PEDIATRIC 5 INFECTIOUS DISEASES

CHILDHOOD EXANTHEMS
MEASLES(RUBEOLA) MEASLES IS AN ACUTE,
VIRAL, INFECTIOUS DISEASE
• 1-The measles virus is a paramyxovirus of the genus Morbillivirus.
MEASLES(RUBEOLA)

• Incubation period 8 to 12 days.

• ■ Exposure to rash onset averages 14 days
(range, 7 to 21 days)
• ● Prodrome lasts 2 to 4 days (range, 1 to 7 days)
(Communicable period from 4 days before to 5
days after rash appears mainly during prodromal
stage pertaining to early symptoms that may
mark the onset of the disease)
• ■ Stepwise increase in fever to 103°F–105°F
• ■ *Cough, coryza, and conjunctivitis
• ■* Koplik spots (on mucous membranes)
MEASLES

• Koplik spots, present on mucous

membranes, are considered to be unique
to measles. They occur 1 to 2 days
before the measles rash (i.e., during the
prodromal period), and appear as
punctate blue-white spots on the bright
red background of the buccal mucosa.
MEASLES

• The measles rash is a maculopapular eruption that

usually lasts 5 to 6 days. It begins at the hairline,
then involves the face and upper neck. During the
next 3 days, the rash gradually proceeds downward
and outward, reaching the hands and feet. The
maculopapular lesions are generally individually
distinct but may run together, particularly on the
upper body. Initially, lesions blanch (become white
or pale) with fingertip pressure. By 3 to 4 days, most
do not blanch with pressure. The lesions peel off in
scales in more severely involved areas. The rash
fades in the same order that it appears, from head to
extremities.
MEASLES
• Complications include diarrhea, otitis
media, pneumonia, encephalitis,
subacute sclerosing panencephalitis, and
death. Complications of measles were
most common among children younger
than age 5 years and adults.
• Transmission: Measles transmission
occurs person-to-person via large
respiratory droplets and via airborne
transmission of aerosolized droplet
nuclei in closed areas (e.g., an office
examination room) for up to 2 hours
after a person with measles occupied the
area.
MEASLES VACCINATION(AGE 12 MONTHS
BECAUSE IS VIRUS VACCINE LIVE)
• MMR vaccine is a lyophilized
preparation of measles virus vaccine live,
an attenuated line of measles virus,
derived from Enders’ attenuated
Edmonton strain and propagated in chick
embryo cell culture; mumps virus
vaccine live, the Jeryl Lynn strain of
mumps virus propagated in chick
embryo cell culture; and rubella virus
vaccine live
MMR VACCINE

• Prevention: MMR vaccine or MMRV

vaccine can be used to implement the
vaccination recommendations for
prevention of measles, mumps, and
rubella. MMR vaccine is licensed for use
in persons age 12 months or older.
MMRV vaccine is licensed for use in
persons age 12 months through 12 years
QUESTION

• A child seen in the clinic is found to have rubeola (measles) and the mother asks the nurse
how to care for the child. Which instruction should the nurse provide to the mother?
• 1.Keep the child in a room with dim lights.
• 2.Give the child warm baths to help prevent itching.
• 3.Allow the child to play outdoors because sunlight will help the rash.
• 4.Take the child's temperature every 4 hours and administer 1 baby aspirin for fever.
ANSWER

• 1.Keep the child in a room with dim lights.

QUESTION

•Several children have contracted rubeola (measles) in a local school, and the school nurse conducts a teaching

session for the parents of the school children. Which statement, if made by a parent, indicates a need for further

teaching regarding this communicable disease?

•A."Small blue-white spots with a red base may appear in the mouth."

•B."The rash usually begins centrally and spreads downward to the limbs."

•C."Respiratory symptoms such as a very runny nose, cough, and fever occur before the development of a rash."

•D."The communicable period ranges from 10 days before the onset of symptoms to 15 days after the rash appears."
ANSWER

• D is the correct answer need further teaching.

