Fiebre escarlatina, kawasaki y mononucleosis infecciosa

FIEBRE ESCARLATINA, KAWASAKI Y MONONUCLEOSIS

INFECCIOSA

Dr. Alcibíades Batista González

Pediatría II (MED-530)

UNACHI

ESTREPTOCOCOS GRUPO A (GAS)

• La infección aguda más frecuente por GAS es la faringoamigadalitis aguda.

• Complicaciones purulentas ocurren en algunos pacientes, con mayor frecuencia los no tratados, e incluyen: – Otitis media – Sinusitis – Abscesos peritonsilares y retrofaríngeos– Adenitis cervicales supurativas

Copyright ©2006 American Academy of Pediatrics

Red Book Online Visual Library, 2006. Image 124_63. Available at: http://aapredbook.aappublications.org/visual. Accessed May 26, 2007

Group A Streptococcal Infections. Streptococcus pyogenes, 24h sheep Blood Agar Plate, beta hemolysis (close-up view)



Group A streptococcal pharyngitis with inflammation of the tonsils and uvula.



Erythematous tonsils in a child with group A streptococcal pharyngitis.



Group A streptococcal pharyngitis with petechiae on the soft palate.



Group A streptococcal nasopharyngitis in toddlers often is associated with tender anterior cervical lymphadenopathy. A throat culture is not always positive when the infection has localized to the cervical

lymph nodes.


• En menores de 3 años (1 a 3 años) puede presentarse una infección de vías respiratorias altas por GAS.

• Se le conoce como:– Estreptococosis– Fiebre estreptocócica

• Su importancia clínica se relaciona con la morbilidad aguda y no con las secuelas no supurativas.


• Características clínicas de la fiebre estreptocócica:– 1-3 años con cuadro febril agudo.– Rinitis con descarga serosa,

serosanguinolenta o mucopurulenta.– Irritabilidad e hiporexia.– Lesiones impetiginizadas alrededor de las

narinas.


• Características clínicas de la fiebre estreptocócica:– Puede presentarse artritis reactiva.– El cuadro clínico puede presentarse asociado

a H. influenzae y S. pneumoniae.– La clásica presentación de la infección por

GAS con faringitis es poco frecuente en < 3 años.

– La fiebre reumática es muy rara en < 3 años.



Protracted nasopharyngitis is the most common presentation of group A streptococcal infection in toddlers. Inflammation of the skin beneath the nares often is present as in this child.

FIEBRE ESCARLATINA

• Resulta de una infección por GAS que produzca cualquiera de las 3 exotoxinas pirogénicas (eritrogénicas).

• Foco primario de infección es con mayor frecuencia una faringitis.

• También puede ocurrir secundaria a una herida infectada o a una infección de la piel.

FIEBRE ESCARLATINA

• El inicio es agudo y se caracteriza por:– Fiebre– Escalofríos– Vómitos– Cefalea– Toxicidad– Exantema generalizado que parece

quemadura solar (escarlatiniforme).

FIEBRE ESCARLATINA

Figure 35-2 Schematic diagram of a typical case of untreated uncomplicated scarlet fever. The rash usually appears within 24 hours of onset of fever and sore throat.

Gershon: Krugman's Infectious Diseases of Children, 11th ed. 2004

FIEBRE ESCARLATINAFigure 35-3 Schematic drawing illustrating development and distribution of scarlet fever rash.

Gershon: Krugman's Infectious Diseases of Children, 11th ed. 2004

FIEBRE ESCARLATINA

• El exantema es más acentuado en las axilas, áreas inguinales y el cuello.

• Punteado de máculas rojas o finas pápulas que blanquean con la presión.

• Puede haber petequias en partes distales de las extremidades.

• En algunos individuos el exantema da la sensación de papel de lija.



A 4-1/2 year-old white male with the rash and strawberry tongue of scarlet fever.



Confluent rash of scarlet fever over the posterior surfaces of the 4-1/2 year old white male in the previous image.



