tailieunhanh - Paediatrics & Child Health - part 4

Đỉnh cao tuổi: 3-8 tháng. phổ biến nhất trong t vòm động mạch chủ trong tuần thứ 5 và thứ 6 của thai kỳ. A / R: hội chứng Turner, rubella bẩm sinh, VSD, PDA, tim trái giảm sản, gián đoạn của vòm động mạch chủ (hình thức nghiêm trọng coarctation không có kết nối giữa động mạch chủ gần và xa). | Encephalitis 51 D Inflammation of the brain parenchyma. A Viruses enteroviruses HSV1 HSV2 VZV arboviruses adenoviruses HIV mumps rare now due to immunisation rubella and rabies. Post-measles SSPE. A R Foreign travel measles immunosuppression active maternal HSV2 infection. _E 1 100000. Peak age 3-8 months. Commonest in 4 years. _H General lethargy poor feeding irritability hypotonia behavioural change vomiting. Neurological headache drowsiness confusion photophobia neck pain seizures focal fits suggestive of HSV encephalitis . Associated pharyngitis conjunctivitis and myositis. E General fever GCS positive Kernig s sign pain on extension of the knee with hips and knees flexed whilst in a supine position. Neurological cranial nerve and motor abnormalities ataxia varicella-associated encephalitis . _P Infectious viruses enter into the blood stream during systemic febrile illness and affect several organs. There is further viral replication and subsequent invasion into the brain parenchyma with cell destruction localised inflammation swelling and inflammation of the meninges. HSV probably reaches the brain directly via neuronal axons. Post-infectious immune-mediated reaction to viral antigens that perivascular inflammation and demyelination. I Bloods FBC blood cultures serum glucose U Es serum and urine osmolalities. LP for CSF WCC normal lymphocytes protein mildly normal glucose normal. CSF microscopy Gram stain culture and sensitivity. CSF PCR HSV. CSF serology HSV antibody can be detected in the CSF in later stages. Radiology CT MRI brain may show oedema or focal lesions particularly in the temporal lobes with HSV encephalitis. EEG shows diffuse slow wave activity usually without focal changes. ICP monitoring may be required in severe cases. M Empirical antibiotic therapy 3rd generation cephalosporin is indicated until bacterial meningitis is excluded. Supportive fluid resuscitation and correction of electrolyte imbalance anticonvulsants for seizures .