• The communicable period for rubeola ranges from 4 days before to 5 days after the rash
appears, mainly during the prodromal (catarrhal) stage. Options 1, 2, and 3 are accurate
descriptions of rubeola. The small blue-white spots found in this communicable disease
are called Koplik spots. Option 3 describes the incubation period for rubella, not rubeola.
HEP B IS 0, 1 TO 2, 6 MONTHS.
2 MONTHS IS DR. HIP FOR DTAP, ROTAVIRUS, HIB, IPV, PCV13
4 MONTHS ALSO DR. HIP.
6 MONTHS IS DR. HIP PLUS INFLUENZA STARTS AT 6 MONTHS AND THE LAST DOSE OF HEP B IS AT
SIX MONTHS.
12-15 MONTHS IS MAD HPV
4-6 YEARS IS VERY DIM
QUESTION

• A mother brings her 4-month-old infant to the well-baby clinic for immunizations. Which
immunizations should be administered to this infant?
• 1.Diphtheria, tetanus, acellular pertussis (DTaP), Measles, mumps, rubella (MMR),
inactivated poliovirus vaccine (IPV)
• 2.Varicella and hepatitis B vaccines
• 3.MMR, Hib, DTaP
• 4.DTaP, Hib, IPV, pneumococcal vaccine (PCV)
ANSWER

• 4.DTaP, Hib, IPV, pneumococcal vaccine (PCV)

QUESTION

•A 6-month-old infant receives a diphtheria, tetanus, and pertussis (DTaP) immunization at the well-baby clinic.

The mother returns home and calls the clinic to report that the infant has developed swelling and redness at the

site of injection. Which is the appropriate response by the nurse?

•A. "Monitor the infant for a fever."

•B. "Bring the infant back to the clinic."

•C. "Apply an ice pack to the injection site."

•D. "Apply a warm pack to the injection site."

ANSWER

• ."Apply an ice pack to the injection site."

• Occasionally, tenderness, redness, or swelling may occur at the site of the injection. This
can be relieved with ice packs for the first 24 hours followed by warm compresses if the
inflammation persists. It is not necessary to bring the infant back to the clinic. Option 1
may be an appropriate intervention but is not specific to the subject of the question
QUESTION

•- The nurse obtains a health history from a mother of a 15-month-old child before administering a measles,

mumps, and rubella (MMR) vaccine. Which is essential information to obtain before the administration of this

vaccine?

•A.A recent cold

•B. Allergy to eggs

•C. The presence of diarrhea

•D. Any recent ear infections

ANSWER

• B-Allergy to eggs
• Before the administration of a measles, mumps, and rubella vaccine, a thorough health
history needs to be obtained. The MMR vaccine is used with caution in a child with a
history of allergy to gelatin or eggs because the live measles vaccine is produced by chick
embryo cell culture. The MMR vaccine also contains a small amount of the antibiotic
neomycin. Options 1, 3, and 4 are not contraindications to administering this
immunization.
QUESTION

•15-The nurse of a well-baby clinic prepares to administer an immunization to a child. The mother of the child

tells the nurse that the child has had a fever and is taking antibiotics. The nurse takes the child's temperature

and notes that it is 101.5° F rectally. The nurse plans to take which action?

•A. Delay the immunization.

•B. Administer the immunization.

•C. Administer one of the three scheduled immunizations.

• D. Administer one half of the prescribed dose of each scheduled immunization
ANSWER

• A/Delay the immunization.

• High fevers and severe illnesses are reasons to delay immunization, but only until the
child has recovered from the acute stage of the illness. Minor illnesses such as a cold,
otitis media, or mild diarrhea without fever are not contraindications to immunization.
QUESTION

• A child with Measles( Rubeola) is being admitted to the hospital . In the preparing for the
admission of the child, a nurse plans to pace the child on which precautions?
• 1- Neutropenic
• 2- Enteric
• 3- Airborne
• 4- Protective
ANSWER