Erythema and desquamation of the palms and confluent rash of scarlet fever over the anterior surfaces of the 4-1/2 year old white male in the 2 previous images.



Group A streptococcal rash in a white male with a positive throat culture for group A streptococci and an elevated antistreptolysin O titer.



Pastias lines in the antecubital space of a 12-year-old white male with scarlet fever

SÍNDROME DE KAWASAKI

• Síndrome mucocutáneo-nódulo linfático.• Enfermedad febril, exantemática.• Vasculitis aguda de niños pequeños.

– 1-8 años (80% son < 4 años).

• Aneurismas coronarios en 20% de los pacientes no tratados.

• Muerte súbita puede resultar de IAM, miocarditis o ruptura de aneurisma coronario.


• Descrito en 1967, en Japón, cuando Tomisaku Kawasaki describió su experiencia con 50 casos.

• Desarrolló los criterios diagnósticos que aún se utilizan.


• Causa desconocida.

• Gatillo infeccioso – Marcada respuesta inmune inflamatoria.

• Hallazgos patológicos ampliamente descritos y virtualmente idénticos en todos los pacientes afectados, con variaciones en la severidad.


• Lesiones inflamatorias sistémicas:– Vasculares (arterias de mediano calibre)– Sistema cardiovascular:

• Miocarditis • Pericarditis • Endocarditis (menos frecuente)

– Sistema respiratorio:• Bronquitis • Neumonía intersticial


• Lesiones inflamatorias sistémicas:– Sistema digestivo:

• Estomatitis• Adenitis sialoductal• Enteritis• Hepatitis, colangitis• Pancreatitis• Ductitis pancreática


• Lesiones inflamatorias sistémicas:– Sistema urinario:

• Nefritis intersticial focal• Cistitis• Prostatitis

– Sistema nervioso:• Meningitis aséptica• Neuritis

– Sistema hematopoyético:• Linfadenitis y esplenitis.


• El cuadro clínico es la base del diagnóstico.

• No existe una prueba de laboratorio que apoye o confirme el diagnóstico.

• El diagnóstico se basa en los criterios diagnósticos del síndrome de Kawasaki.

DIAGNOSTIC CRITERIA FOR KAWASAKI SYNDROME

Fever, daily for more than 5 days, high spiking and intermittent, with

four of the five following clinical features: •Bulbar conjunctival injection, generally nonpurulent•Changes in the oral mucosa, consisting of:

- Red, fissured lips

- Redness of the mouth

- Strawberry tongue

•Changes in the hands and feet, consisting of:

- Redness of the palms and soles - Swelling of the hands and feet - Peripheral desquamation in the subacute stage of illness

DIAGNOSTIC CRITERIA FOR KAWASAKI SYNDROME

Fever, daily for more than 5 days, high spiking and intermittent, with

four of the five following clinical features:

•Rash, erythematous and polymorphous but nonvesicular: - Maculopapular - Erythema multiforme–like - Scarlatiniform

•Cervical lymphadenopathy, greater than 1.5 cm in diameter

ASSOCIATED FEATURES OF KAWASAKI SYNDROME


• Tratamiento:– Inmunoglobulina Intravenosa 2 g/kg en 10-12

horas.– ASA 80-100 mg/kg/día divididos c/6h– Medidas de sostén.– Seguimiento con ecocardiograma.

Some clinical signs of Kawasaki syndrome. A, Discrete vascular injection of the bulbar conjunctiva. B, Generalized lip erythema with mild edema, cracking, and bleeding fissures. C, Diffuse red-purple discoloration of the palm(s). D, Desquamation beginning at the fingertips just below the nailbeds. E, Diffuse erythematous, nonvesicular and nonbullous, polymorphic rash. F, Unilaterally enlarged cervical lymph node.



Image 068_01. Kawasaki Disease. Child with Kawasaki syndrome with striking facial rash and erythema of the oral mucous membrane.



