Download MBBS Pediatric PPT 3 Childhood Infection Immunological Profile Lecture Notes

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? Musculoskeletal infections in children

Pyomyositis
Septic arthritis
Osteomyelitis

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? They are called "deep seated infections"
? Rare
? Not present in immunocompetent children
Immunoglobulin levels vs. age

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Innate and adaptive immunity
Classified as

PRIMARY

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IMMUNODEFECIENCY

SECONDARY

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? TCELL DEFECT

IMMUNODEFECIENCY

? B CELL DEFECT

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DRUGS

? COMPLEMENT DEFECT

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RADIATION

? PHAGOCYTIC DEFECT

SPLENECTOMY

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MALNUTRITION

INFECTIONS

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When to suspect immunodeficiency ?

? In every case of musculoskeletal infection

Special y when....

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Very frequent infections
Very severe infections
Family history
Unusual clinical presentation
Unusual microorganism

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Longer duration of treatment
Not responding to treatment
Additional clues..

? >8 ear infections per year

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? >2 serious sinus infections per year
? >2 months treatment with poor result
? Requirement of iv antibiotics
? Failure to thrive with or without diarrhea

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At Any Age...

? History for secondary immunodeficiency
Diet
Medication

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Infections
Immunization
Splenectomy
Radiation
Systemic illness

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Age of presentation

? Onset before age 6 mo suggests a T-cel defect

? Onset between the age of 6 and 12 mo may suggest combined B- and T-cel

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defects or a B-cel defect

? Later than 12 mo usual y suggests a B-cel defect or secondary

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immunodeficiency

Detailed history

Upto 6 months

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? History of newborn seizures, cardiac anomaly
? Delayed cord detachment, recurrent infection
? Diarrhea, pneumonia, oral thrush, FTT
? Bloody stools, draining ears, eczema
6 months to 5 years

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? Persistent thrush, nail dystrophy, endocrinopathies
? Short stature, fine hair, severe varicella
? Oculocutaneous albinism with recurrent infection
? Lymphadenopathy, dermatitis, pneumonia, osteomyelitis

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Characterstic features

Predominant T cel

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Gram positive and

neg bacteria,

Early onset (2-6

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mycobacteria,CMV,

mnths)

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EBV, and fungi ?

candida
Characterstic features

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Predominant B cel

Pneumococci,staph,

Onset after 5-7 months of strepto,enteroviruses,giard

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age

ia

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Characterstic features

Phagocytic defect

Staph, pseudomonas,

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Early onset

candida, nocardia
Characterstic features

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Compliment defect

Onset at any age

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Pneumococci and neiserria

Muscukoskeletal Infection in HIV patients

? Arthalgia and myalgia-symptom of acute infection

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? Staphylococcus aureus, Streptococcus pyogenes, Mycobacterium

tuberculosis, Nocardia and Cryptococcus common organisms

? Myositis common- bacterial infections, opportunistic and direct viral

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infection

? Tuberculous osteomyelitis common
? Bacillay angiomatosis

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? Knee and ankle arthritis common
Examination

Clinical y-

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? BCG scar absent
? wasted, stunted, malnourished
? Skin eczema present, hypopigmented patches
? Oral thrush, nail fungal infection
? Absence of tonsils and lymph nodes

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? Respiratory system-b/l ronchi , wheeze, crepts

Screening tests

Skin testing for

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CBC with

delayed

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manual

hypersensitivity

differential

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Quantitative Ig

Antibody titers

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measurements
Laboratory tests to assess

immune function

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(1) T cell: Enumeration (flow cytometry), functional assays (mitogen

response, DTH skin tests)

(2) B cell: Enumeration, circulating antibody levels

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(3) Macrophage: Enumeration, functional assays (nitroblue

tetrazolium)

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(4) Complement: Direct measurement of complement components,

complement hemolysis assay

Key Points

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? Done in every child with musculoskeletal infection
? High index of suspicion
? Thorough history and complete physical examination is must
? Begin with screening tests and appropriate additional testing as

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required

? Early diagnosis and prompt treatment could be life saving
References

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? Nelsons textbook of pediatrics 19 th ed

? Diagnostic Approach to Primary Immunodeficiency Disorders; indian

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pediatrics,june 2013

? Approach to the Patient With Suspected Immunodeficiency:

Immunodeficiency Disorders: Merck Manual

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