Category Archives: Pediatric

Roseola

Alternative Names: Exanthem subitum; Sixth disease

Definition:
Roseola is a generally mild infection that usually affects children by age 2. It occasionally affects adults. Roseola is extremely common — so common that most children have been infected with roseola by the time they enter kindergarten.
CLICK & SEE THE PICTURES

Two common strains of herpes viruses cause roseola. The condition typically causes several days of fever, followed by a rash.

Some children develop only a very mild case of roseola and never show any clear indication of illness, while others experience the full range of symptoms.

Roseola typically isn’t serious. Rarely, complications from a very high fever can result. Treatment of roseola includes bed rest, fluids and medications to reduce fever.

It is frequently called roseola, although this term could be applied to any rose-colored rash.

Symptoms:
The child may have a runny nose, sore throat, and eye redness.

A fever usually occurs before the rash appears. It lasts for 3 (sometimes up to 7) days. The fever may be as high as 105° Fahrenheit, and it generally responds well to acetaminophen (Tylenol).

Between the second and fourth day of the illness, the fever drops and a rash appears (often as the fever falls).

•The rash starts on the trunk and spreads to the limbs, neck, and face. The rash is pink or rose-colored, and has fairly small sores that are slightly raised.
•The rash lasts from a few hours to 2 – 3 days. It usually does not itch.
Other symptoms include:
CLICK & SEE

•Irritability
•High fever that comes on quickly

Causes:
Until recently, its origin was unknown, but it is now known to be caused by two human herpesviruses, HHV-6 (Human herpesvirus 6) and HHV-7, which are sometimes referred to collectively as Roseolovirus. There are two variants of HHV-6 and studies in the US, Europe and Japan have shown that exanthema subitum is caused by HHV-6B which infects over 90% of infants by age 2. Current research indicates that babies congenitally infected with the HHV-6A virus can have inherited the virus on a chromosome

The virus is spread through the faecal-oral route (poor hygiene after using the toilet) or by airborne droplets. Careful handwashing can help prevent its spread.

Occasionally other viruses cause an illness very similar to roseola.

Like other viral illnesses, such as a common cold, roseola spreads from person to person through contact with an infected person’s respiratory secretions or saliva. For example, a healthy child who shares a cup with a child who has roseola could contract the virus.
CLICK & SEE

Roseola is contagious even if no rash is present. That means the condition can spread while an infected child has only a fever, even before it’s clear that the child has roseola. Watch for signs of roseola if your child has interacted with another child who has the illness.

Unlike chickenpox and other childhood viral illnesses that spread rapidly, roseola rarely results in a communitywide outbreak. The infection can occur at any time of the year.
Roseola occurs throughout the year. The time between becoming infected and the beginning of symptoms (incubation period) is 5 to 15 days.

Risk Factors:
Older infants are at greatest risk of acquiring roseola because they haven’t had time yet to develop their own antibodies against many viruses. While in the uterus, babies receive antibodies from their mothers that protect them as newborns from contracting infections, such as roseola. But this immunity fades with time. The most common age for a child to contract roseola is between 6 and 15 months.

Complications:
Seizures in children
Occasionally a child with roseola experiences a seizure brought on by a rapid rise in body temperature. If this happens, your child might briefly lose consciousness and jerk his or her arms, legs or head for several seconds to minutes. He or she may also lose bladder or bowel control temporarily.

If your child has a seizure, seek emergency care. Although frightening, fever-related seizures in otherwise healthy young children are generally short-lived and are rarely harmful.

Complications from roseola are rare. The vast majority of otherwise healthy children and adults with roseola recover quickly and completely.

Concerns for people with weak immune systems
Roseola is of greater concern in people whose immune system is compromised, such as those who have recently received a bone marrow or organ transplant. They may contract a new case of roseola — or a previous infection may come back while their immune system is weakened. Because they have less resistance to viruses in general, immune-compromised people tend to develop more severe cases of infection and have a harder time fighting off illness.

People with weak immune systems who contract roseola may experience potentially serious complications from the infection, such as pneumonia or encephalitis — a potentially life-threatening inflammation of the brain.

Diagnosis:
Roseola is usually diagnosed from the history and symptoms, especially if the infection has recently been reported in the community.
•Physical exam of rash
•Swollen lymph nodes on the neck (cervical nodes) or back of the scalp (occipital nodes)

Clinical features:
Typically the disease affects a child between six months and two years of age, and begins with a sudden high fever (39–40 °C; 102.2-104 °F). This can cause, in rare cases, febrile convulsions (also known as febrile seizures or “fever fits”) due to the sudden rise in body temperature, but in many cases the child appears normal. After a few days the fever subsides, and just as the child appears to be recovering, a red rash appears. This usually begins on the trunk, spreading to the legs and neck. The rash is not itchy and may last 1 to 2 days.  In contrast, a child suffering from measles would usually appear more infirm, with symptoms of conjunctivitis and a cough, and their rash would affect the face and last for several days. Liver dysfunction can occur in rare cases.

The rare adult reactivates with HHV-6 and can show signs of mononucleosis.

Treatment:
The disease usually gets better without complications.
Most children recover fully from roseola within a week of the onset of the fever. With your doctor’s advice, you can give your child over-the-counter medications to reduce fever, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others). However, don’t give aspirin to a child who has a viral illness because aspirin has been associated with the development of Reye’s syndrome, which can be serious.

There’s no specific treatment for roseola, although some doctors may prescribe the antiviral medication ganciclovir (Cytovene) to treat the infection in people with weakened immunity. Antibiotics aren’t effective in treating viral illnesses, such as roseola.

Like most viruses, roseola just needs to run its course. Once the fever subsides, your child should feel better soon. However, a fever can make your child uncomfortable. To treat your child’s fever at home, your doctor may recommend:

*Plenty of rest. Let your child rest in bed until the fever disappears.

*Plenty of fluids. Encourage your child to drink clear fluids, such as water, ginger ale, lemon-lime soda, clear broth or an electrolyte solution (such as Pedialyte) or sports drinks (such as Gatorade and Powerade) to prevent dehydration. Remove the gas bubbles from carbonated fluids. You can do this by letting the carbonated beverage stand or by shaking, pouring or stirring the beverage. Removing the carbonation will mean having your child avoid the added discomfort of excess burping or intestinal gas that carbonated beverages may cause.

*Sponge baths. A lukewarm sponge bath or a cool washcloth applied to your child’s head can soothe the discomfort of a fever. However, avoid using ice, cold water, fans or cold baths. These may give the child unwanted chills.There’s no specific treatment for the rash of roseola, which fades on its own in a short time

Prevention:
Because there’s no vaccine to prevent roseola, the best you can do to prevent the spread of roseola is to avoid exposing your child to an infected child. If your child is sick with roseola, keep him or her home and away from other children until the fever has broken. Once the rash appears, the virus is much less contagious.

Most people have antibodies to roseola by the time they’re of school age, making them immune to a second infection. Even so, if one household member contracts the virus, make sure that all family members wash their hands frequently to prevent spread of the virus to anyone who isn’t immune.

Adults who never contracted roseola as children can become infected later in life, though the disease tends to be mild in healthy adults. The main concern is that infected adults can pass the virus on to children.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:

http://www.mayoclinic.com/health/roseola/DS00452

http://www.nlm.nih.gov/medlineplus/ency/article/000968.htm

http://en.wikipedia.org/wiki/Exanthema_subitum

http://www.bbc.co.uk/health/physical_health/conditions/roseola2.shtml

Pyloric stenosis

Alternative Name : Infantile hypertrophic pyloric stenosis

Definition:
Pyloric stenosis is a condition that causes severe vomiting in the first few months of life. There is narrowing (stenosis) of the opening from the stomach to the intestines, due to enlargement (hypertrophy) of the muscle surrounding this opening (the pylorus, meaning “gate”), which spasms when the stomach empties. It is uncertain whether there is a real congenital narrowing or whether there is a functional hypertrophy of the muscle which develops in the first few weeks of life. Babies with this condition may seem to always be hungry
click to see the pictures……..(01)...…(1)..….…(2).……..(3)....……
Pyloric stenosis also occurs in adults where the cause is usually a narrowed pylorus due to scarring from chronic peptic ulceration. This is a different condition from the infantile form.

Prompt treatment of pyloric stenosis is important for preventing complications. Pyloric stenosis can be corrected with surgery.

Males are more commonly affected than females, with firstborn males affected about four times as often, and there is a genetic predisposition for the disease. It is commonly associated with people of Jewish ancestry, and has multifactorial inheritance patterns. Pyloric stenosis is more common in Caucasians than Hispanics, Blacks, or Asians. The incidence is 2.4 per 1000 live births in Caucasians , 1.8 in Hispanics, 0.7 in Blacks, and 0.6 in Asians. It is also less common amongst children of mixed race parents.  Caucasian babies with blood type B or O are more likely than other types to be affected

Symptoms:
Signs of pyloric stenosis usually appear within three to five weeks after birth. Pyloric stenosis is rare in babies older than age 3 months.

Signs and symptoms are:
*Frequent projectile vomiting. Pyloric stenosis often causes projectile vomiting — the forceful ejection of milk or formula up to several feet away — within 30 minutes after your baby eats. Vomiting may be mild at first and gradually become more severe. The vomit may sometimes contain blood.

*Persistent hunger. Babies who have pyloric stenosis often want to eat soon after vomiting.

*Stomach contractions. You may notice wave-like contractions that move across your baby’s upper abdomen (peristalsis) soon after feeding but before vomiting. This is caused by stomach muscles trying to force food past the outlet of the pylorus.

*Dehydration. Your baby may cry without tears or become lethargic. You may find yourself changing fewer wet diapers or diapers that aren’t as wet as you expect.

*Changes in bowel movements. Since pyloric stenosis prevents food from reaching the intestines, babies with this condition may be constipated.

*Weight problems. Pyloric stenosis can prevent a baby from gaining weight, and can sometimes even cause weight loss.

*Less active or seems unusually irritable

*Urinating much less frequently or is having noticeably fewer bowel movements

 

Causes:
The cause of the thickening is unknown, although genetic factors may play a role. Children of parents who had pyloric stenosis are more likely to have this problem.

Normally, food passes easily from the stomach into the duodenum (the first part of the small intestine) through a valve called the pylorus. In pyloric stenosis, the muscles of the pylorus are thickened. This thickening prevents the stomach from emptying into the small intestine.