• # 3 Airborne precautions.
ROSEOLA( EXANTHEMA SUBITUM ) SIXTH
DISEASE
• Roseola infantum is a common disease of
childhood that is seen globally and is caused by
infection with human herpesvirus 6 (HHV-6),
or, less frequently, by human herpesvirus 7
(HHV-7). Roseola infantum, also known as
Exanthema Subitum or sixth disease, typically
presents in children between six and 12 months
of age; ninety percent of cases occur in children
younger than two years. This condition is
responsible for between 10 and 45 percent of
febrile illness in infants. Fifteen percent of
children will also experience an acute febrile
seizure during the febrile phase of the illness.
ROSEOLA( EXANTHEMA SUBITUM ) SIXTH
DISEASE
• .Remember *: Patients with the virus classically
present with acute onset high-grade fever up to 40
degrees celsius (104 degrees F) lasting between
three and five days. After that, rapid defervescence
of the fever is accompanied by a nonpruritic, pink
papular rash that begins on the trunk.
• Upon rapid defervescence of the fever around days
three to five, small, rose-pink or red 2 mm to 5mm
papules and macules will develop. The rash
usually begins on the trunk and can spread to the
neck, extremities, and face. The rash is typically
nonpruritic, blanching and can persist from one to
two days
ROSEOLA( EXANTHEMA SUBITUM ) SIXTH
DISEASE
• The prognosis of roseola infantum is
excellent. It is a self-limited disease with
few long term adverse events.
• Complications: Primary HHV-6 infection
has been associated with a large range of
potential complications including
myocarditis, rhabdomyolysis,
thrombocytopenia, Guillain-Barre
syndrome and hepatitis.
QUESTION

• A mother of a child brings the child to a clinic and reports that the child has a fever and has developed a rash on
the neck and trunk. Roseola is diagnosed, and the mother is concerned that her other children will contract the
disease. Which instruction should the nurse reinforce to the mother to prevent the transmission of the disease?
• 1."Disease transmission is unknown."
• 2."The disease is transmitted through the urine and feces, so the other children should use a separate bathroom."
• 3."The disease is transmitted through the respiratory tract, so the child should be isolated from the other children
as much as possible."
• 4."The disease is transmitted by contact with body fluids, so any items contaminated with body fluids need to
discarded in a separate receptacle."
ANSWER

• 1."Disease transmission is unknown."

• The method of transmission of roseola is unknown. Options 2, 3, and 4 are not correct
transmission routes of roseola.
RUBELLA (GERMAN MEASLES)

• Rubella virus is the sole member of the genus

Rubivirus, in the family Matonaviridae.
• Following respiratory transmission, the virus
replicates in the nasopharynx and regional lymph
nodes. In a pregnant woman, placental infection
occurs during viremia and may lead to
transplacental fetal infection. Fetal damage
occurs through destruction of cells, as well as
disruption of cell division. Fetal infection often
results in a persistent infection typically leading
to hearing impairment and ocular and
cardiovascular abnormalities.
RUBELLA (GERMAN MEASLES

• Forchheimer spots.
RUBELLA (GERMAN MEASLES

• Rubella Clinical Features

• ● Incubation period 14 days (range, 12 to 23 days)
• ● Rash first symptom in young children ● Prodrome
with low-grade fever, malaise, lymphadenopathy, and
upper respiratory symptoms before rash in older children
and adults
• ● Maculopapular rash 14 to 17 days after exposure
• ● Arthralgia common in adult women
• Transmission: Rubella is spread from person-to-person
via direct contact or droplets shed from the respiratory
secretions of infected persons. Rubella may be
transmitted by persons with subclinical or asymptomatic
cases (up to 50% of all rubella virus infections).
CONGENITAL RUBELLA SYNDROME

• Remember contraindicated Rubella

vaccine during pregnancy.
MEASLES(RUBEOLA)— RUBELLA------ROSEOLA(EXANTHEM
SUBITUM)
MUMPS

