1. 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.

2. 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).

3. rash appears with in 24-48 hr
* rash appears with in 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.

4. * 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.

5. 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 .

6. *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 .

7. * 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

8. 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.

9. * 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 .

10. * 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 .

11. * 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