Risk Factors:
Risk factors for pyloric stenosis include:

*Sex. Pyloric stenosis occurs more often in males than in females.

*Birth order. About one-third of babies affected by pyloric stenosis are firstborns.

*Family history. More than 1 in 10 babies with pyloric stenosis has a family member who had the disorder.

*Early antibiotic use. Babies given certain antibiotics, such as erythromycin, in the first weeks of life for whooping cough (pertussis) have an increased risk of pyloric stenosis. In addition, babies born to mothers who were given certain antibiotics in late pregnancy also may have an increased risk of pyloric stenosis.

Complications:
Pyloric stenosis can lead to:

*An electrolyte imbalance. Electrolytes are minerals, such as chloride and potassium, that circulate in the body’s fluids to help regulate many vital functions, such as heartbeat. When a baby vomits every time he or she eats, dehydration and an imbalance of electrolytes eventually occurs

*Stomach irritation. Repeated vomiting can irritate your baby’s stomach. This irritation may even cause mild bleeding.

*Jaundice. Rarely, infants who have pyloric stenosis develop jaundice — a yellowish discoloration of the skin and eyes caused by a buildup of a substance secreted by the liver called bilirubin.

 

Diagnosis:
Diagnosis is via a careful history and physical examination, often supplemented by radiographic studies. There should be suspicion for pyloric stenosis in any young infant with severe vomiting. On exam, palpation of the abdomen may reveal a mass in the epigastrium. This mass, which consists of the enlarged pylorus, is referred to as the ‘olive,’ and is sometimes evident after the infant is given formula to drink. It is an elusive diagnostic skill requiring much patience and experience. There are often palpable (or even visible) peristaltic waves due to the stomach trying to force its contents past the narrowed pyloric outlet.

At this point, most cases of pyloric stenosis are diagnosed/confirmed with ultrasound, if available, showing the thickened pylorus. Although somewhat less useful, an upper GI series (x-rays taken after the baby drinks a special contrast agent) can be diagnostic by showing the narrowed pyloric outlet filled with a thin stream of contrast material; a “string sign” or the “railroad track sign”. For either type of study, there are specific measurement criteria used to identify the abnormal results. Plain x-rays of the abdomen are not useful, except when needed to rule out other problems.

Blood tests will reveal hypokalemic, hypochloremic metabolic alkalosis due to loss of gastric acid (which contain hydrochloric acid and potassium) via persistent vomiting; these findings can be seen with severe vomiting from any cause. The potassium is decreased further by the body’s release of aldosterone, in an attempt to compensate for the hypovolaemia due to the severe vomiting.

Pathophysiology
The gastric outlet obstruction due to the hypertrophic pylorus impairs emptying of gastric contents into the duodenum. As a consequence, all ingested food and gastric secretions can only exit via vomiting, which can be of a projectile nature. The vomited material does not contain bile because the pyloric obstruction prevents entry of duodenal contents (containing bile) into the stomach.

This results in loss of gastric acid (hydrochloric acid). The chloride loss results in hypochloremia which impairs the kidney’s ability to excrete bicarbonate. This is the significant factor that prevents correction of the alkalosis.

A secondary hyperaldosteronism develops due to the hypovolemia. The high aldosterone levels causes the kidneys to:

*avidly retain Na+ (to correct the intravascular volume depletion)

*excrete increased amounts of K+ into the urine (resulting in hypokalaemia).

The body’s compensatory response to the metabolic alkalosis is hypoventilation resulting in an elevated arterial pCO2.=[pp\][[\=0808i[po9il;

 

Treatment:
Infantile pyloric stenosis is typically managed with surgery; very few cases are mild enough to be treated medically.

Prior to surgery and surgery alternatives:
The danger of pyloric stenosis comes from the dehydration and electrolyte disturbance rather than the underlying problem itself. Therefore, the baby must be initially stabilized by correcting the dehydration and hypochloremic alkalosis with IV fluids. This can usually be accomplished in about 24–48 hours.

Intravenous and oral atropine may be used to treat pyloric stenosis. It has a success rate of 85-89% compared to nearly 100% for pyloromyotomy, however it requires prolonged hospitalization, skilled nursing and careful follow up during treatment. It might be an alternative to surgery in children who have contraindications for anesthesia or surgery.

Surgery
The definitive treatment of pyloric stenosis is with surgical pyloromyotomy known as Ramstedt’s procedure (dividing the muscle of the pylorus to open up the gastric outlet). This is a relatively straightforward surgery that can possibly be done through a single incision (usually 3–4 cm long) or laparoscopically (through several tiny incisions), depending on the surgeon’s experience and preference.
CLICK & SEE THE PICTURES
Today, the laparoscopic technique has largely supplanted the traditional open repairs which involved either a tiny circular incision around the navel or the Ramstedt procedure. Compared to the older open techniques, the complication rate is equivalent, except for a markedly lower risk of wound infection.[9] This is now considered the standard of care at the majority of Children Hospitals across the US, although some surgeons still perform the open technique. Following repair, the small 3mm incisions are hard to see.

The vertical incision, pictured and listed above, is no longer usually required. Though many incisions have been horizontal in the past years.

Once the stomach can empty into the duodenum, feeding can commence. Some vomiting may be expected during the first days after surgery as the gastro-intestinal tract settles. Very occasionally the myotomy was incomplete and projectile vomiting continues, requiring repeat surgery. But the condition generally has no long term side-effects or impact on the child’s future.

Prognosis:
Surgery usually provides complete relief of symptoms. The infant can usually tolerate small, frequent feedings several hours after surgery.

Prevention
There are no known ways of preventing pyloric stenosis, although it is possible that breastfeeding might reduce the risk.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:

http://en.wikipedia.org/wiki/Pyloric_stenosis

http://www.mayoclinic.com/health/pyloric-stenosis/DS00815

http://www.nlm.nih.gov/medlineplus/ency/article/000970.htm

http://www.bbc.co.uk/health/physical_health/conditions/pyloricstenosis.shtml

http://www.empowher.com/media/reference/pyloric-stenosis

Plagiocephaly

Definition:
The skull isn’t perfectly smooth – it’s covered with lumps, dips and some flatter areas. But sometimes a large area of flattening distorts the skull, making it look parallelogram-shaped. This is known as plagiocephaly.

The most common form is positional plagiocephaly. It occurs when a baby’s head develops a flat spot due to pressure on that area. Babies are vulnerable because their skull is soft and pliable when they’re born.

CLICK & SEE THE PICTURES

Positional plagiocephaly typically develops after birth when babies spend time in a position that puts pressure on one part of the skull. Because babies spend so much time lying on their back, for example, they may develop a flat spot where their head presses against the mattress.

Starting in the early 1990s, parents were told to put their babies to sleep on their back to reduce the risk of SIDS. While this advice has saved thousands of babies’ lives, experts have noticed a fivefold increase in misshapen heads since then.

More rarely, babies develop positional plagiocephaly when movement in the uterus is constricted for some reason – because their mother is carrying more than one baby, for example. It can also happen to breech babies who get wedged under their mother’s ribs.

Another type of plagiocephaly is craniosynostosis, a birth defect in which the joints between the bones of the skull close early. Babies born with craniosynostosis need surgery to allow their brain to grow properly.

Symptoms
Plagiocephaly may become apparent at different ages, depending on the cause. Some babies are born with a flat head (this may be a temporary deformity due to the baby’s passage down the birth canal), while others develop it later as the bones of the skull fuse. The abnormal shape can best be seen if you look down on the baby’s head from above.

Signs of plagiocephaly include:
CLICK & SEE THE PICTURES
•Parallelogram-shaped skull when viewed from above
•Flattening on one side at the back of the head, with a compensatory protrusion or bulge in the forehead on the same side
•Eyes appearing to have unequal positioning
•A bald spot on flattened side (may be asymmetrical)

To learn more you may click to see :Plagiocephaly, Brachycephaly, Brachycephaly with Plagiocephaly and Scaphocephaly

Causes & Risk Factors:
A baby’s skull is very soft and can be forced to grow in different directions fairly easily. When the skull is kept in one particular position for long periods – because the baby is sleeping in a set position (such as on his back) or because muscles attached to the skull go into spasm (known as torticollis) – areas of the skull may be squashed or pulled flat. This is known as positional or deformation plagiocephaly. It generally gets better by itself over time.

Other factors that increase the risk of plagiocephaly include a multiple birth pregnancy (as the babies ‘squash together’ in the womb), prematurity, poor muscle tone and a condition known as oligohydramnios, where there’s insufficient fluid in the womb to cushion the baby.

In the US at least, plagiocephaly has become more common in recent years. Statistics show that while one in 300 healthy infants was affected in 1992, by 1999 one in 60 had the condition.

This increase is thought to be due to the Back to Sleep campaign, designed to reduce the number of sudden infant deaths (cot deaths).

It’s possible to prevent positional plagiocephaly by changing your baby’s resting position frequently. Your baby still needs to be laid on their back to sleep, but try to alternate the position of the head and encourage them to spend time on their tummy while they’re awake and supervised.

Switch between putting them in a sloping chair, car seat or sling, or on a flat surface, so there’s no constant pressure on one area of the skull.Prolonge keeping the baby in the carseat is  very dengerous for the babies.

Plagiocephaly may also be caused by the bones of the skull joining together abnormally early. These bones normally grow together slowly so the skull expands in all directions. But if some fuse too soon (craniosynostosis), that part of the skull can’t grow in the way it should, pulling the head out of shape. This may occur in isolation, or as part of a genetic syndrome such as Apert syndrome or Crouzon syndrome.

Many vaginally delivered babies are born with an oddly shaped head caused by the pressure of passing through the birth canal. This usually corrects itself within about six weeks. But if your baby’s head hasn’t rounded out by age 6 weeks – or if you first notice that your baby has a flat spot on her skull after 6 weeks of age – it’s probably a case of positional plagiocephaly.

Plagiocephaly shows up most often in babies who are reported to be “good sleepers,” babies with unusually large heads, and babies who are born prematurely and have weak muscle tone.

Babies with torticollis can also develop a flat spot on their skull because they often sleep with their head turned to one side. Torticollis occurs when a tight or shortened muscle on one side of the neck causes the chin to tilt to the other side. Premature babies are especially prone to torticollis

Diagnosis:
Most often, your child’s doctor can make the diagnosis of positional plagiocephaly simply by examining your child’s head, without having to order lab tests or X-rays. The doctor will also note whether regular repositioning of your child’s head during sleep successfully reshapes the child’s growing skull over time, whereas craniosynostosis, on the other hand, typically worsens over time.