• Mumps virus is a paramyxovirus in the same

group as parainfluenza.The virus is acquired by
respiratory droplet transmission. It replicates in
the nasopharynx and regional lymph nodes.
During viremia, the virus spreads to multiple
tissues, including the meninges, salivary
glands, pancreas, testes, and ovaries.
Inflammation in infected tissues leads to
characteristic symptoms of parotitis and other
complications such as orchitis and aseptic
meningitis. .
MUMPS
• Infection control: Highly contagious, the most
contagious periods is from 2 days before symptoms
begin to 6 days after they end.
• ● Nonspecific prodrome of myalgia, malaise,
headache, low-grade fever
• ● Typically presents as parotitis
• ● May presents with respiratory symptoms or be
subclinical
• As the disease advances, bilateral or unilateral parotid
gland swelling appears, swelling generally peaks
around the third day and lasts up to 6 days.
• Complications:
• The main complications is orchitis in post
puberal males. Sterility secondary to this
complications is rare.
• ● Less likely in vaccinated persons
compared to unvaccinated persons
• ● Meningitis, encephalitis, pancreatitis, and
hearing loss 1% or less among infected
persons in the postvaccine era
MUMPS

• Reservoir ■ Human • Implementation:

• ● Transmission • Droplet precautions
• ■ Infectious respiratory droplet secretions
• ■ Saliva
• ● Communicability
• ■ 2 days before through 5 days after onset
of parotitis
QUESTION

• The child has been diagnosed with mumps. The home-health nurse has given the mother
instructions on caring for the child during the acute period. Which statement by the mother
indicates a need for additional education?
• 1."I can give my child acetaminophen for fever."
2. "My child will be more comfortable if I give him fluids and soft foods."
3. "I should watch my child for headache and vomiting."
4. "I will give my child antibiotics every four hours around the clock."
ANSWER

• #4 Mumps is a viral infection.

QUESTION

• The nurse assigned to care for a child with mumps is monitoring the child for the signs
and symptoms associated with the common complication of mumps. The nurse monitors
for which sign/symptom that is indicative of this common complication?
• 1.Pain
• 2.Deafness
• 3.Nuchal rigidity
• 4.A red, swollen testicle
ANSWER

• 3. Nuchal rigidity

The most common complication of mumps is aseptic meningitis, with the virus being
identified in the cerebrospinal fluid. Common signs include nuchal rigidity, lethargy, and
vomiting. A red, swollen testicle may be indicative of orchitis. Although this complication
appears to cause most concern among parents, it is not the most common complication.
CHICKENPOX(VARICELLA)

• VZV is a DNA virus and is a member of

the herpesvirus group. Like other
herpesviruses, VZV persists in the body
as a latent infection after the primary
(first) infection; VZV persists in sensory
nerve ganglia. Primary infection with
VZV results in varicella. Latent infection
can reactivate resulting in herpes zoster
(shingles).
CHICKENPOX(VARICELLA

• A mild prodrome may precede the onset of a rash. Adults may

• The clinical course in healthy children
have 1 to 2 days of fever and malaise prior to rash onset, but in
children the rash is often the first sign of disease. In individuals is generally mild, fever (up to 102°F)
who have not received varicella vaccine, the rash is generalized
and pruritic and progresses rapidly (within 24 hours) from
and other systemic symptoms (e.g.,
macules to papules to vesicular lesions before crusting. The malaise, headache) usually resolve
rash usually appears first on the scalp, face or trunk, and then
spreads to the extremities; the highest concentration of lesions
within 2 to 4 days after onset of the
is on the trunk. Lesions also can occur on mucous membranes rash.
of the oropharynx, respiratory tract, vagina, conjunctiva, and
the cornea. Lesions are usually 1 to 4 mm in diameter. The
vesicles are superficial and delicate and contain clear fluid on
an erythematous base. Vesicles may rupture or become purulent
before they dry and crust. Successive crops appear over several
days, with lesions present in all stages of development at the
same time
CHICKENPOX(VARICELLA)

