There are six diseases in the tropics that are so common and spread easily.
Their mortality rates are so high among children that they have been named killer diseases. These diseases are:
- Tuberculosis
- Diphtheria
- Pertussis (whooping cough )
- Tetanus
- Poliomyelitis
- Measles
The order above does not indicate the prevalence of the diseases but shows the order in the immunization schedule.
Tuberculosis
The greatest incidence of tuberculosis is in children. However, after the age of five years, it no longer produces as much mortality and morbidity as in smaller children.
Clinical features of tuberculosis in children are not specific as would be found in adults. The feature of tuberculosis are outlined below and include:
- General malaise and apathy
- Loss of appetite
- Loss of weight
- Slight dry cough
- Evening pyrexia and night sweat are not common but may occur.
On examination, the child looks emaciated and there is chronic reddening of the conjunctiva called phyctenular conjunctivitis.
There is also generalized lymphadenopathy but hilar lymph nodded are more prominent and occur more on the right side. The nodes are non-tender and matted together.
What is the clinical investigation of tuberculosis?
These are the lab tests that your healthcare provider is likely to order to ascertain:
- Manteaux test
- Chest X-ray
- Sputum for both microscopy examination and culture
- Lymph node biopsy
Treatment of Tuberculosis
The drugs must be administered by your healthcare provider, and they are Streptomycin, Rifampicin, Rimactazid, Isoniazid, Thiacetazone, Pyrimidone, and others.
The smaller children who cannot take tablets are placed on Streptomycin injection and Rifampicin syrup. Adequate nutrition with a balanced diet and vitamin supplements are of vital importance in the management.
Disease conditions that affect post-primary tuberculosis patients include:
- Malnutrition
- Prolonged diarrhea
- Measles
- Intercurrent infection
Complications of Tuberculosis
The infection affects virtually all the organs of the body such as
- The Brain is affected by Tuberculosis meningitis
- The Kidneys affected by Haematuria and sterile pyuria
- The Abdomen is affected by Tuberculosis of the abdomen
- The Bone is affected by Kyphosis
Prevention of Tuberculosis
BCG vaccine is given to the body at birth. It produces chronic granuloma at the site of injection within six weeks. The body thereby produces antibodies against the vaccine. The vaccine can give an adverse reaction in some children. There is axillary lymphadenopathy which underage and discharges caseous material. Isoniazid INH is given to such children for three months. To prevent the reaction, INH-resistant BCG is given first before the BCG vaccine.
Diphtheria
This is an infection by a bacteria called Corynebacterium diphtheria. It produces its effect by the release of toxins. It is transmitted by droplet infection.
Clinical Features of Diphtheria
- Upper respiratory tract obstruction with a barking cough and labored breathing.
- Sore throat
- Nasal discharge that is slightly blood stained
- Fetororis
On examination, there is cervical adenitis and brown edema of the neck (bull neck).
Later signs of shock supervene. Neuritis and myocardial occur much later as it also affects the nerves and the heart.
Laboratory Investigation Of Diphtheria
- Throat and nasal swab for culture and sensitivity
- E.C.G (electrocardiogram)
- Myelography
Treatment of Diphtheria
The drugs are to be administered by your healthcare provider.
- Anti toxin
- Penicillin or Erythromycin if there allergy to penicillin
Prevention of Diphtheria
The diphtheria vaccine is given to the baby at six weeks with a booster dose at eighteen months of age.
Pertussis (Whooping Cough)
This is an infectious disease occurring worldwide but is more common in developing countries due to poor sanitary conditions. In an unimmunized population, about 70% would have been affected by the age of five years.
The infective organism is a bacteria called Bordetella pertussis. There is high morbidity and mortality rate and the younger the age of onset the worst the mortality.
It acts by causing an inflammatory reaction in the trachea and bronchioles leading to the production of a copious amount of mucus. The colliery mucosa is paralyzed and so the cilia cannot remove all the mucus produced.
The organism has a slow onset of action. In the first ten days, there are:
- Dry cough
- Clear nasal discharge
By the second week, there are:
- Cough appears in the paroxysms and there is whooping
- Facial swelling
- Watering of the eyes
- Portusion of the tongue
- The patient sits up in bed and finds it difficult to lie down.
Soon after these, the child produces thick mucus which comes in a string-like manner and this is followed by vomiting. Children less than three months present with apnea and cyanosis during the attack but look well in between attacks.
In uncomplicated pertussis, examination of the child shows no abnormalities but the complicated case shows pneumonia signs.
The signs are tachycardia, tachypnea, rhonchi, recitation, and reduced air entry in both lungs.
Laboratory Investigation Of Pertussis
- Full blood count
- Culture of para nasal swab
Treatment of Pertussis
The drugs are to be administered by your healthcare provider.
- Clear the airway
- Frequent small meal
- Erythromycin or Ceporexyrubs
Complications Of Pertussis
- Bleeding: epistaxis, hemoptysis, and subconjunctival hemorrhage
- Pulmonary collapse
- Bronchopneumonia
- Malnutrition
Prevention Of Pertussis
DPT vaccine at six weeks, ten weeks, fourteen weeks, and a booster dose at eighteen months of age. Do not give OPT vaccine after the age of seven years as it may cause encephalitis.
Poliomyelitis
This is one of the most crippling diseases in the tropics. It is a disease of poor hygiene and it is spread by droplet infection and by face-oral.
In an unimmunized population, about 100% would have been affected by the age of five years.