If there’s still some doubt, X-rays or a CT scan of the head will show your child’s doctor if the skull bones are normally separated or if they fused together too soon. If the bones aren’t fused, the doctor will probably rule out craniosynostosis and confirm that the child has positional plagiocephaly.

It’s important the type and cause of plagiocephaly are determined, as each requires different treatment. X-rays, CT scans and other tests may be needed to confirm diagnosis.

Treatment:
The condition will sometimes improve as the baby grows, but in many cases, treatment can significantly improve the shape of a baby’s head. Initially, treatment usually takes the form of reducing the pressure on the affected area through repositioning of the baby onto his or her tummy for extended periods of time throughout the day. Other treatments include repositioning the child’s head throughout the day so that the rounded side of the head is placed dependent against the mattress, repositioning cribs and other areas that infants spend time in so that they will have to look in a different direction to see their parents, or others in the room, repositioning mobiles and other toys for similar reasons, and avoiding extended time sleeping in car-seats (when not in a vehicle), bouncy seats, or other supine seating which is thought to exacerbate the problem. If the child appears to have discomfort or cries when they are repositioned, they may have a problem with the neck.  If this is unsuccessful, treatment using a cranial remoulding orthosis (baby helmet) can help to correct abnormal head shapes. These helmets are used to treat deformational plagiocephaly, brachycephaly, scaphocephaly and other head shape deformities in infants 3-18 months of age. For years, infants have been successfully treated with cranial remolding orthoses. A cranial remolding orthoses (helmet) provides painless total contact over the prominent areas of the skull and leaves voids over the flattened areas to provide a pathway for more symmetrical skull growth. Treatment generally takes 3-4 months, but varies depending on the infant’s age and severity of the cranial asymmetry.

Prognosis:
There are some beginning studies that indicate that babies with plagiocephaly tend to have learning difficulties later on in school, however these studies are still early, and do not yet represent a scientific consensus. Other more complete studies suggest that there is no evidence to suggest that plagiocephaly is harmful to brain development, vision, or hearing

Prevention:

To successfully prevent Plagiocephaly, prenatal education on skull deformation   is crucial.
Being aware of preventative measures can help reduce the chance your child will develop positional plagiocephaly. Different repositioning techniques and adequate Tummy Time are keys to prevention and also help your baby meet developmental milestones.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:

http://www.bbc.co.uk/health/physical_health/conditions/plagiocephaly2.shtml

http://en.wikipedia.org/wiki/Plagiocephaly

http://www.babycenter.com/0_plagiocephaly-flat-head-syndrome_1187981.bc

http://www.cranialtech.com/index.php?option=com_content&view=article&id=73&Itemid=76

http://www.cranialtech.com/

http://www.monroeoandp.com/diagnosis_of_plagiocephaly.html

Enhanced by Zemanta

Oral thrush

 

Alternative Names: Candidiasis – oral; Oral thrush; Fungal infection – mouth; Candide – oral

Definition:
Oral thurs  is an infection of yeast fungi of the genus Candida on the mucous membranes of the mouth and tongue. It is frequently caused by Candida albicans, or less commonly by Candida glabrata or Candida tropicalis. Oral thrush may refer to candidiasis in the mouths of babies, while if occurring in the mouth or throat of adults it may also be termed candidosis or moniliasis…

 

click to see the pictures……….(1)…..…(2)....

Although oral thrush can affect anyone, it’s more likely to occur in babies and people who wear dentures, use inhaled corticosteroids or have compromised immune systems. Oral thrush is a minor problem if you’re healthy, but if you have a weakened immune system, symptoms of oral thrush may be more severe and difficult to control.

Symtoms:
Signs and symptoms of oral infection by Candida species may not be immediately noticeable but can develop suddenly and may persist for a long time. The infection usually appears as thick white or cream-colored deposits on mucosal membranes such as the tongue, inner cheeks, gums, tonsils, and palate. The infected mucosa may appear inflamed (red and possibly slightly raised) and sometimes have a cottage cheese-like appearance. The lesions can be painful and will become tender and often bleed if rubbed or scraped. Cracking at the corners of the mouth, a cottony-like sensation inside the mouth, and even temporary loss of taste can occur.

In more severe cases, the infection can spread down the esophagus and cause difficulty swallowing – this is referred to as Esophageal candidiasis. Thrush does not usually cause a fever unless the infection has spread beyond the esophagus to other body parts, such as the lungs (systemic candidiasis).

click to  see….>…....(1)..…...(2.)

In addition to the distinctive lesions, infants can become irritable and may have trouble feeding. The infection can be communicated during breast-feeding to and from the breast and the infant’s mouth repeatedly

Causes:
Thrush is caused by forms of a fungus called Candida. A small amount of this fungus lives in your mouth most of the time. It is usually kept in check by your immune system and other types of germs that also normally live in your mouth.

However, when your immune system is weaker, the fungus can grow, leading to sores (lesions) in your mouth and on your tongue. The following can increase your chances of getting thrush:

•Taking steroid medications
•Having an HIV infection or AIDS
•Receiving chemotherapy for cancer or drugs to suppress your immune system following an organ transplant
•Being very old or very young
•Being in poor health
Thrush is commonly seen in infants. It is not considered abnormal in infants unless it lasts longer than a couple of weeks.

Candida can also cause yeast infections in the vagina.

People who have diabetes and had high blood sugar levels are more likely to get thrush in the mouth (oral thrush), because the extra sugar in your saliva acts like food for Candida.

Taking high doses of antibiotics or taking antibiotics for a long time also increases the risk of oral thrush. Antibiotics kill some of the healthy bacteria that help keep Candida from growing too much.

People with poorly fitting dentures are also more likely to get thrush.

Risk Factors:
*Newborn babies.

*Diabetics with poorly controlled diabetes.

*As a side effect of medication, most commonly having taken antibiotics. Inhaled corticosteroids for treatment of lung conditions (e.g., asthma or COPD) may also result in oral candidiasis: the risk may be reduced by regularly rinsing the mouth with water after taking the medication.

*People with an immune deficiency (e.g. as a result of AIDS/HIV or chemotherapy treatment).

*Women undergoing hormonal changes, like pregnancy or those on birth control pills.

*Denture users.

*Tongue piercing

Complications:
Oral thrush is seldom a problem for healthy children and adults, although the infection may return even after it’s been treated. For people with compromised immune systems, however, thrush can be more serious.

If you have HIV, you may have especially severe symptoms in your mouth or esophagus, which can make eating painful and difficult. If the infection spreads to the intestines, it becomes difficult to receive adequate nutrition. In addition, thrush is more likely to spread to other parts of the body if you have cancer or other conditions that weaken the immune system. In that case, the areas most likely to be affected include the digestive tract, lungs and liver.

Diagnosis;
Oral thrush can usually be diagnosed simply by looking at the lesions, but sometimes a small sample is examined under a microscope to confirm the diagnosis.

In older children or adolescents who have no other identified risk factors, an underlying medical condition may be the cause of oral thrush. If your doctor suspects that to be the case, your doctor will perform a physical exam as well as recommend certain blood tests to help find the source of the problem.

If thrush is in your esophagus
Thrush that extends into the esophagus can be serious. To help diagnose this condition, your doctor may ask you to have one or more of the following tests:

*Throat culture. In this procedure, the back of your throat is swabbed with sterile cotton and the tissue sample cultured on a special medium to help determine which bacteria or fungi, if any, are causing your symptoms.

*Endoscopic examination. In this procedure, your doctor examines your esophagus, stomach and the upper part of your small intestine (duodenum), using a lighted, flexible tube with a camera on the tip (endoscope).

Treatment:
For thrush in infants, treatment is often NOT necessary. It generally gets better on its own within 2 weeks.

If you develop a mild case of thrush after taking antibiotics, eating yogurt or taking over-the-counter acidophilus capsules can help.

Use a soft toothbrush and rinse your mouth with a diluted 3% hydrogen peroxide solution several times a day.

Good control of blood sugar levels in persons with diabetes may be all that is needed to clear a thrush infection.

Your doctor may prescribe an antifungal mouthwash (nystatin) or lozenges (clotrimazole) to suck on if you have a severe case of thrush or a weakened immune system. These products are usually used for 5 – 10 days. If they don’t work, other medication may be prescribed.

If the infection has spread throughout your body or you have HIV/AIDS, stronger medications may be used, such as fluconazole (Diflucan) or ketoconazole (Nizoral).

Prognosis:
Thrush in infants may be painful, but is rarely serious. Because of discomfort, it can interfere with eating. If it does not resolve on its own within 2 weeks, call your pediatrician.

In adults, thrush that occurs in the mouth can be cured. However, the long-term outlook is dependent on your immune status and the cause of the immune deficit.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:

http://www.nlm.nih.gov/medlineplus/ency/article/000626.htm

http://en.wikipedia.org/wiki/Oral_candidiasis

http://www.bbc.co.uk/health/physical_health/conditions/oralthrush2.shtml

http://www.mayoclinic.com/health/oral-thrush/DS00408

http://www.nlm.nih.gov/medlineplus/ency/imagepages/17284.htm

http://www.clivir.com/lessons/show/yeast-infection-in-mouth-and-throat.html

Enhanced by Zemanta

Torticollis

Alternative Names : Wry neck; Loxia

Definition:
Torticollis is a twisted neck in which the head is tipped to one side, while the chin is turned to the other.It is a stiff neck associated with muscle spasm, classically causing lateral flexion contracture of the cervical spine musculature. The muscles affected are principally those supplied by the spinal accessory nerve.

CLICK  &  SEE THE PICTURES

Symptoms:
•Limited range of motion of the head
•Headache
•Head tremor
•Neck pain
•Shoulder is higher on one side of the body
•Stiffness of neck muscles
•Swelling of the neck muscles (possibly present at birth)

Diagnosis:
Evaluation of a child with torticollis begins with history taking to determine circumstances surrounding birth and any possibility of trauma or associated symptoms. Physical examination reveals decreased rotation and bending to the side opposite from the affected muscle. Some say that congenital cases more often involve the right side, but there is not complete agreement about this in published studies. Evaluation should include a thorough neurologic examination, and the possibility of associated conditions such as developmental dysplasia of the hip and clubfoot should be examined. Radiographs of the cervical spine should be obtained to rule out obvious bony abnormality, and MRI should be considered if there is concern about structural problems or other conditions.

