. The eggs stick to the tape and can be easily viewed under a microscope (Figure 20-12). Treatment. Treatment includes over-the-counter or prescription drug therapy and instructions in good hand washing. Treatment might have to be repeated in approximately two weeks, and the entire family might need treating. Cleaning bed linens, clothing, and surfaces helps reduce surface infection. Prevention. Good hand washing, good toileting habits, not placing fingers in or around the mouth, and not biting fingernails are all preventive measures.

Poliomyelitis

Description. Poliomyelitis, also called polio, occurred in pandemics and crippled thousands of children and adults prior to the discovery of a vaccine by Jonas Salk in 1952 (Figure 20-6). Since the development of the vaccine, the number of polio cases has dropped dramatically. Beginning in 1988, a global effort to eradicate polio has been led by the World Health Organization (WHO). Due to this effort, the number of worldwide cases decreased 99%, from 350,000 cases in 1988 to only 74 in 2015! WHO reports that failure to eradicate all cases of polio could lead to a resurgence of the disease with an estimated 200,000 more new cases per year. If worldwide eradication of polio is accomplished, it will represent only the second time in history that man was able to eliminate a disease completely; the first was smallpox in 1979. Etiology. Polio is caused by the poliovirus (PV) and is spread through an oral route or fecal-oral route from an infected individual. Abortive poliomyelitis is a mild form of the disease that does not affect the central nervous system. The incubation period is 3 to 6 days for abortive poliomyelitis and 7 to 21 days for the more severe form of poliomyelitis. Symptoms. In the more severe form of polio, early symptoms include fever, headache, sore throat, and abdominal pain. This can progress to stiffness of the neck, trunk, and extremities. Although the disease might subside at this point, it can also progress to paralysis. If the respiratory center of the brain is affected, the disease is life-threatening. Diagnosis. The disease can be suspected in an individual with symptoms of weakness or paralysis in an arm or leg that has no other reason for such symptoms. Diagnosis is confirmed by a stool sample or throat swab showing poliovirus. Treatment. Treatment of polio is based on the symptoms and severity, but is usually only supportive. Physical therapy is important to prevent wasting of muscles. Ventilator support is necessary if the respiratory center is affected. Prevention. Sixty years of an aggressive immunization program in the United States has reduced the threat of polio. However, it could still recur as a major health problem, so all children should be vaccinated against polio (see the Healthy Highlight titled "Immunization Schedule for Children").

Respiratory Syncytial Virus (RSV)

Description. RSV is a viral infection of the airways. It is the most common cause of bronchiolitis (inflammation of the small airways of the lungs) and pneumonia in children younger than 1 year of age. It is also the most common reason for hospitalization of an infant. Etiology. The cause is the respiratory syncytial virus. Symptoms. The infant or child has cold-like symptoms including a runny nose, coughing, congestion, sneezing, fever, irritability, and difficulty breathing, and may have wheezing. Diagnosis. Diagnosis is based on symptoms. Treatment. Almost all children have had an RSV infection at some time, but many do not have serious symptoms. Most cases of RSV do not require treatment but medications may be given to treat any complications. It is dangerous in infants, so those who are under six months of age who have the virus are usually hospitalized for treatment. Prevention. Researchers are working to develop a vaccine. For infants and children who are at high risk, a preventive medication (Palivizumab) may be given. This medication can help prevent development of serious RSV, but cannot cure or treat children with RSV. Prevention involves avoiding those who are infected, avoiding kissing, not sharing eating utensils, and good handwashing.

Round Worms

Description. Roundworms (Ascaris lumbricoides) are commonly found in soil. A handful of dirt can easily contain thousands of roundworms (Figure 20-13). Etiology. These parasites are easily ingested by infected hand-to-mouth activity. In the digestive system, these parasites lodge in the intestine, absorbing nutrients from the host. Roundworms, like pinworms, are transmitted by transfer of the eggs to the mouth or nose. Symptoms. Symptoms can be more severe than in pinworm infestations, depending on how long they reside in the intestine before treatment. The child might complain of abdominal pain, excessive gas, loss of appetite, or weight loss. Vomiting also can occur. If the helminthes are inhaled, symptoms of pneumonia might be present. Diagnosis. Diagnosis is usually made by identification of the parasites in a stool specimen. Treatment. Treatment is the same as for pinworms. Prevention. Good hand washing and keeping the fingers away from the mouth are preventive measures.

