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General issues of Vaccine
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General issues of Tropical med.
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General issues of Travel med.
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Trematode (fluke, distoma)
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epidemiology
- 1.2 mil. (~10%) of 10 mil. new cases/year are under 15 y/o in 2019
- third cause of deaths of children by infectious diseases
special issues in children TB
- children TB means recent transmission
- direct consequence of adult TB
- difficulty of diagonsis
- non-specific symptoms
- difficulty to produce sputum
- more likely to have paucibacillary lesions
- means often negative sputum smear
risk factors
- close contact with TB case
- HIV co-infection
- severe malnutrition
- low socioeconomic level
- promiscuity
- enclosed space
- low education for parents/care givers
latent TB
- 80-90% of children cases
- no symptoms
- Mantoux test
- IGRA is often unavailable in LMIC
- R+H for 3 months
clinical TB
- often paucibacillary, difficult to diagnose
pulmonary TB
- 75% (60-80%) of clinical TB
- <2 y/o symptoms are very uncommon
- fever, weight loss, cough, anorexia, diarrhea
- hilar adenopathy on CXR is very common
- gastric aspiration when sputum unavailable
- peripheral lymphadenitis TB counts for 50-60% of extrapulmonary TB in DRC
- anterior cervical, submandibular, supraclavicular
- painless, without inflammation, fistulation
- TB pericardial effusion
- rare but possible
- right-side heart failure
- bone/joint TB
- large weightbearing bones/joints
- Pott's diesase
- cold abscess beside vertebra
- gibbus deformity
- abd TB
- TB meningitis
- common in <2 y/o
- BCG provides protection
- no specific symptoms
- fever, anorexia, weight loss,
- 30% mortality
- miliary TB
- most common in <2 y/o
- high fever, weight loss, respiratory distress,
treatment of clinical TB
- H+R+Z+E
- every morning 2 hours before eating
- H 10 mg/kg/d
- R 15 mg/kg/d
- Z 25-30 mg/kg/d
- E 20-25 mg/kg/d