Evaluation by an ophthalmologist should be considered in children to ensure that the torticollis is not caused by vision problems (IV cranial nerve palsy, nystagmus-associated “null position,” etc.). Most cases in infants respond well to physical therapy. Other causes should be treated as noted above.

Causes & Treatment:
Torticollis can be congenital or may be acquired.

Congenital muscular torticollis:
The etiology of congenital muscular torticollis is unclear. Birth trauma or intrauterine malposition is also considered to cause damage to the sternocleidomastoid muscle in the neck. This results in a shortening or excessive contraction of the sternocleidomastoid muscle, often with limited range of motion in both rotation and lateral bending. The head is typically tilted in lateral bending toward the affected muscle and rotated toward the opposite side. The condition may be caused by scars, disease of cervical vertebrae, adenitis, tonsillitis, rheumatism, enlarged cervical glands, retropharyngeal abscess, or cerebellar tumors. It may be spasmodic (clonic) or permanent (tonic). The latter type may be due to Pott’s Disease (tuberculosis of the spine).

The reported incidence of congenital torticollis is 0.3-2.0 %. Sometimes a mass (a sternocleidomastoid tumor) in the affected muscle may be noted, this appears at the age of two to four weeks, it disappears gradually, but sometimes the muscle becomes fibrotic. It is likely to disappear within the first five to eight months of life.

The condition is treated initially with physical therapy, with stretching to correct the tightness, strengthening exercises to achieve muscular balance, handling to stimulate symmetry. A TOT Collar is sometimes used. About 5–10% require “surgical release” of the muscle if stretching fails.

Infants with torticollis have a higher risk for plagiocephaly. Altering the head position and using a pillow when supine helps as does giving a lot of tummy time when awake.

Other less common causes such as tumors, infections, ophthalmologic problems and other abnormalities should be ruled out. For example, ocular torticollis due to cranial nerve IV palsy should not be treated with physical therapy. In this situation, the torticollis is a neurological adaptation designed to maintain binocularity. Treatment should be targeted at the extraocular muscle imbalance.

In general, if torticollis is not corrected facial asymmetry can develop.  Head position should be corrected before adulthood (to about the age of 18 there can be improvement). Younger children show the best results.

Congenital torticollis develops in the infant but can be diagnosed at older ages, even in adults who were missed as infants/children.

The word torticollis means wry neck: Acquired torticollis is not the same as congenital torticollis. All ages can suffer from acquired torticollis.

TREATMENT:
Common treatments  might involve a multi-phase process:

1.Low-impact exercise to increase strong form neck stability
2.Manipulation of the neck by a chiropractor, physical therapist, or D.O.†
3.Extended heat application.
4.Repetitive shiatsu massage.

†An Osteopathic Physician (D.O.) may choose to use Cranial techniques to properly position the occipital condyles – thereby relieving compression of cranial nerve XI in children with Torticollis. This is an example of Osteopathic Manipulative Treatment.

Acquired torticollis:
Acquired torticollis occurs because of another problem and usually presents in previously normal children and adults…..

*A self-limiting spontaneously occurring form of torticollis with one or more painful neck muscles is by far the most common (‘stiff neck’) and will pass spontaneously in 1–4 weeks. Usually the sternocleidomastoid muscle or the trapezius muscle is involved. Sometimes draughts, colds or unusual postures are implicated; however in many cases no clear cause is found. These episodes are rarely seen by doctors other than a family physician.

*Trauma to the neck can cause atlantoaxial rotatory subluxation, in which the two vertebrae closest to the skull slide with respect to each other, tearing stabilizing ligaments; this condition is treated with traction to reduce the subluxation, followed by bracing or casting until the ligamentous injury heals.

*Tumors of the skull base (posterior fossa tumors) can compress the nerve supply to the neck and cause torticollis, and these problems must be treated surgically.

*Infections in the posterior pharynx can irritate the nerves supplying the neck muscles and cause torticollis, and these infections may be treated with antibiotics if they are not too severe, but could require surgical debridement in intractable cases.

*Ear infections and surgical removal of the adenoids can cause an entity known as Grisel’s syndrome, a subluxation of the upper cervical joints, mostly the atlantoaxial joint, due to inflammatory laxity of the ligaments caused by an infection. This bridge must either be broken through manipulation of the neck, or surgically resected.

*The use of certain drugs, such as antipsychotics, can cause torticollis.

*Antiemetics – Neuroleptic Class – Phenothiazines

There are many other rare causes of torticollis.

Spasmodic torticollis:
Torticollis with recurrent but transient contraction of the muscles of the neck and esp. of the sternocleidomastoid. “intermittent torticollis . “cervical dystonia”

TREATMENT: Botulinum toxin has been used to inhibit the spastic contractions of the affected muscles.

In animals:.CLICK & SEE
The condition can also occur in animals, usually as a result of an inner ear infection but sometimes as a result of an injury. It is seen largely in domestic rodents and rabbits, but may also appear in dogs and other different animals.

Possible ComplicationsComplications may include:

•Muscle swelling due to constant tension
•Neurological symptoms due to compressed nerve roots

Prognosis:
The condition may be easier to correct in infants and children. If the condition becomes chronic, numbness and tingling may develop as nerve roots become compressed in the neck.

The muscle itself may become large (hypertrophic) due to constant stimulation and exercise.

Botulinum toxin injections often provide substantial relief.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:

http://en.wikipedia.org/wiki/Torticollis

http://www.nlm.nih.gov/medlineplus/ency/article/000749.htm

http://www.umm.edu/imagepages/19090.htm

http://commons.wikimedia.org/wiki/File:Sternocleidomastoideus.png

Enhanced by Zemanta

Hydrocephalus

Definition:
Hydrocephalus (pronounced hi-dro-SEF-a-lus) is a potentially harmful build up of cerebrospinal fluid (CSF) in parts of the brain.
CLICK & SEE THE PICTURES…………

Images from a patient with normal pressure hyd...

Images from a patient with normal pressure hydrocephalus (NPH) showing pulsations of CSF with heartbeat. (Photo credit: Wikipedia)

Cerebrospinal fluid (CSF)A clear fluid produced in the brain’s ventricular system – the four cavities in the brain. It travels throughout the brain and in the area outside the brain and spinal cord. It bathes and protects or cushions the brain and spinal cord.

Hydrocephalus literally means water (hydro) in the head (cephalus). It is sometimes called water on the brain. The “water” is actually cerebrospinal fluid. Cerebrospinal fluid is normally present in areas both inside and outside the brain.

Children with hydrocephalus have too much cerebrospinal fluid in the areas of the brain called ventricles.

Ventricles are four small cavities in the brain that produce cerebrospinal fluid (CSF). This fluid flows through the ventricles to the area around the brain and spinal cord.
.

The ventricles store and circulate cerebrospinal fluid. Children with hydrocephalus may also have extra fluid in spaces between the brain and the skull called the  subarachnoid spaces

Subarachnoid spaces  are the spaces lie between the three membranes protecting the brain. Cerebrospinal fluid moves through these spaces. Delicate connective tissue extends across them.

When a child’s cerebrospinal fluid cannot flow or be reabsorbed properly, it builds up. This makes the ventricles bigger and puts pressure on the tissues of the brain

Hydrocephalus is sometimes present at birth, although it may develop later. About 1 out of 500 children is born with the disorder. The outlook if  some one has hydrocephalus depends on how quickly the condition is diagnosed and whether any underlying disorders are present.

 

Symptoms:
The signs and symptoms of hydrocephalus vary by age group and disease progression.

In infants, common signs and symptoms of hydrocephalus include:

*An unusually large head
*A rapid increase in the size of the head
*A bulging “soft spot” on the top of the head
*Vomiting
*Sleepiness
*Irritability
*Seizures
*Eyes fixed downward (sunsetting of the eyes)
*Developmental delay

In older children and adults, common signs and symptoms of hydrocephalus include:

*Headache followed by vomiting
*Nausea
*Blurred or double vision
*Eyes fixed downward (sunsetting of the eyes)
*Problems with balance, coordination or gait
*Sluggishness or lack of energy
*Slowing or regression of development
*Memory loss
*Confusion
*Urinary incontinence
*Irritability
*Changes in personality
*Impaired performance in school or work

Hydrocephalus produces different combinations of these signs and symptoms, depending on its cause, which also varies by age. For example, a condition known as normal pressure hydrocephalus, which mainly affects older people, typically starts with difficulty walking. Urinary incontinence often develops, along with a type of dementia marked by slowness of thinking and information processing.
Causes:
The cause of hydrocephalus is excess fluid buildup in the brain.

Our brain is the consistency of gelatin, and it floats in a bath of cerebrospinal fluid. This fluid also fills large open structures, called ventricles, which lie deep inside the brain. The fluid-filled ventricles help keep the brain buoyant and cushioned.

Cerebrospinal fluid flows through the ventricles by way of interconnecting channels. The fluid eventually flows into spaces around the brain, where it’s absorbed into your bloodstream.

Keeping the production, flow and absorption of cerebrospinal fluid in balance is important to maintaining normal pressure inside your skull. Hydrocephalus results when the flow of cerebrospinal fluid is disrupted — for example, when a channel between ventricles becomes narrowed — or when your body doesn’t properly absorb this fluid.

Defective absorption of cerebrospinal fluid causes normal pressure hydrocephalus, seen most often in older people. In normal pressure hydrocephalus, excess fluid enlarges the ventricles but does not increase pressure on the brain. Normal pressure hydrocephalus may be the result of injury or illness, but in many cases the cause is unknown.

Risk Factors:
Premature infants have an increased risk of severe bleeding within the ventricles of the brain (intraventricular hemorrhage), which can lead to hydrocephalus.

Certain problems during pregnancy may increase an infant’s risk of developing hydrocephalus, including:

*An infection within the uterus
*Problems in fetal development, such as incomplete closure of the spinal column

Congenital or developmental defects not apparent at birth also can increase older children’s risk of hydrocephalus.

