INFECTIONS IN CHILDREN

Once healthy children are past the first few months of life they are able to combat infections as well as adults. During the first few months the child may not have developed a sufficient number of antibodies to be able to combat successfully the many bacteria in his environment.

The process of developing antibodies takes place rapidly after six months of age, and healthy children may show an even greater resistance to the ordinary bacterial infections than adults.

Children tend to develop an immunity to the bacteria that flourish in their environment. However, such bacteria as staphylo-coccus, streptococcus, colon bacillus, and others can cause an

infection if they gain access, to the child's body through a break in the skin or through one of his apertures.

There are some conditions which can affect a child's ability to combat an infection.

1. If a child is undernourished and lacks sufficient body proteins,
vitamins and essential minerals, he will be poorly equipped to
combat infections.

2. An anemic child will find it more difficult to mobilize his
body resources to combat infections.

3. If there is a disease in one of the major organs, such as
liver, kidneys, or bone marrow, a child will be less able to fight
off the invasion of bacteria.

Any infection may cause temperatures as high as 105 °F to 106 °F in a, child. This is not a bad indication, as it demonstrates the child's ability to mobilize his defence mechanisms.

It is necessary to give a patient large quantities of fluids because most generalized infections are associated with temperature elevation and profuse sweating. Furthermore, large quantities of fluids tend to dilute the toxins produced by the bacteria.

Bed rest and prompt treatment of minor infections such as head colds or other upper respiratory infections will often prevent the onset of a more serious infection such as pneumonia.

It must be remembered that antibiotics are usually ineffective in ridding the body of a viral infection. However, they may be given to prevent a secondary invasion of bacteria that would complicate the original viral infection.

In certain instances the vaccines are effective in preventing the viral infection but not in curing it. For example, the measles virus can be prevented from taking hold within the body by vaccinating the child against it.

DISEASE

DISEASE is the unhealthy state of a body part, a physiological system, or the body as a whole. A disease may be a structural anomaly, such as a congenital heart defect, or a functional condition such as high blood pressure or trauma.

An important aspect of any disease is its etiology. Many diseases are known to be caused by infectious agents for example, childhood infectious diseases; the common cold and the flu and catarrhal jaundice are considered to be viral infections while inflamatory processes and abscesses being caused by bacteria. Another important aspect of a disease is the way of its manifes­tation — the symptoms and signs.

Diagnosis, the determination of the nature of a disease, is based on many factors including the signs, symptoms and often, laboratory arid clinical findings. To make a diagnosis a physician obtains information from a physical examination, from interviewing the patient or a family member, as well as from a medical history of the patient.

The physician having made a diagnosis states the possible prognosis of the disease, the course it is to take and an outcome of the disease.

The treatment considered most effective should be prescribed and may include medication, surgery, radiation therapy, etc.

Physicians know the course of the disease often to vary. It may have a sudden onset and a short duration in which case it is stated to be an abute disease. A disease may begin insidiously curable one or have a fatal outcome.

Acute Tonsillitis

Acute tonsillitis is a systemic infection characterized by an acute inflammatory process, it may have drastic effect on many vital organs of the body.

Acute tonsillitis may be due to different bacteria. The most common cause is the haemolytic streptococcus. Its highest, incidence is between October and March. Care must be taken to prevent spread of infection. In the early stages it may be difficult to differentiate from diphtheria, and if there is any doubt as to diagnosis, a throat swab must be taken to determine the infecting organism. Acute tonsillitis is caused by the contact with infectious patients, through articles. The child may carry a dormant infection in his decayed teeth or chronically inflamed tonsils. And when his body is weakened or he is subjected to prolonged chilling he falls ill.

Protection against tonsillitis includes elimination of factors that lower resistance to disease. An important factor in the prevention of tonsillitis is the protection of healthy children against exposure to it and as well as to other diseases, such as upper respiratory catarrhs, grippe, colds.

There are several forms of acute tonsillitis, depending on the nature of the lesion: catarrhal, follicular and lacunar tonsillitis.

The onset of tonsillitis is usually sudden with malaise, pain on swallowing, a sensation of chilliness, .fever, impaired sleep and appetite. On examination one or both tonsils are found to be enlarged and covered with whitish or grey material.

This material or exudate consists of purulent discharge from the tonsil. The inflammatory process is seldom restricted to the tonsils, and the whole of the throat is reddened and inflamed. The tongue is covered with a thick fur, and the breath has often an unpleasant odour. There is sometimes pain in the ear on the affected side, it may lead to infection of the ear with serious consequences.

The most frequent complications of acute tonsillitis are rheumatic fever and kidney trouble. A condition called chronic tonsillitis may develop following recurrent .attacks of acute tonsillitis.