Rubella

Description. Rubella is a type of measles also known as German measles or 3-day measles. It is usually a very mild disease in children but can be quite serious in pregnant women. If it occurs during the first three months of pregnancy, serious consequences can result. These include miscarriage, fetal death/stillbirth and severe congenital anomalies (birth defects). Birth defects of the eyes, heart, and brain are common. Etiology. Rubella, like measles, is spread by contaminated airborne droplets. It is less contagious than rubeola, with an incubation period of 14 to 21 days. Symptoms. Symptoms of rubella include a classic rash similar to measles but lighter in color (Figure 20-3), lymph node enlargement, nasal discharge, joint pain, chills, and fever. Diagnosis. A blood test showing a significant rise in rubella antibodies is helpful in diagnosis. These antibodies can show whether there has been a recent or past infection with rubella. Treatment. Treatment is usually symptomatic with rest, good nutrition, and prevention of spread of the infection. Prevention. All children and women of childbearing age should be immunized to prevent rubella (see the Healthy Highlight titled "Immunization Schedule for Children").

20-2aSudden Unexpected Infant Death (SUID) and Sudden Infant Death Syndrome (SIDS)

Description. Sudden unexpected infant death (SUID) and sudden infant death syndrome, or SIDS, is the abrupt unexplainable death of an infant under age 1. SUIDs includes several catagories of which SIDS is the largest, making up approximately 50% of SUIDs. Other categories of SUID include unknown cause, suffocation/strangulation and homocides. To be diagnosed as SIDS, the infant has to have a complete investigation including an autopsy, examination of the scene, and review of clinical history. Unknown-cause infant death is described as any death that does not meet the criteria for SIDS. Suffocation/strangulation infant death is the third type of SUID and is defined as an infant death of a child 1 year or less in age that is found to have suffocated on bedding or mattress material. Strangulation may occur when an infant is caught between the crib rails or between the mattress and crib frame. Etiology. SIDS is also known as crib death because the infant is found dead after being put in bed to sleep. There are several theories about the cause of SIDS, but none have been proven at this time. It is now recommended that infants be placed in bed in the supine (SUE-pine; on the back) position rather than prone (on the stomach side) because more cases of SIDS have occurred in children lying in the prone position. Children at higher risk for SIDS include premature infants and siblings of SIDS infants and those with sleep apnea and respiratory problems. Symptoms. The only sign of SIDS is an infant death of unknown cause that has been confirmed by autopsy, scene investigation, and clinical history. Diagnosis. Diagnosis might be suspected when the child is taken to the emergency department, but SIDS can be confirmed only by autopsy and investigation. A diagnosis of SIDS is very traumatic to parents and families, who experience not only loss and grief but also guilt. Treatment. SIDS often elicits a 911 emergency call. Prevention. Counseling, along with further education, should be available for these families so SIDS might be prevented in future children.

TB

Description. TB is an infectious disease primarily affecting the respiratory system. For many years, the incidence of TB was decreasing, but unfortunately, the incidence of TB in children has been increasing in recent years. Etiology. TB is an infectious disease caused by the tubercle bacillus, Mycobacterium tuberculosis. Although the disease typically affects the respiratory system, it can also be found in the gastrointestinal system and the bones, brain, and lymph nodes. TB is transmitted by contaminated droplets. When the child is infected with the tubercle bacillus and the incubation period of 4 to 12 weeks is past, the skin test will test positive. Symptoms. Signs and symptoms of TB include a persistent cough, bloody sputum, lymph node enlargement, fever, and malaise (see Chapter 9, "Respiratory System Diseases and Disorders," for more information about TB). Most children infected by the bacillus will not develop the symptomatic disease. The greatest percentage of cases of TB infection in children stays dormant (state of being inactive) and does not develop into the clinical disease. Diagnosis. Diagnosis is made by a positive skin test and sputum culture and clinical manifestations as well as a chest X-ray. Treatment. For those children who develop active TB, treatment consists of drug therapy, rest, good nutrition, and preventing the spread of the disease to other family members. Children at higher risk for developing TB are those who have other chronic diseases, are HIV positive or have AIDS, are malnourished, live in poor hygienic conditions, live with adults with TB, or are otherwise immunosuppressed. Prevention. The TB vaccine, bacille Calmette-Guérin (BCG), can be used for prevention and is recommended in communities where the rate of infection is greater than 1% per year.

Common Cold

Description. The common cold is appropriately named because it is the most frequently occurring disease. Etiology. Numerous strains of viruses can cause the common cold, but the rhinoviruses are usually the causative agent. It is transmitted by direct contact and droplet contact. Symptoms. Symptoms of the common cold include rhinitis (RYE-NIGH-tis; inflammation of the nasal mucous membrane), runny nose, coughing, sneezing, fever, and watery eyes. Diagnosis. There are no tests for the common cold. Diagnosis is made by physical examination of the individual's symptoms. Blood tests and throat cultures can be completed to rule out any other disease. Treatment. Treatment is directed at symptom relief and getting adequate rest, hydration, and good nutrition. Prevention. Good hand washing is the best preventive strategy for transmission of the cold virus.