Other factors that increase your risk of hydrocephalus include:

*Lesions or tumors of the brain or spinal cord
*Central nervous system infections
*Bleeding in the brain
*Severe head injury

Complications:
The severity of hydrocephalus depends on the age at which the condition develops and the course it follows. If the condition is well advanced at birth, major brain damage and physical disabilities are likely. In less severe cases, with proper treatment, it’s possible to have a nearly normal life span and intelligence

 

Diagnosis:
Doctors will examine the child, looking for signs of hydrocephalus. They may also use techniques to monitor pressure inside your baby’s head. Doctors also use imaging tests to see signs of hydrocephalus. These tests include:

*CT scan (computerized tomography) of the head
*MRI (magnetic resonance imaging)

If the child has hydrocephalus, doctors may use ultrasound images of the brain to monitor the condition.
Treatment:
To treat hydrocephalus, doctors try to improve the flow of cerebrospinal fluid. Most often, they use surgery to do this.
Surgery:
Neurosurgeons most often perform three types of operations for hydrocephalus.

1.Shunts
The most common surgery for hydrocephalus is putting in a shunt.

A shunt is a small tube (catheter) that drains extra cerebrospinal fluid from a ventricle in your child’s brain to another area in the body. There, the fluid is either reabsorbed by your child’s body or passed out through the kidneys.

Neurosurgeons place one end of the small tube in the ventricle where extra fluid is causing problems. A valve in the tube controls the amount of fluid that runs through it. This controls the pressure in your child’s head. It also makes sure that the fluid flows in only one direction, away from the brain.
CLICK & SEE

The three areas a VP shunt can be placed in the head
The tube is placed under the skin and drains the fluid to another area of the body. The end of the tube most often is placed in the belly (abdomen). This is called a ventricular to peritoneal shunt. If the abdomen is not suitable for the tube, it may be placed in the heart (ventricular to atrial shunt), chest, or other areas. No matter where the tube ends, the fluid from the brain is reabsorbed by the body.

Placement of a VP shunt from the head to the belly.
Our neurosurgeons choose from many different types of shunts and valves, depending on your child’s needs. In some cases, they use a valve that can be adjusted from the outside by a small magnet. If your child has an MRI, these types of valves must always be reset immediately by one of our neurosurgery nurse practitioners.

2.Endoscopy:
An endoscope is a thin, flexible tube that carries a light and a camera. Surgeons can use it to see inside the body and perform some operations. Endoscopy requires smaller cuts (incisions) than other types of surgery (open surgery). It is a minimally invasive technique. Neurosurgeons use it to treat some types of hydrocephalus.

The approach made by an endoscope to make a hole in the ventricle so that the patient can avoid needing a shunt.
Some children have a complex type of the condition called multiloculated hydrocephalus. This happens when bleeding or infection causes scars within the ventricles of the brain. The scaring causes many small compartments of spinal fluid that do not connect with each other to develop.

In the past, doctors treated this condition by placing a separate shunt in each area with fluid and draining it. But by using an endoscope, they can make small holes in each of the areas. This connects them so they need only one shunt to drain the entire system.

3.Endoscopic third ventriculostomy (ETV)
Depending on your child’s brain structures and age, the neurosurgeon may talk with you about using an ETV instead of putting in a shunt.

During an ETV, the neurosurgeon makes a small hole in your child’s skull. Then the neurosurgeon uses an endoscope to reach the third ventricle in brain. Using the endoscope, the neurosurgeon makes a hole in the ventricle. This lets the extra fluid drain out and be reabsorbed.

An ETV lets neurosurgeons avoid putting in any permanent hardware, such as a shunt. Such a treatment may avoid the complications of using shunt hardware. But the treatment may fail and a shunt may be needed.

This video, developed by Anthony M. Avellino, MD, shows an example of an endoscopic third ventriculostomy procedure for treatment of obstructed hydrocephalus.

Prevention:

To reduce the risk of hydrocephalus:

*If you’re pregnant, get regular prenatal care. Following your doctor’s recommended schedule for checkups during pregnancy can reduce your risk of premature labor, which places your baby at risk of hydrocephalus and other complications.

*Protect against infectious illness. Follow the recommended vaccination and screening schedules for your age and sex. Preventing and promptly treating the infections and other illnesses associated with hydrocephalus may reduce your risk.

To prevent head injury:

*Use appropriate safety equipment. For babies and children, use a properly installed, age- and size-appropriate child safety seat on all car trips. Make sure all your baby equipment — crib, stroller, swing, highchair — meets all safety standards and is properly adjusted for your baby’s size and development. Older children and adults should wear a helmet while riding a bicycle, skateboard, motorcycle, snowmobile or all-terrain vehicle.

*Always wear a seat belt in a motor vehicle. Small children should be secured in child safety seats or booster seats. Depending on their size, older children may be adequately restrained with seat belts.

Should you be vaccinated against meningitis?

Ask your doctor if you or your child should receive a vaccine against meningitis, once a common cause of hydrocephalus. A meningitis vaccine is now recommended for people ages 2 and older who are at increased risk of this disease due to:

*Traveling to countries where meningitis is common

*Having an immune system disorder called terminal complement deficiency

*Having a damaged spleen or having had your spleen removed

*Living in a dormitory as a college freshman

*Joining the military

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:

http://sbhi.ie/images/What-is-ETV.pdf

http://en.wikipedia.org/wiki/Hydrocephalus

http://trialx.com/curebyte/2011/06/01/hydrocephalus-photos/

http://www.mayoclinic.com/health/hydrocephalus/DS00393

Helping children swallow medicine

Most parents know the battle of getting a child to swallow medicine when necessary. It’s strange how children can savour the most disgusting sweets but refuse medicine that tastes far more pleasant. It’s all part of the art of being two: recognising when your parents are really worried about something and then refusing to play the game.

But it’s important for children to get the doses of medicine they’ve been prescribed and that they finish any course of antibiotics they’re given, so you need to be patient and keep trying.

Some of the following might help:

*Make sure younger children get liquid rather than tablet forms of medicine where possible.

*Ask your doctor or pharmacist if the medicine can be prescribed in a flavour your child likes. This isn’t always possible, but there are lots of different makes of antibiotics, so it’s worth a try.

*Try mixing the medicine with something very sweet, such as honey or fruit syrup. This is particularly useful if the medicine is in tablet form. These can often be crushed into the syrup (but check with your pharmacist first, as some come in a gel form that doesn’t dissolve easily) or mixed with other more solid foods.

*Use a syringe (from the pharmacy) to give medicine, especially to younger children. This is much easier to hold than a spoon and far less likely to spill, especially when you’re holding the child tight and they’re trying to push you and the medicine away. When you put the syringe in your child’s mouth, point it towards their cheek as you press the plunger to avoid squirting it straight down their throat and choking them.

*Toddlers may be more willing when they’re given medicine in an animal-shaped medicine tube and allowed to sip it at their own pace.

*Try reverse psychology – tell your child it’s special medicine and she’s not allowed to have it. It’s amazing how often this one works.

*Bribery and corruption involving large amounts of sweets is often a good bet, too (but don’t tell your dentist).

*Stay calm and never force your child to take medicine. If they persistently refuse, try again after about half an hour.

*Say you’ll take them back to the doctor to be given the medicine (this showdown is too much for most toddlers, who’ll back down at this point).

Many children find it hard to swallow pills and capsules. Most have never had to, since almost all medications for children are available in liquid form. However, pills have their advantages: parents know the child gets the entire dose, pills hide the flavor of medicines that taste bad, pills are easier to take when traveling, and pills do not have to be refrigerated like many liquids.

What is the best way to teach a child to take a pill? There are many techniques parents can try, but everyone agrees that it is a good idea for parents to teach their kids the technique of pill swallowing before they really need it. A sick or cranky child is not a cooperative student!

Here are some suggestions that might help:

*Keep a calm and positive attitude

*Be patient. Some normal children can’t accomplish pill-swallowing until their late teens!

*Show the child how to swallow pills calmly and quickly. Demonstrate by placing a tablet or capsule back in the center of their tongue. Have them quickly drink water, Kool-Aid, or their favorite drink through a straw. When the child concentrates on using the straw and swallowing the liquid, the pill usually follows quickly along.

*Train in small steps with success at every stage. For example, have your child practice with a piece of small cake decoration. When the smallest size is swallowed without a problem, a slightly larger size may be tried. Then work up to the size of an M & M. Use substances that will melt if they get stuck or coat them first with butter. It is best to work in short sessions (5-10 minutes) several times a day over a couple of days.

*Eliminate distractions during medicine taking time. Close the door, turn the TV off, etc. allowing the child can concentrate on the job at hand
If the child gags or vomits, be calm and clean up the mess in a matter-of-fact way. Let the child settle down and try again in 10 or 15 minutes.

*Some kids like to play “Beat the Clock.” Use a one or two minute time limit!

*Give plenty of praise, such as “Oh good! You swallowed it right down.” Avoid negative comments like “Only babies take liquid medicine.” These comments rarely motivate children to try harder.

*Some pills are easier to swallow if they are broken into halves. Check with the pharmacist first, however, to make sure a divided pill does not lose its potency.

*Have the child drink a little water before taking the pill. Tables and capsules are harder to swallow when the youngster’s mouth is dry (which often happens when they are sick).

*As long as the pill does not have to be taken on “an empty stomach,” have your child place a little piece of food on their tongue, next to the pill. Next have them drink some water to swallow the food and the pill usually goes down at the same time. Don’t have your child tilt their head back too far when swallowing as this can sometimes make it more difficult for the pill to go down.

*Another way to get a child to swallow a pill is to stick it in a cube of Jell-O TM. The pill will usually slide down easily with Jell-O.
One pharmacist recommended the “Tic Tac” strategy: Put a “Tic Tac” on the tip of the child’s tongue. Place a glass of water filled to the brim on the table. Have the child suck in water from the brim without picking up the class. About one half mouthful will do. Remove the lips from the glass and quickly tip head back. The “tic tac pill” will be washed to the throat and swallowed with the gulp of water without the tongue being involved. The pharmacist claims this method works with kids as young as three years old.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:

http://www.kidsgrowth.com/resources/articledetail.cfm?id=428

http://www.bbc.co.uk/health/physical_health/conditions/medicinechildrenswallow.shtml

http://www.ehow.com/how_6607984_child-swallow-pill.html

Enhanced by Zemanta

Mastitis

Definition
Mastitis is an infection of the breast tissue that results in breast pain, swelling, warmth and redness of the breast. If you have mastitis, you might also experience fever and chills. Mastitis most commonly affects women who are breast-feeding (lactation mastitis), although in rare circumstances this condition can occur outside of lactation.

click to see the pictures

The term mastitis is from the Greek word mastos, for breast, and itis, for inflammation of. The response to injury to the udder of sheep is called inflammation. Mastitis is the reaction of milk -secreting tissue to injury produced by physical force, chemicals introduced into the gland or most commonly from bacteria and their toxins.

