Infections in children( childhood infections) - Causes, symptoms and treatment. MF.

Infectious diseases for children are known from antiquity. Written sources of Mesopotamia, China, ancient Egypt( II-III century BC) indicate a description of cases of tetanus, poliomyelitis, erysipelas, mumps and fever in children. And only since the XX century vaccine prevention of such diseases has been introduced. Historically, infectious diseases, which are found mainly in children, are called children's diseases.

So, children's infections is a group of infectious diseases that are registered in the overwhelming majority in the children's age group, are transferred from the patient to a healthy child and are able to acquire epidemic spread( that is, acquire a flash or mass character).

What can be associated with the allocation of childhood infections in a separate group? Due to the high prevalence, the first meeting with the causative agent of infection occurs precisely in childhood. In rare cases, the child manages to live to the adult state without becoming infected from the sick or carriers of the causative agents of these infectious diseases. After the transferred disease, a stable( sometimes lifelong) immunity is formed, so most adults do not suffer from these diseases again.

Due to close contacts in the children's age group, when one person develops an infection, the others are almost always infected.

What are the infections called children?

1. Traditional childhood diseases with an aerogenic mechanism of infection( rubella, chickenpox, whooping cough, diphtheria, measles, scarlet fever, mumps, poliomyelitis, pneumococcal infection, hemophilic infection)
2. Infections occurring in both children's age group with the possibility of developing outbreaksdiseases in collectives, and among adults with various mechanisms of infection( meningococcal infection, infectious mononucleosis, acute respiratory infections, acute intestinal infections, acute viral hepatitis A).

Almost any infectious disease a child can get if there is an accidental contact with the patient. The exception is the first year of the baby's life, when the mother's antibodies are circulating in his blood to many diseases, which protects his body from infection when he meets the infectious pathogen.

Causes of childhood infections

The source of the infection is a person. It can be painful with a clinically expressed form of the disease, an asymptomatic form of the disease, and also a carrier of an infectious agent.

One of the frequent questions of parents: when the patient becomes infectious and how long can it infect?

Infectious period in childhood infections

Disease	Disease	Infectious period	Infectious child during illness	Infectious child after disappearance of complaints
Period in which one can infect others( infectious period)
Rubella	3-4 days before the onset of symptoms	the entire period of rash +4 days
Measles	4 days before the onset of symptoms	entire period of rash + 4 days
Chickenpox	from the first symptoms of the disease	entire period of rash + 5 days
Scarlet fever	from the first symptoms of the disease	the first days of illness	is not infectious
Pertussis	a day before the onset of symptoms of	1 week of illness = 90-100% of "contagion", 2 weeks = 65%, 3 weeks.= 35%, 4 weeks.= 10%	for more than 4 weeks
Diphtheria	with onset of the disease - first symptoms	2 weeks	for more than 4 weeks, "carriage" for more than 6 months
Epidemic parotitis( mumps)	1 to 2 days before the first symptoms of	up to 9 days of disease	is not contagious
Polio	1-2 days before the first complaints	3-6 weeks
Hepatitis A	from 3 to 23 days	the entire period of jaundice, 1 month	months
Dysentery	from the first symptoms of the disease	the entire period of the disease	1- 4 weeks, months
Salmonellosis	from the first symptoms of the	disease for the entire period of the	disease 3 weeks, further more than 1 to 5% of the

patients. The infection mechanism in traditional childhood infections is aerogenic, and the infection route : airborne. Nasopharyngeal mucus, bronchial secretion( sputum), saliva are known that can be sprayed as a fine aerosol at a distance of 2-3 meters from itself when coughing, sneezing, talking. In the contact area are all children who are close to the sick. Some pathogens spread well at a distance. For example, the measles virus in the cold season can spread through the ventilation system in a single building( that is, patients may be from the same building entrance, for example).Also has epidemiological significance of the contact-household transmission route( household items, toys, towels).In this respect, everything depends on the stability of the pathogens in the external environment. But, despite this, an example is the high infection with chicken pox by a contact and household way, with the virus being stable in the environment for only 2 hours. The causative agents of scarlet fever and diphtheria are highly stable in the external environment, therefore the contact-household way is also significant. Also, in some diseases, infection occurs by the fecal-oral route( intestinal infections, hepatitis A, polio, for example), and transmission factors can come as household items - toys, furniture, utensils, and infected food.

Susceptibility to childhood infections is quite high. Of course, specific prevention( vaccination) does its job. Due to it, an immunological layer of non-responsive individuals is created to measles, mumps, polio, pertussis, diphtheria. However, unvaccinated children belonging to the risk group remain vulnerable enough. When childhood infections are characterized by frequent occurrence of collective outbreaks of infection.

Features of the course of childhood infections

Infectious diseases for children have a clear cyclicity. There are several periods of
disease, flowing from one another. Allocate: 1) the incubation period;2) the prodromal period;3) the period of the height of the illness;4) the period of convalescence( early and late).