Acute Tonsillitis

Description. Tonsillitis is an infection of the palatine tonsils, tissue located on the posterior wall of the nasopharynx (Figure 20-8). The purpose of the tonsils is to help protect the respiratory tract from pathogens; thus, they tend to be a common site for inflammation and infection. Etiology. Most tonsillar infections are caused by group A Beta-hemolytic streptococci. Symptoms. Symptoms include a sore throat, enlarged tonsils, cough, fever, and pain with swallowing. Diagnosis. Diagnosis is made by visual exam and throat culture. Treatment. Antibiotics are given as supportive treatment. A tonsillectomy (TON-sih-LECT-toh-me; ectomy = removal; removal of the tonsils) is not recommended for children under 3 years of age but can be performed on older children who incur repeated infections. Prevention. Preventive methods include avoiding contact with infected individuals, never sharing drinking glasses, and washing hands frequently with antibacterial soap. After recovery from tonsillitis, the infected child's toothbrush should be thrown away to prevent reinfection.

Tulermia

Description. Tularemia is an infectious disease of rodents transmitted to humans usually through an insect bite. It may also be called rabbit fever or deer fly fever. Etiology. Tularemia is caused by the bacterium Francisella tularensis and transmitted by the bite of an infected tick, deer fly, or other bloodsucking insect or by direct contact with an infected animal. Symptoms. Symptoms include headache, fever, generalized or localized pain, swelling of lymph nodes, chills, and vomiting. Diagnosis. Diagnosis is made by blood testing to identify antibodies to the bacteria. A chest X-ray can rule out pneumonia. Treatment. Treatment with antibiotics given by muscle injection or intravenously is usually effective. Prevention. Preventive methods include: Wearing long-sleeved shirt and long pants to protect the extremities from insects. Using insecticide containing DEET. Handling animals carefully. If hunting wild rabbit or deer, wearing gloves and using care in skinning and dressing the animal. Protecting pets by applying systemic preventives. Keeping away from wild or dead animals.

Varicella

Description. Varicella, more commonly known as chicken pox, is one of the most common childhood infectious diseases and a highly contagious one. After an infection, the individual usually develops lifelong protective immunity from further bouts. Etiology. Chicken pox is the result of an infection with the herpes varicella-zoster virus. As discussed in Chapter 18, Integumentary System Diseases and Disorders, this virus causes both chicken pox (called varicella) and shingles (called herpes zoster). Varicella has an incubation period of 10 to 21 days, making it highly contagious. A person with chicken pox can be contagious up to five days before a rash appears. Varicella can be transmitted by airborne particles or direct contact. A common complication of chicken pox is shingles, a reactivation of the virus in an adult Symptoms. Symptoms of varicella include a classic dew drop on a rose petal macular rash. The rose petal is the development of an irregular red macular rash with the shape of a rose petal. The dew drops are thin-walled blisters or vesicles (VES-ih-kuls; blister-like eruptions on the skin) that form on the rash, appearing like a drop of dew on a rose petal. This rash develops over the face, trunk, and extremities (Figure 20-5). The rash usually develops over a period of several days with new lesions appearing every day for several days. This rash can be quite limited or very widespread and usually causes intense itching. The vesicles break, dry, and become crusty, often leaving a crater-like scar. Diagnosis. Diagnosis is by physical examination of symptoms including the classic rash. Treatment. Treatment is usually symptomatic with care taken to prevent a secondary skin infection at the sites of the lesions. Prevention. A vaccine has been available since 1995. Vaccine protection is recommended for children under age 13 and for adolescents and adults who have not been vaccinated and have not had chicken pox.

Tularemia is caused by the bacterium:

Francisella tularensis

20-1Infectious Diseases

More children are seen yearly by physicians for infectious disease diagnosis and treatment than for any other problem. Infectious diseases of childhood fall into four categories: viral, bacterial, fungal, and parasitic diseases. Disorders in these categories include some of the most familiar diseases such as colds, influenza, measles, pertussis, and tonsillitis, several of which can be prevented by maintenance of a regular immunization schedule (see the Healthy Highlight titled "Immunization Schedule for Children"). Many of these diseases have an incubation period, the time between exposure to the disease and the presence of symptoms, which lasts several days. In general, signs and symptoms of the common infectious diseases include fever, malaise (a feeling of general discomfort), coughing, anorexia, nausea or vomiting, rashes, or any combination of these. Treatment varies with the specific disease. In many cases, treatment consists of symptom relief, good nutrition, and rest. Nonaspirin antipyretics are given to children with fever because aspirin has been linked to Reye's syndrome. Good hand washing is always important to prevent the spread of infectious diseases.

