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Ailmemts & Remedies 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.
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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:
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•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.
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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

Categories
Ailmemts & Remedies

Cat-Scratch Disease

Definition:
Cat-scratch disease is an infection caused by bacteria (germs) carried in cat saliva. The bacteria can be passed from a cat to a human. Doctors and researchers think cats may get the bacteria from fleas, although this hasn’t been proved.

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.You can get cat-scratch disease from a cat bite or cat scratch. You can get the infection after a cat scratches you if the cat’s paws have the bacteria on them. (A cat can get the bacteria on its paws when it licks itself.) With a cat bite, the cat can pass the bacteria to you in its saliva. You can also get the bacteria in your eyes if you pet a cat that has the bacteria on its fur and then rub your eyes. Many people who get cat-scratch disease do not remember being scratched or bitten by a cat.

Cat-scratch disease is not a severe illness in people who are healthy. But it can be a problem in people with weak immune systems. People with weak immune systems include those who are receiving chemotherapy for cancer, those who have diabetes or those who have acquired immunodeficiency syndrome (AIDS).

It is a bacterial disease caused by Bartonella henselae. Most people with CSD have been bitten or scratched by a cat and developed a mild infection at the point of injury. Lymph nodes, especially those around the head, neck, and upper limbs, become swollen. Additionally, a person with CSD may experience fever, headache, fatigue, and a poor appetite. Rare complications of B. henselae infection are bacillary angiomatosis and Parinaud’s oculolandular syndrome.


Other Names:

The condition has also been termed Cat-Scratch Adenitis, Cat-Scratch-Oculoglandular Syndrome, Debre’s Syndrome, Debre-Mollaret Syndrome, Foshay-Mollaret Cat-Scratch Fever, Foshay-Mollaret syndrome, Foshay-Mollaret Cat-Scratch Fever Syndrome, Lymphadenitis-Regional Non-bacterial, Lymphoreticulosis-Benign Inoculation, maladie des griffes du chat, Parinaud oculoglandular disease, and Petzetakis’ disease.CSD; Cat scratch fever; Bartonellosis

Transmission
The cat was recognized as the vector of the disease in 1950 by Dr. Robert Debré.

The causative organism was first thought to be Afipia felis, but this was disproved by immunological studies demonstrating that cat scratch fever patients developed antibodies to two other organisms, Bartonella henselae and Bartonella clarridgeiae, which are rod-shaped Gram negative bacteria.

Kittens are more likely to carry the bacteria in their blood, and are therefore more likely to transmit the disease than are adult cats.

Ticks are also a major transmitter of this disease. It is often transmitted at the same time a human may get Lyme Disease.

Causes :

Cat scratch disease is caused by Bartonella henselae. The disease is spread through contact with an infected cat (a bite or scratch), or contact with cat saliva on broken skin or the white of the eye.

About 2 – 3 weeks after becoming infection, lymph nodes swelling (lymphadenopathy) occurs near the site of the scratch or bite.

Occasionally, an infected lymph node may form a tunnel (fistula) through the skin and drain. Cat scratch disease is a common causes of chronic lymph node swelling in children.

Sign & Symptoms:

A person who has had contact with a cat may show common symptoms, including:

* Bump (papule) or blister (pustule) at site of injury (usually the first sign)
* Lymph node swelling near the scratch or bite
* Fever (in some patients)
* Fatigue
* Overall discomfort (malaise)
* Headache

Less common symptoms may include:

* Loss of appetite
* Weight loss
* Enlarged spleen
* Sore throat
* Draining lymph nodes
A sore may develop where a cat has bitten or scratched you. The sore might not happen right away. It may take 3 to 10 days for the sore to appear after the bite or scratch.

The sore may take a long time to heal. An infection of the lymph nodes (also called lymph glands) also develops, most often in the glands that are near the place where you got the cat scratch or cat bite. For example, if the infection is from a cat scratch on your arm, the glands in your armpit may become tender and swollen. The lymph nodes may swell to an inch or more in size.

Cat scratch fever presents with tender regional lymphadenopathy, sterile suppurative papules at the site of inoculation, slight fever, headache, chills, backache, abdominal pain, malaise, alteration of mental status, and convulsions. It may take 7 to 14 days, or as long as two months, before symptoms appear. Most cases are benign and self-limiting, but lymphadenopathy may persist for several months after other symptoms disappear. The prognosis is generally favorable. In temperate climates, most cases occur in fall and winter. The disease usually resolves spontaneously, with or without treatment, in one month. In immunocompromised patients more severe complications sometimes occur.

Exams and Tests :

A scratch or injury and a history of contact with a cat indicates that cat scratch disease is a possible cause of the lymph node swelling. In some cases, physical examination also shows an enlarged spleen (splenomegaly).

The disease often goes unrecognized because of the difficulty in testing. However, the Bartonella henselae IFA test is highly sensitive and specific for the detection of infection caused by this bacteria.

Other tests used in the diagnosis of cat scratch disease:

* Lymph node biopsy to rule out other causes of swollen glands

When to call a Doctor?
Call your family doctor if you notice any of the following problems:

* A cat scratch or bite that does not heal in the usual length of time.
* An area of redness around a cat scratch or bite that continues to get bigger for more than 2 days after the injury.
* Fever that lasts for several days after a cat scratch or bite.
* Painful and swollen lymph nodes for more than 2 or 3 weeks.
* Bone or joint pain, abdominal pain (without fever, vomiting or diarrhea) or an unusual degree of tiredness for more than 2 or 3 weeks.

Treatment:

In AIDS patients and in other people who have suppressed immune systems, cat scratch disease is more serious, and treatment with antibiotics is recommended.

Azithromycin, ciprofloxacin, doxycycline, and multiple other antibiotics have been used successfully.

In most people, cat-scratch disease clears up without treatment. However, antibiotics (medicines that kill bacteria) may be needed when infected lymph nodes stay painful and swollen for more than 2 or 3 months. Antibiotics may also help if you have a fever for a long time or if the infection is in your bones, liver or another organ.

If a lymph node is very large or painful, your doctor may drain it to help relieve the pain. The lymph node is drained by putting a needle through normal skin off to the side of the node and moving the needle to the swollen node. The needle is then inserted into the node and the fluid in the node is drained out.

Treatment for the cat:

Cats require no treatment. The bacteria doesn’t cause cats to get sick. They merely carry the bacteria that causes cat-scratch disease in people.

Resources:
http://familydoctor.org/online/famdocen/home/healthy/firstaid/bites/024.html
http://www.nlm.nih.gov/medlineplus/ency/article/001614.htm
http://en.wikipedia.org/wiki/Cat_scratch_fever

Prognosis:

In children with normal immune systems, full recovery without treatment is the norm. In immunocompromised people, treatment with antibiotics generally leads to recovery.

Possible Complications:

* Parinaud’s syndrome
* Encephalopathy
* Neuroretinitis
* Osteomyelitis


Prevention:

Avoiding contact with cats prevents the disease. Where this is not reasonable, good hand-washing after playing with a cat, avoiding scratches and bites, and avoiding cat saliva will lessen the risk of infection.

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://familydoctor.org/online/famdocen/home/healthy/firstaid/bites/024.html
http://www.nlm.nih.gov/medlineplus/ency/article/001614.htm
http://en.wikipedia.org/wiki/Cat_scratch_fever

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