Click to see the picture   :Udder of a of a Roux du Valais sheep after a healed mastitis, one teat was lost due to the disease.

In most cases, lactation mastitis occurs within the first three months after giving birth (postpartum), but it can happen later during breast-feeding. The condition can leave you feeling exhausted and rundown, making it difficult to care for your baby.

Sometimes mastitis leads a mother mistakenly to wean her baby before she intends to. But you can continue breast-feeding while you have mastitis.

Types:
It is called puerperal mastitis when it occurs in lactating mothers and non-puerperal otherwise. Mastitis can occur in men, albeit rarely. Inflammatory breast cancer has symptoms very similar to mastitis and must be ruled out.

The popular misconception that mastitis in humans is an infection is highly misleading and in many cases incorrect. Infections play only a minor role in the pathogenesis of both puerperal and nonpuerperal mastitis in humans and many cases of mastitis are completely aseptic under normal hygienic conditions. Infection as primary cause of mastitis is presumed to be more prevalent in veterinary mastitis and poor hygienic conditions.

The symptoms are similar for puerperal and nonpuerperal mastitis but predisposing factors and treatment can be very different.

Click to see the picture    Serous exudate from bovine udder in E. coli mastitis at left. Normal milk at right.

Puerperal:
Puerperal mastitis is the inflammation of breast in connection with pregnancy, breastfeeding or weaning. Since one of the most prominent symptoms is tension and engourgement of the breast, it is thought to be caused by blocked milk ducts or milk excess. It is relatively common, estimates range depending on methodology between 5-33%. However only about 0.4-0.5% of breastfeeding mothers develop an abscess.

Nonpuerperal:
The term nonpuerperal mastitis describes inflammatory lesions of the breast occurring unrelated to pregnancy and breastfeeding. This article includes description of mastitis as well as various kinds of mammary abscesses. Skin related conditions like dermatitis and foliculitis are a separate entity.

Names for non-puerperal mastitis are not used very consistently and include Mastitis, Subareolar Abscess, Duct Ectasia, Periductal Inflammation, Zuska’s Disease and others.

Symptoms:
Lactation mastitis usually affects only one breast and the symptoms can develop quickly.[3] The signs and symptoms usually appear suddenly and they include:

Click to see the pictures..…….
*Breast tenderness or warmth to the touch
*General malaise or feeling ill
*Swelling of the breast
*Pain or a burning sensation continuously or while breast-feeding
*Skin redness, often in a wedge-shaped pattern
*Fever of 101 F (38.3 C) or greater [4]
*The affected breast can then start to appear lumpy and red.

Click to see the picture

Some women may also experience flu-like symptoms such as:

*Aches
*Shivering and chills
*Feeling anxious or stressed
*Fatigue
*Breast engorgement

Contact should be made with a health care provider with special breastfeeding competence as soon as the patient recognizes the combination of signs and symptoms. Most of the women first experience the flu-like symptoms and just after they may notice a sore red area on the breast. Also, women should seek medical care if they notice any abnormal discharge from the nipples, if breast pain is making it difficult to function each day or they have prolonged, unexplained breast pain.

Causes:
Since the 1980s mastitis has often been divided into non-infectious and infectious sub-groups. However, recent research [6] suggests that it may not be feasible to make divisions in this way. It has been shown that types and amounts of potentially pathogenic bacteria in breast milk are not correlated to the severity of symptoms. Moreover, although only 15% of women with mastitis in Kvist et al.’s study were given antibiotics, all recovered and few had recurring symptoms. Many healthy breastfeeding women wishing to donate breast milk have potentially pathogenic bacteria in their milk but have no symptoms of mastitis.

Mastitis typically develops when the milk is not properly removed from the breast. Milk stasis can lead to the milk ducts in the breasts becoming blocked, as the breast milk not being properly and regularly expressed.  It has also been suggested that blocked milk ducts can occur as a result of pressure on the breast, such as tight-fitting clothing or an over-restrictive bra, although there is sparse evidence for this supposition . Mastitis may occur when the baby is not appropriately attached to the breast while feeding, when the baby has infrequent feeds or has problems suckling the milk out of the breast.

Experts are still unsure why breast milk can cause the breast tissue to become inflamed. One theory is that it may be due to the presence of cytokines in breast milk. Cytokines are special proteins that are used by the immune system and are passed on to the baby in order to help them resist infection. It may be the case that the woman’s immune system mistakes these cytokines for a bacterial or viral infection and responds by inflaming the breast tissue in an attempt to stop the spread of what the body perceives as an infection.

Some women (approximately 15% in Kvist et al. study) will require antibiotic treatment for infection which is usually caused by bacteria from the skin or the baby’s mouth that entering the milk ducts through skin lesions of the nipple or through the opening of the nipple.[8] Infection is usually caused by staphylococcus aureus.

Mastitis is quite common among breastfeeding women. The WHO estimates that although incidences vary between 2.6% and 33%, the prevalence globally is approximately 10% of breastfeeding women. Most mothers who develop mastitis usually do so within the first few weeks after delivery. Most breast infections occur within the first or second month after delivery or at the time of weaning.  However, in rare cases it affects women who are not breastfeeding.

Mastitis can also develop after nipple piercing. In some rare cases, however, Mastitis can occur in men.

 

Risk Factors:
Women who are breastfeeding are at risk for developing mastitis especially if they have sore or cracked nipples or have had mastitis before while breastfeeding another baby. Also, the chances of getting mastitis increases if women use only one position to breastfeed or wear a tight-fitting bra, which may restrict milk flow

Women with diabetes, chronic illness, AIDS, or an impaired immune system may be more susceptible to the development of mastitis.

Complications:
Complications that may arise from mastitis include recurrence, milk stasis and abscess. The abscess is the most severe complication that women can get from this condition. Also, women who have had mastitis once are likely to develop it again with a future child or with the same infant. Recurrence appears especially in cases of delayed or inadequate treatment.

Milk stasis is another complication that may arise from mastitis and it occurs when the milk is not completely drained from the breast. This causes increased pressure on the ducts and leakage of milk into surrounding breast tissue, which can lead to pain and inflammation.

Delayed treatment or inadequate treatment, especially in mastitis related to milk stasis, may lead to the formation of an abscess within the breast tissue. An abscess is a collection of pus that develops into the breast which ultimately requires surgical drainage.

Diagnosis:
The diagnosis of mastitis and breast abscess can usually be made based on a physical examination. The doctor will also take into account the signs and symptoms of the condition.

However, if the doctor is not sure whether the mass is an abscess or a tumor, an ultrasound may be performed. The ultrasound provides a clear image of the breast tissue and may be helpful in distinguishing between simple mastitis and abscess or in diagnosing an abscess deep in the breast. The test consists of placing an ultrasound probe over the breast.

In cases of infectious mastitis, cultures may be needed in order to determine what type of organism is causing the infection. Cultures are helpful in deciding the specific type of antibiotics that will be used in curing the disease. These cultures may be taken either from the breast milk or of the material aspirated from an abscess.

Mammograms or breast biopsies are normally performed on women who do not respond to treatment or on non-breastfeeding women. This type of tests is sometimes ordered to exclude the possibility of a rare type of breast cancer which causes symptoms similar to those of mastitis.

Treatment:
If you develop a painful, red or swollen breast, and especially if you have generalized symptoms such as a fever, it’s important to see your doctor because there may be infection that needs treatment with antibiotics.

You should try to continue breastfeeding. Although mastitis may interfere with breastfeeding – because the breasts become distorted in shape, for example – it is often the best treatment because it empties the breast.

In fact it’s important to persevere, because otherwise engorged breasts rapidly lead to a fall in milk production, as the body sees it as a signal that more milk is being produced than is needed.

With engorgement, if the affected area is not drained there’s a risk of infection developing. Try to give frequent feeds varying the position of the baby (many recommend a position where the baby’s chin points towards the affected area). Offer the affected breast first for the best chance of good drainage.

You can also try massaging the affected area of the breast as you feed, and applying warmth to the area.

There’s no risk to the baby from infection being passed on in the milk, so this is not a reason to stop feeding.

You can try to relieve the symptoms with cooling treatments – everything from cabbage leaves to cold flannels to gel-filled cool packs. Gentle breast massage can also help. If there is no infection, medicines are often not very effective in resolving the mastitis but may help with symptoms.

Paracetamol or ibuprofen may ease pain and reduce fever for example. These are usually safe although ibuprofen can get through into breast milk in small amounts – this doesn’t usually do any harm but you should check with your GP if your baby was born prematurely, had a low birth weight or any other medical problems. Paracetamol can also pass through into breast milk in tiny amounts but is thought to be even less likely to do harm.

 

Lifestyle and home remedies :
If you have mastitis, it’s safe to continue breast-feeding. Continuing breast-feeding offers the added benefit of helping clear the infection in your breast.

To relieve your discomfort:

*Maintain your breast-feeding routine.
*Get as much rest as possible.
*Avoid prolonged engorgement before breast-feeding.
*Use varied positions to breast-feed.
*Drink plenty of fluids.
*If you have trouble emptying a portion of your breast, apply warm compresses to the breast or take a warm shower before breast-feeding or pumping milk.
*Wear a supportive bra.
*While waiting for the antibiotics to take effect, take a mild pain reliever, such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others).

If breast-feeding on the infected breast is too painful or your infant refuses to nurse on that breast, try pumping or hand-expressing milk.

 

Prevention :
To get your breast-feeding relationship with your infant off to its best possible start — and to avoid complications such as mastitis — consider making an appointment with a lactation consultant. A lactation consultant can give you tips and provide invaluable advice for proper breast-feeding technique.

Minimize your chances of getting mastitis by fully draining the milk from your breasts while breast-feeding. Allow your baby to completely empty one breast before switching to the other breast during feeding. If your baby nurses for only a few minutes on the second breast — or not at all — start breast-feeding on that breast the next time you feed your baby.