• Acute varicella is generally mild and self- • Very important remember*. Reye
limited, but it may be associated with syndrome may follow varicella, although
complications. Secondary bacterial this outcome has become very rare with
infections of skin lesions with the recommendation to not use aspirin or
Staphylococcus or Streptococcus (primarily other salicylates to reduce fever in
invasive group A) are the most common
children with varicella.
cause of hospitalization and outpatient
medical visits and can lead to death.
Pneumonia following varicella is usually
viral but may be bacterial.
CONGENITAL VARICELLA ZOSTER VIRUS
INFECTION
• Congenital VZV Infection ● Results
from maternal infection in the first 20
weeks of gestation ● Associated with
newborn limb hypoplasia, skin scarring,
localized muscular atrophy, encephalitis,
cortical atrophy, chorioretinitis,
microcephaly, and low birth weight
VARICELLA VACCINE

• At 12-15 months and again at 4 to 6 years

of age.
• Children receive the vaccine should avoid
aspirin or aspirin contains product
because for risk of Reye Syndrome.
• Contraindications: Severe allergic
reaction to a previous dose or vaccine
components(gelatin , bovine albumin ,
neomycin),significant suppression of
cellular immunity , pregnancy.
PERTUSSIS ( WHOOPING COUGH)

• Agent: Bordetella pertussis): 5 to 21

days( usually 10 days).
• Communicable period; greatest during
the catarrhal phase when discharge from
respiratory secretion occurs.
• Transmission: direct contact or droplet
spread from infected person.
 PERTUSSIS ( WHOOPING COUGH)
• Assessment : Symptoms of respiratory
infection followed by increasing severity
of cough, with a loud whooping
inspiration.
• May experienced cyanosis ,respiratory
distress and tongue protrusion.
• Irritability ,anorexia.
• Interventions: Isolate child during the catarrhal
phase, if the child is hospitalized ,institute
droplet precautions.
• Administer antimicrobial therapy as prescribed.
• Reduce environmental factors that cause cough
spasms, such as dust , smoke and sudden
changes in temperature.
• Ensure adequate hydration and nutrition.
• Provide suction and humidified oxygen if
needed.
PERTUSSIS ( WHOOPING COUGH)

• Diphtheria , tetanus and acellular

pertussis vaccine administered by IM
route at 2,4,6 months, between 15 and 18
months and between 4 and 6 years of
age.
DIPHTHERIA

• Agent: Corynebacterium diphtheriae

• Incubation period 2 to 5 days.
• Communicable period: Variable , until
virulent bacilli are not longer present( 3
negative cultures of discharge from the nose
and nasopharynx of the infected person.
• Transmission: Direct contact with infected
person , carrier or contaminated articles.
DIPHTHERIA

• ● Incubation period 2 to 5 days (range, 1

to 10 days)
• ● May involve any mucous membrane
• ● Classified based on site of disease ■
Respiratory (pharyngeal, tonsillar,
laryngeal, nasal)
• ■ Non-respiratory (cutaneous and other
mucus membranes)
• ● Most common sites of infection are
the pharynx and tonsils
DIPHTHERIA

• Assessment: Low grade fever , malaise

and sore throat. Foul smelling
mucopurulent nasal discharge, dense
pseudo membrane formation of the
throat that may interfere with eating,
drinking and breathing. Lymphadenitis,
neck edema, ”bull neck”.
DIPHTHERIA

• Ensure strict isolation for the hospitalized

child.
• Administer diphtheria antitoxin as
prescribed.( after a skin or conjunctival test
to rule out sensitivity to horse serum).
• Provide suction and humidified oxygen as
needed.
• Provide tracheostomy care if a tracheostomy
is necessary.
(FIFTH DISEASE)ERYTHEMA INFECTIOSUM

• Fifth disease is a mild viral illness

caused by parvovirus B19, that usually
affects children. It is called fifth disease
because it was the fifth of six similar
rash-causing illnesses to be described.
Most cases of fifth disease occur in late
winter or early spring
FIFTH DISEASE ERYTHEMA INFECTIOSUM

• Symptoms and signs: The first stage of

illness often consists of mild symptoms such
as headache, body ache, sore throat, low-
grade fever and chills. These symptoms last
approximately two to three days and are
followed by a second stage, lasting about a
week, during which the person has no
symptoms at all. In children, the third stage
involves a bright red rash on the cheeks
which gives a “slapped cheek” appearance.
SCARLET FEVER

