Infection

Infection

Typhoid,tuberculosis,roseola infantum

Typhoid may not show such severe constitutional symptoms as in an adult. Irregular pyrexia, cough, disturbed mental state and abdominal distension, followed by diarrhoes, splenomegaly and rose spots should lead to blood and stool culture, and serological tests. Chloramphenicol is the drug of choice in the acute stage.


Tuberculosis Infections with Mycobaterium tuberculosis should always be considered in the differential diagnosis. When it has already spread through the bloodstream presentation may be bizarre.
BEWARE exudates, urine or gastric washing's, if appropriate, for M.tuberculosis. Biopsy or operation may occasionally be needed to confirm diagnosis. An opportunistic mycobacterium, e.g. Avium intracellulare, may also produce lymph node enlargement and cold abscesses, especially in the cervical region; this is histologically indistinguishable from human/bovine TB but the Mantoux test is negative. Specific skin testing reagents to these species can be obtained in the UK through the public Health Laboratory Service. TB is notifiable.
Roseola infantum Is thought to be due to human herpesvirus 6 and is characterized by irritability and high fever for 3-4 days, often with no other abnormal physical signs. The fever falls by crisis, when a macular or maculopapular rash appears on trunk and spreads, but this fades within 24 hours. The rash may be mistaken for an allergy to antimicrobial agents and must be differentiated from that of rubella and measles.
Meningitis
Must be suspected in any acutely ill child, especially in the newborn period. The presence of an upper respiratory tract infection does not exclude its coexistence. Puroura is suggestive of meningococcaemia. Moderate pleocytosis or equivocal CSF changes may require the child to be treated, especially if under a year or if previous antibiotics given. Review is then needed after culture and CSF chemistry reported upon. For causative organisms and treatment.
Erythema infectiosum
Is due to parvovirus B19. In addition to a rash with the characteristic 'slapped cheek' appearance, the virus can cause arthropathy, precipitate an aplastic crisis in patients with haemoglobinopathies and cause hydrops fetalis and abortion. test for B19-specific IgM.
Herpes simplex
High fever at onest of primary illness and before appearance of vesicles is usual. For Keratitis, place acyclovir ointment in the conjunctival sac 4-hourly. Extensive superficial skin lesions in the immunocompromized, and in herpes encephalitis, are treated with acyclovir.