A sick child must be put to bed immediately. Particular care should be taken to give the child a lot of vitamins, the patient's food must be soft and warm. The children have to gargle their throats with a solution of salt, soda and boric acid. Vapour inhalations through the mouth are sometimes comforting. Warm compresses to swollen lymph nodes are useful. The drugs usually prescribed for acute tonsillitis are streptocide (sulfanilamide) or other sulfonamides. The child is given drugs to bring the t°down.

Chronic tonsillitis is treated by irrigating the tonsils with various preparations or exposing them to ultraviolet rays. The tonsils may be removed surgically if treatment is of no avail.

DIPHTHERIA

Diphtheria is an acute infectious disease caused by Corynebac-terium diphtheriae.The microorganism produces an exotoxin which is responsible for the resulting pathologic process. The disease is characterized clinically by a sore throat and a membrane which may cover the tonsils, pharynx and larynx.

Epidemiologic factors.The highest seasonal incidence occurs during the autumn and winter months.

Diphtheria is acquired by contact with either a case or carrier, the microorganisms being disseminated by the acts of coughing, sneezing or talking.

Pathogenesis and Pathology.Virulent diphtheria bacilli lodge in the nasopharynx of a susceptible individual. Bacterial growth taking place in the secretions and epithelial debris, a toxin is elaborated and absorbed by the local mucous membrane. The toxic effect on the cells causes tissue necrosis. In addition to the necrosis, an inflammatory and exudative reaction is also induced by the toxin. The necrotic epithelial cells, leucocytes, red cells, ftorinous material, diphtheria bacilli, and other bacterial inhabitants of the nasopharynx — all these elements combine to form the typical "membrane". It sloughs off during the recovery period.

Clinical Manifestations.Diphtheria develops after a short incubation period of 2 to 4 days.

For clinical purposes it is convenient to classify the disease in accordance with the anatomic location of the membrane. The following types of diphtheria may occur: (1) tonsillar (faucial), (2) laryngeal or laryngotracheal, (3) nasal and 4) nonrespiratory types including skin wounds, conjunctival and genital lesions.

Diagnosis.An early diagnosis of diphtheria is essential because delay of administration of antitoxin may impose a serious risk on the patient. The diagnosis of diphtheria must be made clinically.

The bacteriologic confirmation by means of culture is of the greatest importance. The method of accelerated bacteriological diagnosis when the material secured with the aid of a specially prepared moist tampon is placed in a thermostat for 4—6 hours should be more widely employed. A tellurium test has been recently employed as a method of rapid diphtheria diagnosis.

Treatment.It is necessary to isolate the patient at once. Diphtheria antitoxin must be given promptly and in adequate dosage. In severe toxic forms of diphtheria it is advisable in addition to the serum to administer intravenously a hypertonic glucose solution, give the patients vitamins in the form of nicotinic acid and ascorbic acid for a period of 2—3 weeks, some. authors recommending administration of atrychnine from the 1-st days of the disease. Bed rest is very important. Other supportive measures include maintenance of hydration, a high caloric liquid or soft diet rich in vitamins, aspirin or codeine for sore throat and malaise. The patient must gargle his throat several times a day with a 2% boric acid solution. The patient's room must be aired.

Patients with laryngeal diphtheria require special treatment. In very advanced cases with severe symptoms of growing asphyxia, if there is increasing restlessness, irritability and anxiety, associated with progressive respiratory distress, a tracheotomy is indicated for the relief of obstruction. It should be performed before the child becomes cyanotic and exhausted.

Prognosis and Complications,in spite of the low fatality rate sudden death may be caused by a variety of unpredictable events, such as (1) the sudden complete obstruction of the airway by a detached piece of membrane, (2) the development of myocarditis and heart failure, and (3) the late occurrence of the respiratory paralysis due to phrenic nerve involvement. Patients surviving following myocarditis and neuritis, the recovery is a rule.

Immunity.For determining immune status the Shick test is useful. Active immunity may be induced by either an attack of diphtheria or more commonly to-day by inoculations of diphtheria \ toxoid. Immunity following an attack of diphtheria may be either j, permanent or temporary; recurrent attacks of the disease are not \ unusual. The widespread and routine immunization of infants and

children having had a profound effect on the immune status of the population at large, the incidence of diphtheria among inoculated children is lower, and the disease runs a milder course.

BRONCHITIS

This is probably the most common respiratory disorder of childhood. The inflammation affects the mucosa of the bronchial system. In the majority of cases it is harmless, but in very young patients or those weakened by ill health, it may develop into bronchopneumonia.

Bronchitis may be primary, but is very often an accompaniment of some other infection, as tuberculosis, pneumonia, influenza, whooping-cough, diphtheria. Bronchitis may occur at any age.

Etiology.Bronchitis is due to virus and bacterial infection. The microorganisms most frequently found are the staphylococcus, strep­tococcus, pneumococcus.