• Scarlet fever is a disease of childhood due to ease of

transmission in the classrooms and nurseries. It is
most commonly associated with bacterial
pharyngitis caused by GAS or strep throat. Wounds
and burns infected with GAS also can cause scarlet
fever. It has been reported that strep throat is
responsible for 15 to 30% of all pharyngitis in
children aged 5 to 15 years old. The exotoxin
produced by the bacteria causes the classic
“sandpaper” rash. The toxins cause a local
inflammatory response on the skin and are referred
to as erythrogenic toxins.
SCARLET FEVER

• Scarlet fever is a blanching, papular rash,

commonly described as a sandpaper rash. It is
usually associated with Streptococcus pyogenes
pharyngitis in school-age and adolescent children.
The first-line treatment is penicillin.
• The causative bacteria is Streptococcus pyogenes,
which generates an endotoxin mainly responsible
for the skin manifestation of the infection. This is
further classified as group A and referred to as
Group A Strep (GAS).
• The bacteria is the causative agent of strep throat,
impetigo, erysipelas, cellulitis, and necrotizing
fasciitis
SCARLET FEVER

• Typically, scarlet fever is associated with acute pharyngitis. As a

result, fever, sore throat, pain with swallowing, and cervical
adenopathy is present. If there is no pharyngitis, the source of
infection can be a wound or burn which is infected with GAS. The
two vectors of infection can both cause scarlet fever and are not
distinguishable from one another. The rash itself is a blanching,
papular rash. It is distinguished from the macular rash found an
allergic reaction by its insidious emergence and lack of confluence of
the lesions. This lack of confluence is the primary reason it feels like
sandpaper. The rash develops within 2 to 3 days after infection. The
trunk, underarms, and groin are affected first, and then it spreads to
the extremities. The “strawberry tongue” begins with a white coating
of the tongue with hyperplastic papillae. As the white coating
resolves, the papules remain, giving the appearance of a
strawberry. Pastia lines are found in the folds of the skin such as the
neck, antecubital fossa, and groin. This appears as a linear
accumulation of papules around pressure points. After the initial rash
begins to resolve, a period of desquamation can occur and last up to
two weeks in some cases.
SCARLET FEVER COMPLICATIONS.
QUESTION

• A child is diagnosed with scarlet fever. The nurse collects data regarding the child. Which
is characteristic of scarlet fever?
• 1.Pastia's sign
• 2.Abdominal pain and flaccid paralysis
• 3.Dense pseudoformation membrane in the throat
• 4.Foul-smelling and mucopurulent nasal drainage
ANSWER

• 1.Pastia's sign
INFECTIOUS MONONUCLEOSIS

• Agent: Epstein Barr virus

• Incubation period: 4 to 6 weeks
• Source : oral secretions
• Transmission: Direct intimate contact
INFECTIOUS MONONUCLEOSIS

• Assessment:
• 1)Fever,malaise,
headache,fatigue,nausea,abdominal
pain ,sore throat , enlarged red tonsils.
• 2)Lymphadenopathy and
hepatosplenomegaly.
• 3)Discrete macular rash most prominent
over the trunk may occur.
INFECTIOUS MONONUCLEOSIS

• Interventions:
• Provide support care
• * Monitor for signs of splenic rupture.
• Teach the parents of a child with
mononucleosis to monitor for signs of
splenic rupture, left upper quadrant pain ,
and left shoulder pain.
ANIMAL BORNE INFECTIOUS DISEASE

• Animals serve as a reservoir for certain

infectious diseases including Rabies,
West Nile Virus, and Avian Influence.
• Nurse anticipate in prevention of these
disease through education for families.
RABIES