In the first six months of life, antibodies from the mother but after this time they become susceptible to protect the baby. The incubation period is between ten and thirty days. The knowledge of this is of vital importance for quarantine purposes.
Stages Of Poliomyelitis
There are four stages of the disease but these are grouped into two:
- Minor illnesses such as inapparent, abortive and pre-paralytic
- Major illnesses like the paralytic
Clinical Features Of The Minor Illness
- Fever
- Headache
- Nauseous and vomiting
- Loss of appetite
- Diarrhea
- Nasal discharge
- Abdominal pain
The fever usually aborts on its own but after one week the fever comes again and this heralds the major illness.
Clinical Features Of The Major Illness
- Muscle pain
- Pain and stiffness of the neck, leg, and back
- The inability of the child to kiss his knees
- Tripod sign
- Positive Kerning and Brudzinski sign
- Initial hyper-relexia and later there is either reduced reflex or absent reflex
- Paralysis
The child is always irritable and cries when picked up. Any attempt to exercise the limbs precipitates paralysis. Your healthcare provider is expected to demonstrate a Tripod sign, Kerning, and Bruszinski signs.
The paralysis is asymmetrical. It affects large muscle groups and the lower more than the upper. As the fever decreases. There is a decrease in the spread of muscle weakness or paralysis. Later there is a spontaneous improvement with the return of tendon reflexes and a gradual return of muscle strength.
Atrophy of paralysis muscle occurs after a month or two. Circulation is poorer in the paralyzed limbs. Such a limb naturally becomes shorter.
Bulbar Polio
This results if the virus that causes poliomyelitis called polio hminis affecting the motor nucleus of the cranial nerve. It is the most life-threatening form of poliomyelitis:
- Weakness and paralysis of the soft palate, pharynx, and the vocal cords
- Hoarseness of voice
- Refusal of drink
- Inability to swallow
- Pooling of secretion in the throat
- Laryngeal stridor
Laboratory Investigations Of Poliomyelitis
- Culture the virus from throat swabs and faces
- Lumbar puncture
Treatment Of Poliomyelitis
- Rest the paralyzed leg by splinting
- Analgesic antipyretic
- Nasogastric tube in bulbar polio
- Intermittent positive pressure ventilation (IPPV) if breathing is compromised
- Calipers
- Relieve contracture, especially that of the Achilles tendon.
Prevention Of Poliomyelitis
Oral polio vaccine at six weeks, ten weeks, and fourteen weeks of age. It can be repeated at various other times, as there is no feat of overdose. It should be noted that people who travel to polio-endemic regions need to be immunized otherwise they get poliomyelitis even as adults.
Measles
Measles known as Rubella is an acute illness that is very communicable. It is endemic in large metropolitan areas but seasonal, usually dry season, in small areas. It is caused by a paramyxovirus. The Mode of transmission is droplet infection. We, humans, are the reservoir.
In an unimmunized population, about 90% would have had measles by the age of five years.
The incubation period is ten days (eight to thirteen days) Between exposure and occurrence of fever is fourteen days.
The period of communicability is from the appearance of fever to four days after the appearance of the rash. Everybody is susceptible to the disease except infants of mothers who had the disease. This gives the infant passive immunity for up to four months of life.
Clinical Features Of Measles
There are three phases of this disease:
• Prodromal phase
• Specific enanthem (salt rice appearance)
• Stage of rash
The prodromal phase has the following features:
• Fever
• Nasal discharge
• Barking cough
• Bilateral conjunctivitis
After one to two days, there is the appearance of the specific enanthem called the Koplick spot. This has a “salt over rice” appearance on the buccal mucosa. Over two days the Koplick spot increases to involve every mucous membrane.
Then there is the phase of rash. This appears about three to five days after the onset of illness. It starts as erythema and progresses to a maculopapular rash. The rash starts on the hairline of the forehead and moves progressively down to the sole of the feet. It takes about three days to reach the sole of the feet.
The fever of measles increases rapidly with the appearance of the rash but it crashes down and with rapid improvement in the clinical features as the rash reaches there sole of the feet. The rash then begins to fade in the order it appeared leaving brown desquamation on the skin.
Other Associated Features Of Measles
Apart from the ones listed above, there are other features associated with measles which include:
1. Irritable and unable to sleep
2. Refusal of feed
3. Diarrhea
Symptoms are more common amongst malnourished children whose case fatality rate is very high.
What Are Other Forms Of Measles?
1. Atypical measle: This is a form of measle found in children previously immunized with inactivated measle vaccine. It occurs in whose case fatality rate is very high.
2. Modified measle: This is a form of measle found in children previously with a longer incubation period and the disease period is short.
Complications Of Measles
1. Upper respiratory tract infections
2. Diarrhea
3. Protein-energy malnutrition
4. Dehydration
5. Pneumonia particularly bronchi pneumonia
6. Skin infections especially fungal infections
Treatment Of Measles
This should be administered by your healthcare provider. However, measles is a viral infection but it is easily secondarily infected by bacteria.
1. Broad spectrum antibiotics such as 1m Rocephin
2. Ceporex syrup
3. Syrup Vitamin C
4. Cough Syrup
5. Calamine Lotion
6. Routine antimalarial therapy
7. Restrain the hand from the eyes and ears
Prevention Of Measles
Measles vaccine at nine months of age. It has now been reduced to seven months of age. The vaccine confers life-long immunity.
Tetanus
