Pediatrics(2)

-- Tinea capitis: Fungal infection of the scalp or head and often

-found in children

-- Tinea corporis: Fungal infection of the glabrous skin (hairless part of the body)

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-Investigations

-- Looking at a skin scraping of the rash under the microscope

-using a potassium hydroxide (KOH)test

-- Skin biopsy for histological exams

-Management

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-Recommendation

-- Avoid sharing combs and towels to prevent Tinea capitis

-8.4. Viral Infections

-8.4.1. Herpes Zoster Virus (HZV) Infection

Figure 25-41

Figure 25-42

GENERAL EXAMINATION Lymphadenopathy Regional nodes draining the area are often enlarged and tender.

Sensory or Motor Nerve Changes Detectable by neurologic examination. Sensory defects (temperature, pain, touch) and (mild) motor paralysis, e.g., facial palsy.

Varicella-zoster virus infection: herpes zoster in T8 to T10 dermatomes Typical grouped vesicles and pustules with erythema and edema of three contiguous thoracic dermatomes on the posterior chest wall.

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-Definition: It is a highly contagious systemic disease that normally results in lifelong immunity.

-Causes/Predisposing factors

-- Herpes zoster virus

-- People with no prior immunologic exposure to varicella virus, most commonly children, develop the clinical

-syndrome of varicella, while those with circulating varicella antibodies develop a localized recrudescence zoster (Zona)

-Signs and Symptoms

-- Small red macules that progress rapidly over 12 to 14 hours to papules

-- “dewdrops on a rose petal” Vesicles - pustules, and finally – crusts

-- Pruritus usually associated with skin lesions

-- Prolonged fever

-Complications

-- Bacterial super infection with subsequent scarring

-- Extra-cutaneous complication (CNS involvement, rare) with

-neurological manifestation

-- Hemorrhagic complications in immunocompromised children

-Management

-Immunocompetent children

- • Symptomatic therapy for non severe cases

-→ calamine (ZnO + Fe2O3) lotion 4-5 application /day

-→ Promethazine sp 5mg/5ml, 7.5mg at bed time > 2 -5 yr ;

12.5mg at bed time >6 yr (oral antihistaminic)

- • In severe cases (disseminated or mucosal involvement):

-→ Acyclovir 20mg/kg a day for 5 days

-Immunocompetent ≥ 12 years

-• Symptomatic therapy in less severe disease

-→ calamine (ZnO + Fe2O3) lotion 4-5 application a day

-→ Oral antihistaminic: Promethazine 25mg at bed time associated with oral acyclovir 800 mg 5 times/day for 7 days

-Immunocompromised / Immunosuppressed children

-• Symptomatic therapy

-→ calamine (ZnO + Fe2O3) lotion 4-5 application a day

-→ Oral antihistaminic: Promethazine 25mg at bed time

-→ Oral Acyclovir 800 mg 5 times/day for 7 days

-In life threatening conditions

-• Give IV Acyclovir: 10 mg/kg, infused at a constant rate over 1 h, every 8 hours for 7 days

-8.5. Parasitic Infections

-8.5.1. Scabies

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-Definition: Human scabies is a pruritic and contagious skin condition

-caused by the S. scabies mite var, hominis. It is transmitted via direct and

-prolonged contact with an infected individual.

-Sign and Symptoms

-- Nocturnal intense pruritus

-- Lesion distribution

-• Interdigital web spaces

-• Around the nipples

-• Genital region

-- Lesion characteristics

-• Papules, pustules or excoriations.

-• The pathognomonic sign: intradermal tunnel called scabietic “burrow”

-Complications

-- Secondary skin infection

-- Sepsis

-Investigation

-- Microscopic identification of skin scrapings

-Management

-- Benzyl Benzoate Emulsion (BBE) 25% (12.5% in children <5

yr, diluted in water 1:1, and 7.5% in infant, diluted in water 1:3), applied for 24 hours for three to five successive days. Apply from chin to toes and under fingernails and toenails. Repeat the same treatment ten days after.

-Or Permethrin 5% cream as follows:

-• Apply from chin to toes and under fingernails and toenails

-• Rinse off in shower / bath 12 hours later; repeat in 1 wk

-• Pediatric: >2 months old: Apply on head and neck, repeat in 1 wk

+ Promethazine sp5mg/5ml, 7.5mg/nocte > 2 -5 yr, 12.5mg nocte > 6 yr for 5 days

-Recommendations

-- All family members and close contacts must be evaluated and treated for scabies, even if they do not have symptoms

-- Instruct patients to launder clothing, bed linens, and towels used within the last week in hot water the day after treatment is initiated and again in 1 week

-- Items that cannot be washed may be professionally dry cleaned

-or sealed in plastic bags for 1 week

-9. Infectious Diseases

-9.1. Malaria

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