Image 068_02. Kawasaki Disease. Child with Kawasaki syndrome with conjunctivitis. Note the absence of conjunctival discharge.



Image 068_06. Kawasaki Disease. Periungual desquamation of a patient with Kawasaki syndrome. This is the same patient as in images 068_03, 068_04, and 068_05.



Image 068_08. Kawasaki Disease. Distal desquamation of Kawasaki syndrome. This is the same patient as in image 068_07.



Image 068_09. Kawasaki Disease. A child with the characteristic desquamation of the hands in a later stage of Kawasaki syndrome.



Image 068_10. Kawasaki Disease. Bulbar conjunctivitis in a patient with Kawasaki syndrome. Exudation generally is absent.



Image 068_11. Kawasaki Disease. Erythematous lips and injection of the oropharyngeal membranes in a patient with Kawasaki syndrome. Scarlet fever, toxic shock syndrome, staphylococcal scalded skin

syndrome, and measles may be confused with this disease.



Image 068_12. Kawasaki Disease. Hyperemia and fissuring of lips in a patient with Kawasaki syndrome.



Image 068_19. Kawasaki Disease. Desquamation of the skin of the toes following Kawasaki syndrome. This is the same patient as shown in image 068_18.



Image 068_20. Kawasaki Disease. A 20-month old white male with acute erythroderma and fever associated with Kawasaki Disease



Image 068_21. Kawasaki Disease. This one-year old white child presented with fever, generalized erythroderma, and conjunctivitis compatible with Kawasaki Disease



Image 068_22. Kawasaki Disease. Erythroderma of the palm of the hand of the child in the previous image with Kawasaki disease



Image 068_23. Kawasaki Disease. Erythroderma of the plantar foot surface of the child in the previous 2 images with Kawasaki disease



Image 068_24. Kawasaki Disease. The one-year old white child in the above 3 images presented with this erythema multiforme-like rash most pronounced over the back. The clinical course was characteristic of

Kawasaki disease

MONONUCLEOSIS INFECCIOSA

• Etiología viral– Epstein Barr virus.– Incubación: 4-6 semanas.– Características clínicas:

• Fiebre• Linfadenopatía• Tonsilofaringitis• Esplenomegalia• Hepatitis• Rash• Neumonitis• Compromiso del Sistema Nervioso



Image 043_01. Epstein-Barr Virus Infections (Infectious Mononucleosis). Atypical lymphocyte in a peripheral blood smear of a patient with infectious mononucleosis. This lymphocyte is larger than normal lymphocytes with a higher ratio of cytoplasm to nucleus. The cytoplasm is vacuolated and basophilic. This

may also be present in cytomegalovirus infections.



Image 043_02. Epstein-Barr Virus Infections (Infectious Mononucleosis). Epstein-Barr virus disease. Bilateral cervical lymphadenopathy.



Image 043_04. Epstein-Barr Virus Infections (Infectious Mononucleosis). Epstein-Barr virus disease with pharyngeal and tonsillar exudate.



Image 043_06. Epstein-Barr Virus Infections (Infectious Mononucleosis). Cervical lymphadenopathy in a 7-year-old girl with infectious mononucleosis.



Image 043_08. Epstein-Barr Virus Infections (Infectious Mononucleosis). Rash in the same patient as in image 043_07 with infectious mononucleosis who was receiving ampicillin. These morbilliform rashes are

considered nonallergic.



Image 043_09. Epstein-Barr Virus Infections (Infectious Mononucleosis). A preadolescent child with infectious mononucleosis with petechiae on the soft palate and uvula without exudation.



Image 043_10. Epstein-Barr Virus Infections (Infectious Mononucleosis). A conjunctival hemorrhage of the right eye of a patient with infectious mononucleosis. At times, noninfectious conjunctivitis, as well as other corneal abnormalities, may manifest itself due to the body's systemic response to viral infections

such as infectious mononucleosis.

Fiebre escarlatina, kawasaki y mononucleosis infecciosa

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