Alternate the breast you offer first at each breast-feeding, and change the position you use to breast-feed from one feeding to the next. Make sure your baby latches on properly during feedings. Finally, don’t let your baby use your breast as a pacifier. Babies enjoy sucking and often find comfort in suckling at the breast even when they’re not hungry

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose
Resources:

http://www.bbc.co.uk/health/physical_health/conditions/mastitis1.shtml

http://www.riversideonline.com/health_reference/Womens-Health/DS00678.cfm

http://en.wikipedia.org/wiki/Mastitis

http://www.breastfeedingbasics.com/html/breast_infections.shtml

http://glamomamas.com/2011/05/breastfeeding-it%E2%80%99s-choice/

http://melancoholismo.blogspot.com/2009/12/humor-patologico-5-muestra-del-extrano.html

http://www.righthealth.com/topic/mastitis/overview/adam_images?img=4

Enhanced by Zemanta

Labyrinthitis

Definition:
The labyrinth is a group of interconnected canals chambers located in the inner ear. It is made up of the cochlea and the semicircular canals. The cochlea is involved in transmitting sounds to the brain. The semicircular canals send information to the brain about the head’s position and how it is moving. The brain uses this information to maintain balance. Labyrinthitis is caused by the inflammation of the labyrinth. Its most frequent symptom is vertigo ( dizziness ), because the information that the semicircular canals send to the brain about the position of the head is affected.
click & see the pictures
The labyrinth is a system of narrow fluid-filled channels in the inner ear, which is involved in the detection of body movement, helping to control balance and posture.

Labyrinthitis can cause balance disorders.

In addition to balance control problems, a labyrinthitis patient may encounter hearing loss and tinnitus. Labyrinthitis is usually caused by a virus, but it can also arise from bacterial infection, head injury, extreme stress, an allergy or as a reaction to a particular medication. Both bacterial and viral labyrinthitis can cause permanent hearing loss, although this is rare.

Labyrinthitis often follows an upper respiratory tract infection (URI).

Labyrinthitis is rare and is more likely to occur after middle ear infections, meningitis , or upper respiratory infection. It may also occur after trauma, because of a tumor, or after the ingesting of toxic substances. It is thought to be more common in females than in males.

Symptoms:
•The most common symptoms

*Vertigo

*Nausea

*Vomiting

*Loss of balance

Other possible symptoms are:

*A mild headache

*Tinnitus (a ringing or rushing noise)

*Hearing loss

•These symptoms often are provoked or made worse by moving your head, sitting up, rolling over, or looking upward.

•Symptoms may last for days or even weeks depending on the cause and severity.

*Symptoms may come back, so be careful about driving, working at heights, or operating heavy machinery for at least 1 week from the time the symptoms end.

*Rarely, the condition may last all your life, as with Meniere’s disease. This condition usually involves tinnitus and hearing loss with the vertigo. In rare cases it can be debilitating.

Causes:
Many times, you cannot determine the cause of labyrinthitis. Often, the condition follows a viral illness such as a cold or the flu. Viruses, or your body’s immune response to them, may cause inflammation that results in labyrinthitis.

Other potential causes are these:

•Trauma or injury to your head or ear

•Bacterial infections: If found in nearby structures such as your middle ear, such infections may cause the following:

*Fluid to collect in the labyrinth (serous labyrinthitis)

*Fluid to directly invade the labyrinth, causing pus-producing (suppurative) labyrinthitis

•Allergies

•Alcohol abuse

•A benign tumor of the middle ear

•Certain medications taken in high doses

*Furosemide (Lasix)

*Aspirin

*Some IV antibiotics

*Phenytoin (Dilantin) at toxic levels

•Benign paroxysmal positional vertigo: With this condition, small stones, or calcified particles, break off within the vestibule and bounce around. The particles trigger nerve impulses that the brain interprets as movement.

•More serious causes of vertigo can mimic labyrinthitis, but these occur rarely.

*Tumors at the base of the brain

*Strokes or insufficient blood supply to the brainstem or the nerves surrounding the labyrinth

Diagnosis
Diagnosis of labyrinthitis is based on a combination of the individual’s symptoms and history, especially a history of a recent upper respiratory infection. The doctor will test the child’s hearing and order a laboratory culture to identify the organism if the patient has a discharge.

If there is no history of a recent infection, the doctor will order tests such as a commuted topography (CT) scan or a magnetic resonance imaging (MRI) scan to help rule out other possible causes of vertigo, such as tumors. If it is believed a bacterium is causing the labyrinthitis, blood tests may be done, or any fluid draining from the ear may be analyzed to help determine what type of bacteria is present.

 

Labyrinthitis, or inner ear infection, causes the labyrinth area of the ear to become inflamed.
(Illustration by GGS Information Services.)
Recovery:
Recovery from acute labyrinthine inflammation generally takes from one to six weeks; however, it is not uncommon for residual symptoms (dysequilibrium and/or dizziness) to last for many months or even years[5] if permanent damage occurs.

Recovery from a permanently damaged inner ear typically follows three phases:

1.An acute period, which may include severe vertigo and vomiting
2.approximately two weeks of sub-acute symptoms and rapid recovery
3.finally a period of chronic compensation[clarification needed] which may last for months or years.

Labyrinthitis and anxiety:
Chronic anxiety is a common side effect of labyrinthitis which can produce tremors, heart palpitations, panic attacks, derealization and depression. Often a panic attack is one of the first symptoms to occur as labyrinthitis begins. While dizziness can occur from extreme anxiety, labyrinthitis itself can precipitate a panic disorder. Three models have been proposed to explain the relationship between vestibular dysfunction and panic disorder:

*Psychosomatic model: vestibular dysfunction which occurs as a result of anxiety.

*Somatopsychic model: panic disorder triggered by misinterpreted internal stimuli (e.g., stimuli from vestibular dysfunction), that are interpreted as signifying imminent physical danger. Heightened sensitivity to vestibular sensations leads to increased anxiety and, through conditioning, drives the development of panic disorder.

*Network alarm theory: panic which involves noradrenergic, serotonergic, and other connected neuronal systems. According to this theory, panic can be triggered by stimuli that set off a false alarm via afferents to the locus ceruleus, which then triggers the neuronal network. This network is thought to mediate anxiety and includes limbic, midbrain and prefrontal areas. Vestibular dysfunction in the setting of increased locus ceruleus sensitivity may be a potential trigger.
Treatment:
Vestibular rehabilitation therapy (VRT) is a highly effective way to substantially reduce or eliminate residual dizziness from labyrinthitis. VRT works by causing the brain to use already existing neural mechanisms for adaptation, plasticity, and compensation.

Rehabilitation strategies most commonly used are:
*Gaze stability exercises – moving the head from side to side while fixated on a stationary object (aimed to restore the Vestibulo-ocular reflex) An advanced progression of this exercise would be walking in a straight line while looking side to side by turning the head.

 

*Habituation exercises – movements designed to provoke symptoms and subsequently reduce the negative vestibular response upon repetition. Examples of these include Brandt-Daroff exercises.

 

*Functional retraining - including postural control, relaxation, and balance training.
These exercises function by challenging the vestibular system. Progression occurs by increasing the amplitude of the head or focal point movements, increasing the speed of movement, and combining movements such as walking and head turning.

 

One study found that patients who believed their illness was out of their control showed the slowest progression to full recovery, long after the initial vestibular injury had healed.  The study revealed that the patient who compensated well was one who, at the psychological level, was not afraid of the symptoms and had some positive control over them. Notably, a reduction in negative beliefs over time was greater in those patients treated with rehabilitation than in those untreated. “Of utmost importance, baseline beliefs were the only significant predictor of change in handicap at 6 months followup.”

Prochlorperazine is commonly prescribed to help alleviate the symptoms of vertigo and nausea.

Because anxiety interferes with the balance compensation process, it is important to treat an anxiety disorder and/or depression as soon as possible to allow the brain to compensate for any vestibular damage. Acute anxiety can be treated in the short term with benzodiazepines such as diazepam (Valium); however, long-term use is not recommended because of the addictive nature of benzodiazepines and the interference they may cause with vestibular compensation and adaptive plasticity.  Benzodiazepines and any other form of mind or mood altering addictive drug should not be used on patients with addictive history.

Prognosis :
Most people who have labyrinthitis recover completely, although it often takes five to six weeks for the vertigo to disappear entirely and the individual’s hearing to return to normal. In a few cases, the hearing loss may be permanent. Permanent hearing loss is more common in cases of labyrinthitis that are caused by bacteria. For some individuals, episodes of dizziness may still occur months after the main episode is over.

Prevention :
The most effective preventive strategy includes prompt treatment of middle ear infections, as well as monitoring of patients with mumps, measles, influenza, or colds for signs of dizziness or hearing problems.

Parental concerns:
Labyrinthitis generally resolves by itself; however, in some cases permanent hearing loss can result. Labyrinthitis may cause repeated episodes of vertigo even after the main symptoms have gone away. If the episodes occur when the head is moved suddenly, this can make it difficult for a child to engage in some physical activities or sports .

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose
Resources:

http://www.bbc.co.uk/health/physical_health/conditions/labyrinthitis.shtml

http://www.healthofchildren.com/L/Labyrinthitis.html

http://www.dizziness-and-balance.com/disorders/unilat/vneurit.html

http://en.wikipedia.org/wiki/Labyrinthitis

Enhanced by Zemanta

Kawasaki disease

Alternative Names: Kawasaki syndrome, lymph node syndrome and mucocutaneous lymph node syndrome

Definition:
Kawasaki disease (KD) is an autoimmune disease that manifests as a systemic necrotizing medium-sized vessel vasculitis and is largely seen in children under five years of age. It affects many organ systems, mainly those including the blood vessels, skin, mucous membranes and lymph nodes; however, its most serious effect is on the heart where it can cause severe coronary artery aneurysms in untreated children. Without treatment, mortality may approach 1%, usually within six weeks of onset. With treatment, the mortality rate is less than 0.01% in the U.S. There is often a pre-existing viral infection that may play a role in its pathogenesis. The conjunctivae and oral mucosa, along with the epidermis (skin), become erythematous (red and inflamed). Edema is often seen in the hands and feet and one or both of the cervical lymph nodes are often enlarged. Also, a remittant fever, often 40? (104°F) or higher, is characteristic of the acute phase of the disease. In untreated children, the febrile period lasts on average approximately 10 days, but may range from five to 25 days. The disorder was first described in 1967 by Dr. Tomisaku Kawasaki in Japan.

Kawasaki disease affects boys more than girls with people of Asian ethnicity, particularly Japanese and Korean most susceptible as well as people of Afro-Caribbean ethnicity. The disease was rare in Caucasians until the last few decades and incidence rate fluctuates from country to country.