The incubation period of is the period from the moment of contact of the child with the source of infection until the appearance of a symptom of the disease. During this period the child is called contact and is in quarantine( under the supervision of medical workers).Quarantine can be minimum and maximum. Typically, the quarantine period is set for the period of the maximum incubation period. During this period, monitor the health of the contact child - measure the temperature, monitor the appearance of symptoms of intoxication( weakness, headaches and others).

Incubation period for childhood infections

Rubella from 11 to 24 days
Measles from 9 to 21 days
Chickenpox from 10 to 23 days
Scarf fever from several hours to 12 days
Pertussis from 3 to 20 days
Diphtheria from 1 hour to 10 days
Epidemiological parotitis( mumps) from 11 to 26 days
Poliomyelitis from 3 to 35 days
Hepatitis A from 7 to 45 days
Dysentery from 1 to 7 days
Salmonellosis from 2 hours to 3 days

As soon as one of the complaints appears,the second period is the prodromal , which is directly related to the beginningdisease. Most of the onset of the disease in children's infections is acute. The child is troubled by the temperature, symptoms of intoxication( weakness, chills, headaches, fatigue, sweating, decreased appetite, drowsiness and others).The temperature reaction may be different, but in the vast majority of children - the right type of fever( with a maximum by the evening and a decrease in the morning), the fever height may vary depending on the pathogenicity of the causative agents of childhood infections, the dose infectivity, the reactivity of the child itself. More often it is febrile temperature( more than 38 °) with a peak towards the end of the first-second day of the disease. The duration of the prodromal period varies depending on the type of childhood infectious disease, but on average 1-3 days.

The period of the height of the disease is characterized by a specific symptom-complex( that is, symptoms specific to a particular childhood infection).The development of specific symptoms is accompanied by continuing fever, the duration of which is different for different infections.

A specific symptomatic complex is the consistent occurrence of certain symptoms. For whooping cough - this is a specific cough that has the character of dry and paroxysmal with several short coughing thrusts and a deep wheezing( reprise).For mumps( mumps) - an inflammation of the parotid, submandibular and sublingual salivary glands( swelling of the parotid region, tenderness when touching, puffiness of the face, pain in the affected area, dry mouth).Diphtheria is characterized by a specific lesion of the oropharynx( enlarged tonsils, edema and the appearance of a characteristic fibrinous grayish coating on the tonsils).For hepatitis A, the peak period is manifested by the appearance of jaundice. With poliomyelitis - a characteristic lesion of the nervous system.

However, one of the common manifestations of childhood infections is rash( infectious exanthema) of .It is the rash that is the "frightening business card" of infections in children and requires correct decoding. Rashes can occur at one stage or in stages.

With rubella, the rash has a fine-sparse, and then spotted-papular character, occurs mainly on the extensor surfaces of the extremities and the trunk - back, waist, buttocks, the skin background is not changed. First appears on the face, then spreads throughout the day to the trunk. Disappears without a trace.

Rash for rubella

In measles there is a spotty-papular rash, characterized by a descending sequence of rashes( 1 day of rash - face, scalp, upper chest, 2nd day of rash - trunk and upper half of hands, 3rd day of rash - lower part of arms,lower limbs, and face turns pale), the rash is prone to fusion, after the disappearance, pigmentation of the skin persists. Sometimes the rash with rubella resembles measles. In this situation, to help the doctor comes a specific symptom - the spots of Filatov-Koplik( on the inner side of the cheeks are whitish-green papules that appear on day 2-3 of the disease).

Rash at measles

Filatov spots with measles

When chickenpox, we see a vesicle rash( bubble), the elements of which are located against the background of reddening. At first it is a stain, then it rises, a bubble with a serous transparent liquid forms, then the vesicle dries, the liquid disappears and a crust appears. Characteristic of the podsypaniya with repeated rises in temperature once in 2-3 days. The period from the onset of the rash to the complete dropping of the crusts lasts 2-3 weeks.

Rash with chickenpox

With scarlet fever on the hyperemic background of the skin( reddening background), there is an abundant small-point rash. The rash is more intense in the area of ​​skin folds( elbows folds, axillary cavities, inguinal folds).The nasolabial triangle is pale and free of rash. After the disappearance of the rash peeling, lasting 2-3 weeks.

Rash with scarlet fever

Nasolabial triangle with scarlet fever

Meningococcal infection( meningococcemia) is characterized by the appearance of a hemorrhagic rash, first of a shallow, and then draining character in the form of "stars".The rash often appears on the buttocks, legs, arms, eyelids.