• Rabies is an acute viral infection of the nervous system

cause by Rhabdoviridae Lyssavirus. The primary agent for
this virus is carnivorous wild animals.
• Transmission occurs through direct contact with the brain
tissue or saliva from infected animals. The typical
incubation period for rabies is 3 to 8 weeks but may be
extended for several months.
• Transmission is primarily through saliva from a bite from
the infected animal, although contamination of mucous
membrane ,eyes, mouth, and nose.
• When a potentially risky animal bite occurs, the animal is
captured and tested for rabies while isolated. Death may
occur within days of the onset of symptoms of rabies.
Treatment must be initiated as soon as possible after
exposure and before the onset of symptoms.
RABIES

• SS: Are related to the infection of the

central nervus system which causes
fulminant brain disease and death.
• Early symptoms: Headache, fever and
general weakness.
• Later symptoms;
• Anxiety,Insomnia,confusion,paralysis,ha
llucinations.agitation,hypersalivation and
difficulty swallowing.
RABIES

• Diagnosis: Are performed on samples of

saliva, serum, spinal fluid and skin
biopsies of hair follicles at the nape of
the neck for rabies antigen.
• Human saliva can also be tested for the
virus by PCR and serum and spinal fluid
may be tested for antibodies to rabies
virus.
RABIES

• Nursing Care: Cleanses the wound and

administers immune globulin (HRIG)and the
rabies vaccine series.
• Medical care: Exposure treatment for rabies
includes wound cleansing with a virucidal agent,
administration of HRIG and administration of a
rabies vaccine series. The rabies post exposure
vaccinations consist of 4 doses of rabies vaccine
given on the day of the exposure and then
administered again on days 3, 7 and 14.
• These vaccines are highly effective if given
rapidly after exposure to rabies.
CAT SCRATCH DISEASE

• This infection is common in the pediatric age group

where children are playing and holding kittens or
cats. The bacterium Bartonella henselae is the
source of infection through a cat scratch or bite in
which cat saliva penetrate the skin.
• SS: Within 3 to 10 days, a papule or vesicle(blister)
develops at the site, followed by regional
lymphadenopathy which can last for months.
Because many children are scratched or bitten in
the hands and forearms the most common nodes
involved are the epitrochlear nodes near the elbow
and axillary node ( under arms).Sometimes only
one node is inflamed. The child may have a fever.
CAT SCRATCH DISEASE

• Diagnosis: Is based on signs and symptoms

and sometimes diagnostic testing with lymph
node biopsy. The test include an enzyme
linked immunosorbent assay to detect serum
antibodies, but can need to take at least 8
weeks to develop a positive titer.
• Prevention: Children are taught to avoid
rough play with cats and any scratches or
bites should be cleansed with antiseptic
solution inmediately.
CAT SCRATCH DISEASE

• Nursing care: Teat the wounds and

assesses the lymph nodes. More serious
sequela includes
hepatosplenomegaly( liver and spleen
enlargement) and encephalopathy, the
nurse must observe the patient carefully
for fever, headache, neck stiffness and
abdominal pain especially.
• Medical care: Antibiotics: Azithromycin
or Erythromycin.
WEST NILE VIRUS.

• West Nile Virus causes an infection that is

spread by mosquitoes that become infected
when they bite infected birds.
• The incubation period for West Nile virus is 2 to
14 days and the risk is highest to
immunosuppressed children and adults.
• SS: Non specific symptoms includes; Fever,
weakness, headache, myalgia , nausea,
vomiting, anorexia.
• Diagnosis: Is confirmed by specific Ig M
antibody in serum or in cerebrospinal fluid.
WEST NILE VIRUS

• Prevention: West Nile virus is most associated with

mosquito-borne illness, so during seasons when is most
risky, children may not be allowed outdoors( often late
summer and early autumn).Not to keep any sources of free-
standing water in their yards because they are breeding
grounds for mosquitoes.
• Medical care: Less commonly 1 in 150 people infected with
West Nile Virus develop severe symptoms: neck stiffness,
disorientation, seizures ,vision loss and coma. Sequela
includes meningitis and encephalitis.
• *Insects repellent containing DEET( not to be used on
infants younger than 2 months old. Applying the insect
repellent to the clothing decreases the chance of systemic
absorption ( through the skin) of a potentially harmful
substance. DEET has been know to cause neurotoxicity in
children
THANK YOU.