By far the highest incidence of Kawasaki disease occurs in Japan (175 per 100,000).

However its incidence in the United States is increasing. Kawasaki disease is predominantly a disease of young children, with 80% of patients younger than five years of age. Approximately 2,000-4,000 cases are identified in the United States each year.

In the United Kingdom, estimates of incidence rate vary because of the rarity of Kawasaki disease. However Kawasaki disease is believed to affect fewer than 1 in every 25,000 people.  Incidence of the disease doubled from 1991 to 2000 however, with 4 cases in per 100,000 children in 1991 compared with a rise of 8 cases per 100,000 in 2000.

Symptoms:
Kawasaki disease often begins with a high and persistent fever that is not very responsive to normal treatment with paracetamol (acetaminophen) or ibuprofen.The fever may persist steadily for up to two weeks and is normally accompanied by irritability. Affected children develop red eyes because of non-suppurative conjunctivitis, iritis and bilateral anterior uveitis  Inflammation of the mucous membranes in the mouth, along with erythema (redness), edema (swelling) with fissures (cracks in the lip surface), desquamation (peeling) and exsudation of the lips are also evident. The oropharynx mucosa has enanthema and the tongue maintains an unusual red appearance termed “strawberry tongue” (marked erythema with prominent gustative papillae). Keratic precipitates (detectable by a slit lamp but usually too small to be seen by the unaided eye), and swollen lymph nodes may also be present and can be the first manifestation of the disease. Rashes occur early in the disease, and the cutaneous rash observed in patients with KD is non-specific, polymorphic, non-itchy and normally observed up to the fifth day of fever. Cutaneous exanthema may comprise macular-papular erythematous and fissure lesions, the most common type, in addition to urticariform type rash, purpuric, multiform-like erythema. and peeling of the skin in the genital area, hands, and feet (especially around the nails and on the palms and soles) may occur in later phases. Some of these symptoms may come and go during the course of the illness. It is a syndrome affecting multiple organ systems, and in the acute stage of KD, systemic inflammatory changes are evident in many organs. Myocarditis, pericarditis, valvulitis, aseptic meningitis, pneumonitis, lymphadenitis, and hepatitis may be present and are manifested by the presence of inflammatory cells in the affected tissues. If left untreated, some symptoms will eventually relent, but coronary artery aneurysms will not improve, resulting in a significant risk of death or disability due to myocardial infarction (heart attack). If treated in a timely fashion, this risk can be mostly avoided and the course of illness cut short

*High-grade fever (greater than 39 °C or 102 °F; often as high as 40 °C or 104 °F),  The duration of fever is on average one to two weeks; in the absence of treatment, it may extend for three to four weeks. However, when appropriate therapy is started the fever is gone after two days.

*Red eyes (conjunctivitis) bilateral without pus or drainage, also known as “conjunctival injection”.

*Anterior uveitis.

*Bright red, chapped, or cracked lips.

*Red mucous membranes in the mouth.

*Strawberry tongue, white coating on the tongue or prominent red bumps (papillae) on the back of the tongue.

*Red palms of the hands and the soles of the feet.

*Peeling (desquamation) palms and soles (later in the illness); peeling may begin around the nails.

*Rash which may take many forms, non-specific, polymorphic, non-itchy, but not vesicle-bullous lesions, and appears on the trunk.

*Swollen lymph nodes (frequently only one lymph node is swollen, and is usually on one side), particularly in the neck area.

*Joint pain (arthralgia) and swelling, frequently symmetrical, Also arthritis can occur.

*Irritability.

*Tachycardia (rapid heart beat).

*Beau’s lines (transverse grooves on nails).

*May find breathing difficult

Causes:
Like all autoimmune diseases, the cause of Kawasaki disease is presumably the interaction of genetic and environmental factors, possibly including an infection. The specific cause is unknown, but current theories center primarily on immunological causes for the disease. Evidence increasingly points to an infectious etiology, but debate continues on whether the cause is a conventional antigenic substance or a superantigen. Children’s Hospital Boston reported that “[s]ome studies have found associations between the occurrence of Kawasaki disease and recent exposure to carpet cleaning or residence near a body of stagnant water; however, cause and effect have not been established.”

An association has been identified with a SNP in the ITPKC gene, which codes an enzyme that negatively regulates T-cell activation. An additional factor that suggests genetic susceptibility is the fact that regardless of where they are living, Japanese children are more likely than other children to contract the disease. The HLA-B51 serotype has been found to be associated with endemic instances of the disease

Risk Factors:
Three things are known to increase your child’s risk of developing Kawasaki disease, including:

*Age. Children under 5 years old are most at risk of Kawasaki disease.

*Sex. Boys are slightly more likely than girls are to develop Kawasaki disease.

*Ethnicity. Children of Asian descent, such as Japanese or Korean, have higher rates of Kawasaki disease.

Diagnosis:
Kawasaki disease can only be diagnosed clinically (i.e. by medical signs and symptoms). There exists no specific laboratory test for this condition. It is difficult to establish the diagnosis, especially early in the course of the illness, and frequently children are not diagnosed until they have seen several health care providers. Many other serious illnesses can cause similar symptoms, and must be considered in the differential diagnosis, including scarlet fever, toxic shock syndrome, juvenile idiopathic arthritis, and childhood mercury poisoning (infantile acrodynia).

Classically, five days of fever  plus four of five diagnostic criteria must be met in order to establish the diagnosis. The criteria are: (1) erythema of the lips or oral cavity or cracking of the lips; (2) rash on the trunk; (3) swelling or erythema of the hands or feet; (4) red eyes (conjunctival injection) (5) swollen lymph node in the neck of at least 15 millimeters.

Many children, especially infants, eventually diagnosed with Kawasaki disease do not exhibit all of the above criteria. In fact, many experts now recommend treating for Kawasaki disease even if only three days of fever have passed and at least three diagnostic criteria are present, especially if other tests reveal abnormalities consistent with Kawasaki disease. In addition, the diagnosis can be made purely by the detection of coronary artery aneurysms in the proper clinical setting.

Investigations:
A physical examination will demonstrate many of the features listed above.

Blood tests:
*Complete blood count (CBC) may reveal normocytic anemia and eventually thrombocytosis

*Erythrocyte sedimentation rate (ESR) will be elevated

*C-reactive protein (CRP) will be elevated

*Liver function tests may show evidence of hepatic inflammation and low serum albumin

Other optional tests
*Electrocardiogram may show evidence of ventricular dysfunction or, occasionally, arrhythmia due to myocarditis

*Echocardiogram may show subtle coronary artery changes or, later, true aneurysms.

*Ultrasound or computerized tomography may show hydrops (enlargement) of the gallbladder

*Urinalysis may show white blood cells and protein in the urine (pyuria and proteinuria) without evidence of bacterial growth

*Lumbar puncture may show evidence of aseptic meningitis

*Angiography was historically used to detect coronary artery aneurysms and remains the gold standard for their detection, but is rarely used today unless coronary artery aneurysms have already been detected by echocardiography.

Complications :
•Inflammation of the blood vessels (vasculitis)
•Inflammation of the heart muscle (myocarditis)
•Aneurysms in arteries that increase the risk of blood clots and heart attacks

Treatment :
Children with Kawasaki disease should be hospitalized and cared for by a physician who has experience with this disease. When in an academic medical center, care is often shared between pediatric cardiology and pediatric infectious disease specialists (although no specific infectious agent has been identified as yet). It is imperative that treatment be started as soon as the diagnosis is made to prevent damage to the coronary arteries.

Intravenous immunoglobulin (IVIG) is the standard treatment for Kawasaki disease[38] and is administered in high doses with marked improvement usually noted within 24 hours. If the fever does not respond, an additional dose may have to be considered. In rare cases, a third dose may be given to the child. IVIG by itself is most useful within the first seven days of onset of fever, in terms of preventing coronary artery aneurysm.

Salicylate therapy, particularly aspirin, remains an important part of the treatment (though questioned by some) but salicylates alone are not as effective as IVIG. Aspirin therapy is started at high doses until the fever subsides, and then is continued at a low dose when the patient returns home, usually for two months to prevent blood clots from forming. Except for Kawasaki disease and a few other indications, aspirin is otherwise normally not recommended for children due to its association with Reye’s syndrome. Because children with Kawasaki disease will be taking aspirin for up to several months, vaccination against varicella and influenza is required, as these infections are most likely to cause Reye’s syndrome.

Corticosteroids have also been used, especially when other treatments fail or symptoms recur, but in a randomized controlled trial, the addition of corticosteroid to immune globulin and aspirin did not improve outcome. Additionally, corticosteroid use in the setting of Kawasaki disease is associated with increased risk of coronary artery aneurysm, and so its use is generally contraindicated in this setting. In cases of kawasaki disease refractory to IVIG, cyclophosphamide and plasma exchange have been investigated as possible treatments, with variable outcomes.

There are also treatments for iritis and other eye symptoms. Another treatment may include the use of Infliximab (Remicade). Infliximab works by binding tumour necrosis factor alpha

Prognosis:
With early treatment, rapid recovery from the acute symptoms can be expected and the risk of coronary artery aneurysms greatly reduced. Untreated, the acute symptoms of Kawasaki disease are self-limited (i.e. the patient will recover eventually), but the risk of coronary artery involvement is much greater. Overall, about 2% of patients die from complications of coronary vasculitis. Patients who have had Kawasaki disease should have an echocardiogram initially every few weeks, and then every one or two years to screen for progression of cardiac involvement.

It is also not uncommon that a relapse of symptoms may occur soon after initial treatment with IVIG. This usually requires re-hospitalization and re-treatment. Treatment with IVIG can cause allergic and non-allergic acute reactions, aseptic meningitis, fluid overload and, rarely, other serious reactions. Overall, life-threatening complications resulting from therapy for Kawasaki disease are exceedingly rare, especially compared with the risk of non-treatment. There is also evidence that Kawasaki disease produces altered lipid metabolism that persists beyond clinical resolution of the disease.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose

Resources:

http://en.wikipedia.org/wiki/Kawasaki_disease

http://www.bbc.co.uk/health/physical_health/conditions/kawasaki2.shtml

http://www.vaheart.com/kawasaki-disease/

http://www.mayoclinic.com/health/kawasaki-disease/DS00576/DSECTION=risk-factors

Enhanced by Zemanta