Scalet Faver * caused by group –A- strop to cocci (Gas) . * GAS infection is uncommon in neonates . * incidence of pharyngeal infection is highest between 3-15 y. of age. * most often in winter & spring.

clinical manifestation :. onset is acute *clinical manifestation : * onset is acute . * Fever , vomiting , headache , pharyngitis . * Typical rash appears in 12-48hr. * Tonsils are hyperemic , edematous & may be coverd with a gray – white exudate. * tongue : has a white coat through which the red & edematous papillae project (white strawberry tongue ) . * after several days ; the white coat desquamates , red tongue with prominent papillae (red strawberry tongue).

rash appears with in 24-48 hr * rash appears with in 24-48 hr. , begins around the neck & spreads over the trunk & extremities . * more intense along the creases of elbows , axillae & groin . * skin has a goose- pimple appearance & feels rough . * face is usually spared . * cheeks may be erythematous with pallor around the mouth (circumoral pallor ) . * after 3-4 d.; the rash begins to fade , followed by desquamation.

* diagnosis : * culture of throat swab. * Rapid Antigen detection testes . * increasing streptococcal A.b. titer. * Treatment : * penicillin is the drug of choice for 10 days. * erythromycin , if patient allergic to penicillin . * Complication : Sinusitis , O.M., mastoiditis , broncho paenomia , osteomye litis . R.F., G.N.

Mumps (M.) * epidemiology : * M. occurs more in winter & spring . * M. spread from person to person by R. droplets . * virus appears in the saliva from up to 7d. before to as long as 7d. after onset of parotid swelling . * maximum infectiousness is 1-2d before to 5d. after parotid swelling .

*Clinical manifestations : * I.P. from 12-25d . * Faver , headache , vomiting & achiness . * parotitis : may be unilat ., becomes bilat . in 70% of cases. * ear pain on the ipsilat. side . * parotid gL. Is tender . * Ingestion of sour or acidic foods or liquids may enhance pain in the parotid area. * ear lobe may be lifted upward & outward . * parotid swelling peaks in 3d., subsides over 7d. * diagnosis : * by virology or serologic means .

* D.D. : * parainfluenqa 1&3 , in fluenqa A, CMV , EBV, HIV. * non infections causes : obstruction vascular dis ., SLE tumor . * Treatment : * reduce the pain . * Antipyretics. * Adequate hydration . * Prognosis : * excellent * Prevention : * vaccination

Pertussis (P.) * epidemiology : * P. is extremely contagious . * Neither natural dis. nor vacc. Provides complete or life long immunity . * peak incidence 1-5y . * clinical manifestation : * catarrhal , paroxysmal , convalescent stages . * catarrhal : 1-2 WK.; congestion & rhinorrhea, fever , sneeging.

* paroxysmal stage : 2-6 Wk ., cough begins as dry intermittent , irritative hack & evolves into the inexorable paroxysms. * post tussive emesis is common . * convalescent stage >2 wk. number , severity & duration of episodes diminish . * whoop infrequently occurs in infants < 3m cynosis, apnea . * physical examination : uninformative .

* diagnosis : * absolute lymphocytosis is characteristic in catarrhal stage . * CXR. * isolation of B. pertussis . - PCR. * Treatment : - A.B.: < 1 m . of age : Azithromycin . > 1m. of children : Ergthromy cin . * Adjunct therapies . * isolation until 5d. after initiation of therapy .

* complications : apnea , secondary in f., res. failure. Pul , H.T., or hemorrhage & Bact . pneumonia. conjunctival & scleral hr. epistaxis , hr. in C.N.S., pneumthorax , hernias , seizures . * prevention : Vaccine