20-1dParasitic Diseases

Parasitic diseases include all disorders that are caused by an organism that feeds on another organism, such as a worm that lives in the intestine of an individual. Parasites are common in areas where poor nutrition, contaminated water, and low socioeconomic conditions are widespread. The parasitic diseases common to children in the United States include giardiasis, pediculosis, and some helminth (worm) infestations.

What causes SIDS?

The cause is unknown; there are no symptoms, and it occurs in infants aged 1 to 12 months.

Which of the following statements describe the incubation period of an infectious disease?

The time between exposure to the disease and the presence of symptoms

Which of the following statements is true of asthma?

There is no known prevention

Acquired Immunodeficiency Syndrome

This disease is described in detail in Chapter 5, "Immune System Diseases and Disorders," but is addressed here in relation to its effect in children. Description. Acquired immunodeficiency syndrome, commonly known as AIDS, has now affected thousands of children in the United States. Etiology. AIDS is caused by the human immunodeficiency virus (HIV). During the 1980s, most children diagnosed with an HIV infection probably acquired it through a blood transfusion. Most children infected with HIV were hemophiliacs who had received transfusions or other blood products. Today, virtually all HIV infections in children are as a result of maternal-fetal transfer through blood, also called perinatal transmission. Children not only suffer the effects of infection with the disease but also are often orphaned as a result of both parents dying from the disease. As of 2015, more than 25 million children under 18 had lost one or both parents to AIDS (Avert, 2016). Increasing numbers of sexually active teens also are being diagnosed with HIV/AIDS. The period of time between the HIV infection and development of AIDS is much shorter in infants and toddlers than in infected older children or adults. Symptoms. Many children do not experience symptoms of the disease and live a normal life for years. However, in those with severely compromised immune systems, opportunistic infections can be overwhelming, necessitating repeated hospitalizations to sustain life. Diagnosis. As in adults, when T-cell count drops below 200 cells per microliter, the child has met the criteria set by the Centers for Disease Control and Prevention for a diagnosis of AIDS. Treatment. Treatment of pediatric HIV infection and AIDS varies with the child and the severity of the symptoms. Therapy focuses on prevention and treatment of opportunistic diseases, good nutrition, antiviral drugs, and other support therapies as needed. Prevention. In 2012, the United Nations Children's Fund (UNICEF) assisted in development of a Call to Action program to focus on ending preventable child deaths. The first step in the call to action is to increase efforts in the 24 countries that account for 80% of deaths in children under age 5 years. More recently in 2014, Save the Children organization reported helping over 11.8 million orphaned children with treatment and prevention of HIV/AIDS. Consider This... Every day, more than 500 children worldwide die of AIDS (Avert, 2016).

Which of the following describes a congenital enlargement of the pharyngeal tonsils?

adenoid hyperplasia

German measles is spread by what form of transmission?

airborne droplets

What is the treatment of choice for childhood leukemia?

chemotherapy

infection caused by the herpes Varicella-oster virus

chicken pox

The term strabismus is also known as:

crossed eyes

Which of the following is characterized by a harsh barking cough, fever, and inspiratory stridor?

croup

Which of the following statements describe rhinitis?

inflammation of the nasal membranes

Respiratoru viral infection occuring every year in late fall through early spring

influenza

What infection is caused by viruses in the Orthomyxovirus family?

influenza

Children suffering neurologic symptoms, chronic anemia, or difficulty with coordination should be evaluated for which of the following?

lead poisioning

What is one of the most common food allergies in children under 1 year of age?

eggs

What is the most difficult form of child abuse to recognize and diagnose?

emotional

20-2bCroup

escription. Croup, also known as laryngotracheobronchitis, is an upper respiratory infection. Etiology. Croup is caused by parainfluenza viruses 1 and 2 and affects children from 3 months to 3 years of age. Symptoms. It is characterized by a harsh barking cough, fever, inspiratory stridor (STRYE-dor; high-pitched sound during inspiration through blocked airways), laryngeal spasms, and increased difficulty in breathing at night. Diagnosis. Diagnosis is made by physical examination. Treatment. Treatment usually includes high humidity, fluids, rest, racemic epinephrine (racemic epinephrine provides bronchodilatation with only a minimal increase in heart rate and blood pressure), and antipyretics if needed. Complications can be serious if a patent (open) airway is not maintained. Prevention. Preventive activities include: Good and frequent hand washing. Avoiding sick children. Teaching children to sneeze or cough into a tissue or into their elbow. Keeping immunizations current, especially Haemophilus influenzae type b (Hib).

Which of the following is used in over 50% of suicides?

firearms

Which of the following in children under age 3 would be suggestive of physical abuse?

fractures

What type of medications are short acting medications used to slow or prevent an acute attack of asthma?

rescue medication