Rash with meningococcemia

Disease of meningococcemia Disease of Duration of rash appearance Rubella end of 1st-2nd day of illness 2-5 days Measles 3-4th days of illness 5-7 days Chicken pox 2ndday of illness 1-1,5 weeks Scarlet fever end of day 1 5-6 days Meningococcal infection for 6-14 hours of illness!(i.e., the first day) 8-10 days In addition to the rash, any childhood infection is characterized by lymphadenopathy( an increase in certain groups of lymph nodes) .The involvement of the lymphatic system is an integral part of the infection process in infections. With rubella there is an increase in the supernuminal and occipital lymph nodes. With measles, cervical lymph nodes increase, with chicken pox - behind and cervical, and with scarlet fever - anterovenous lymph nodes. In mononucleosis, a strong increase in the posterior lymph nodes( lymph node packs are visible when the child's head rotates). The period of convalescence( recovery) is characterized by the extinction of all symptoms of infection, the restoration of the functions of the affected organs and systems, the formation of immunity. Early convalescence lasts up to 3 months, late convalescence affects the period up to 6-12 months, and more rarely - longer. Another feature of childhood infections is the diversity of clinical forms. The manifest forms( with characteristic symptoms of the disease) are mild, moderate, severe, erased forms, subclinical( asymptomatic), abortive forms( interruption of the infection). The expected complexity of infections in children is the risk of rapid development of severe complications. This can be: infectious-toxic shock at the onset of the disease( critical pressure drop, which is more common in meningococcal infection, scarlet fever), neurotoxicosis at high temperature( developing cerebral edema), sudden respiratory arrest or apnea in whooping cough( due to respiratory depressioncenter), true croup syndrome with diphtheria( due to powerful toxic edema of the oropharynx), viral brain lesions( rubella encephalitis, measles encephalitis, chickenpox encephalitis), dehydration syndrome( nand acute intestinal infections), bronchial obstruction, gemolitikouremichesky syndrome, ICE syndrome. Given all of the above, it is necessary to maintain a critical attitude towards the child's condition and seek medical help in a timely manner. Symptoms of childhood infections requiring medical attention 1) Febrile temperature( 38 ° and above). 2) Severe symptoms of intoxication( lethargy, drowsiness of the baby). 3) The appearance of a rash. 4) Vomiting and severe headache. 5) Appearance of any symptoms on the background of high temperature. Diagnosis of childhood infections The preliminary diagnosis is made by a pediatrician. Important: contact the patient with other patients with infection, vaccination( vaccination) data, characteristic symptoms of infection. The final diagnosis is made after laboratory tests. - Nonspecific methods( general analysis of blood, urine, feces, biochemical blood tests, studies of blood electrolytes), instrumental diagnostic methods( radiography, ultrasound, MRI on indications) - Specific methods for detection of pathogens and / or their antigens( virologic, bacteriological, PCR), as well as for the detection of antibodies to pathogens in the blood( ELISA, RNGA, RTGA, RA, RPGA and others). Basic principles of treatment of children's infections The goal of the treatment is the recovery of a small patient and the restoration of the disturbed functions of organs and systems, achieved by solving the following tasks: 1) control of the pathogen and its toxins; 2) maintaining the functions of vital organs and systems; 3) increase immunological reactivity( resistance) of the child's body; 4) prevention of complications of childhood infection. The objectives of treatment are carried out by the following activities: 1. Timely detection and, if necessary, hospitalization of a sick child, the establishment of a protective regime for him - bed rest for a serious and moderate condition, adequate nutrition, drinking regime. 2. Etiotropic therapy( specific drugs aimed at suppressing growth or destroying the causative agent of infection).Depending on the infection, antibiotic drugs, antiviral agents are prescribed. Incorrect interpretation of the diagnosis and the appointment of etiotropic treatment, not along the profile, will lead to possible weighting of the infection and the development of complications. 3. Pathogenetic therapy is associated mainly with the infusion therapy of solutions of a certain directivity( glucose-salt solutions, colloids, plasma and blood preparations), as well as specific parenteral drugs( protease inhibitors, glucocorticosteroids and others), immunomodulators. 4. Posindrome therapy is provided for any infection( antipyretic, antiemetic, vasoconstrictive, expectorant, antitussive, antihistamines and many others). How to prevent infections in childhood? 1) Strengthening the child's organism and increasing its resistance to infections( hygiene, hardening, walking outdoors, adequate nutrition) 2) Timely contact with a doctor for the first symptoms of infection 3) Specific prevention of childhood infections - vaccination. With many childhood infections, vaccination has been introduced into the National Vaccination Calendar - measles, rubella, diphtheria, poliomyelitis, mumps, hepatitis B).Currently, vaccines have also been developed for other infections( chicken pox, meningococcal infection, pneumococcal infection, hemophilic infection).Neglect of parents by routine vaccination of children without special medical reasons creates a vulnerable layer of non-immune children, primarily prone to infection by infectious agents. The doctor infektsionist Bykova N.I.