Pathology.Bronchitis is usually part of a general inflammation which may include any or all of the respiratory tract. The infection can begin at any point, and extend down as far as the alveoli, where it results in pneumonia. In a simple case the changes are usually minor: hyperemia of the bronchial mucosa and desquamation of ciliated epithelial cells, with loss of cilia; the mucous glands become distended, the bronchial secretion increases.

Symptoms.The mildest form is confined to the larger tubes. The onset may be sudden or gradual sometimes accompanied by slight fever, from 37.7 °C to 38.8 X, during the first day or two usually there are but few general symptoms. Respiration may be accelerated, and is usually audible. There may be either constipation or diarrhea. The child may be restless and irritable, though giving little evidence of being sick. Catarrh of the upper passages may be associated. Usually there is a dry, hoarse cough, either mild or severe, which may interfere with the taking of food. There may be pain under sternum. When the inflammation reaches the inter­mediate tubes, the fever is usually higher for the first two or three days, after which it gradually declines. Both respiration and pulse are accelerated. In children over three years old bronchitis is not unlike that in adults. There is not the same danger as in infants, of the infection passing over into the smaller bronchi. Often there is no fever, the patient feels well and has a good appetite. ;The symptoms are cough, which is worse at night and soreness over sternum. The cough is with a small amount of whitish expectoration. The cough usually lasts from one to two weeks. In severe cases older children may complain of headache, chilliness, pain in the back, and a feeling ef tightness in the chest.

Expectoration is more profuse, sometimes blood-streaked. Sometimes bronchitis may be more protracted; this is connected with the duration of the primary disease and with domestic conditions, particularly when the child is deprived of fresh air and sunlight for prolonged periods. Such unfavourable factors may lead to a number of complications auch as, otitis media, pyelitis, secondary anemia. Bronchopneumonia is the most frequent complication in infants.

Prognosisis good for acute bronchitis; in childhood the conversion to chronic forms is rare. Even in protracted cases uncomplicated by pneumonia complete recovery is often obtained by proper care and improved domestic conditions.

Treatment.Bronchitis usually requires only fresh air, good ventilation of premises, a well-balanced diet. Warm baths are indicated, especially for infants. Mustard plasters and mustard packs are recommended. The symptomatic drugs administered are usually expectorants or, on the contrary, anesthetics to keep the cough down.

ACUTE BRONCHITIS

Acute bronchitis is an acute disease of the bronchi, characterized by an inflammation of their mucous membrane, caused by the chemical and biological extension of irritation from the upper air passages, often following a rhinitis or a laryngotracheitis. The larger bronchi are first affected. Affection of the smaller bronchi may be secondary to affection of the larger tubes. Further spread of the infection may cause bronchopneumonia. The condition is also found in association with influenza, measles, scarlet fever, and some of the other acute febrile diseases.

Symptoms:These are retrosternal pain, hoarseness, cough, and often soreness; there may be a slight rise of temperature, though the temperature often remains normal.

Physical Signs: Inspection of the chest is negative; the trachea and pharynx may be infected. Nothing abnormal is elicited by palpation and percussion, but on auscultation the respiratory murmur may be harsh, and numerous large moist or dry rales are found along the large bronchi, which of.ten disappear after cough and expectoration.

CHRONIC BRONCHITIS

This is a chronic inflammatory condition of the medium sized and small bronchi, associated with destructive changes in the bronchial wall and peribronchial space. As a rule, it is a secondary

disease. It is characterized by dyspnea, cough and various types of expectoration.

Most cases of chronic bronchitis occur in those past middle life. In the young it may be caused 'by some irritating condition within the upper air passages, the trachea or the bronchi, and also by the presence of enlarged tonsils, sinus infections, focal infections, enlarged pendulous uvula, adenoids, congenital malfor­mation of the trachea. A foreign body in the bronchi or lungs may at times be the cause of chronic bronchitis.

Symptoms:These are cough which occurs in paroxysms, copious expectoration, absence of fever, and a history of long-standing cough.

Physical signs:A person suffering from chronic bronchitis is usually emphysematous. Inspection, therefore, will reveal an em-physematous chest. Palpation will give evidence of diminished tactile fremitus throughout the- chest. Percussion will elicit a hyperresonant note, except when associated congestion of the bases is present, in which case, impaired resonance or relative dullness is obtained over these areas. On auscultation the examiner will hear low-pitched, prolonged inspiration, accompanied by low-pitched, prolonged wheezy expiration. The rales heard will be large and small, moist and dry. A profusion of all kinds of rales is usually audible in this class of cases, though the rales may disappear temporarily after the secretion has been coughed up.

BRONCHIAL ASTHMA

Date: 2016-04-22; view: 1258