Pediatric Infections: Free INBDE Prep Course

Herpetic Gingivostomatitis is linked to the herpes simplex virus (HSV-1 strain) and causes vesicles of the mouth and gingiva. Primary herpetic gingivostomatitis is an acute form usually seen in kids under the age of 3. There is a prodromal phase which can include headache, dysphagia (sore throat), malaise, fever, and irritability. What follows is an eruption of painful, ulcerative lesions of the gingiva and mucosa, and often, yellow, vesicular perioral lesions. The infection is self limiting, lasting 7-10 days, requiring palliative treatment only (over the counter pain relief as needed, perhaps topical anesthetic, normal nutrition and fluids). The virus can remain dormant in the patient’s nerve ganglia and may reactivate any time, presenting as herpes labialis (cold sore).

Herpangina is also caused by a viral infection, a strain of the Coxsackie A virus. Symptoms include a high fever, sore throat and a headache, followed by oral ulceration. The ulcers are usually seen on the roof of the mouth and on pharyngeal soft tissues, appearing clinically as white to whitish-gray with a red border. Though relatively few in number, the ulcers can be very painful. Herpangina is self limiting, lasting 7-10 days, requiring palliative treatment only (over the counter pain relief as needed, perhaps topical anesthetic, normal nutrition and fluids).

Measles, also known as Rubeola, is caused by a paramyxovirus, the same RNA virus family responsible for mumps, measles (rubeola), RSV (respiratory syncytial virus), and parainfluenza. The incubation period for this virus is 1-2 weeks. Symptoms include fever, a cough and a rash. Koplik’s spots (look like tiny grains of white sand, each surrounded by a red ring) can be seen intra-orally. Measles is highly contagious. The infection is preventable with a vaccine, usually included in the MMR (Measles, Mumps, Rubella) vaccine. The infection is self limiting usually only requiring palliative treatment (over the counter pain relief if necessary, normal nutrition and fluids).

German Measles (Rubella) is a viral infection caused by the rubella virus that causes a red rash on the body. Symptoms include a rash, fever and swollen lymph nodes, and petechiae-like spots on the soft palate. The infection can spread from person to person through contact with droplets from an infected person’s sneeze or cough. If a mother is infected with a baby in the first trimester, Rubella can cause enamel defects, hypoplasia, pitting and abnormal tooth morphology. The infection is preventable with a vaccine, usually included in the MMR (Measles, Mumps, Rubella) vaccine. The infection is self limiting usually only requiring palliative treatment (over the counter pain relief if necessary, normal nutrition and fluids).

Mumps is a highly contagious viral disease caused by the mumps virus. Incubation time is 12-25 days. Initial signs and symptoms often include a fever, muscle aches, headache, poor appetite, and malaise, followed by swelling of one or both parotid glands (parotitis). Also spreads with respiratory secretions. The infection is preventable with a vaccine, usually included in the MMR (Measles, Mumps, Rubella) vaccine. The infection is self limiting usually only requiring palliative treatment (over the counter pain relief if necessary, normal nutrition and fluids).

Small pox is caused by the Variola major (more severe) and Variola minor viruses, but population spread has not been seen since 1977 due to vaccinations and public education. Symptoms included a high fever, nausea, vomiting, chills and headaches. Ulcerated vesicular lesions would appear in the mouth, and a distinct skin rash. It sometimes causes swelling of the tongue. It is spread through direct contamination.

Scarlet Fever is an exotoxin-mediated disease caused by Group A Beta hemolytic streptococci. It has a peak incidence in children aged 4-8. Symptoms include strep throat, fever, headaches, nausea, vomiting, muscle and abdominal pain, fatigue, and a strawberry tongue caused by the enlargement of fungiform papillae of the tongue. Penicillin is the drug of choice. It can lead to rheumatic fever, arthritis, localized abscess formation, and glomerulonephritis.

An acute diffusion of infection throughout the dermis and subcutaneous tissues is called cellulitis. Symptoms include pain and tenderness, erythema, and edema. The infected area is often swollen, the skin taught, and warm to the touch. Cellulitis has the potential of becoming serious if the infection spreads unchecked through the lymphatic or circulatory systems. Group A streptococci and Staphylococcus Aureus are the most common cause of cellulitis. A child is susceptible to dehydration and can crash faster than an adult. Hospitalization should be strongly considered if there are signs of a serious systemic infection (lethargy, high fever etc.)

Diphtheria is a contagious bacterial infection caused by Corynebacterium diphtheriae, which produces a systemic toxin that damages the CNS and tissues of the heart. The infection can be prevented with immunization.

A spread of infections in the submandibular, sublingual and submental spaces can cause a condition termed Ludwig’s angina. Inflammation and edema causes the tongue and floor of the mouth to elevate. Ludwig’s angina is a serious complication with the potential of compromising the patient’s airway, and necessitates hospital admission.

Candidiasis (thrush) is caused by the fungus Candida albicans, which is naturally found in the oral cavity. Treatment includes antifungal agents such as nystatin (topical) or ketoconazole (systemic). Candida infections are not common in healthy patients and can be a sign of a compromised immune system or a recent course of antibiotics. Antibiotics disrupt the normal oral biome, leading to fungal colonization.

Diphenylhydantoin sodium (Dilantin or phenytoin) can cause painless hyperplasia of the gingiva called dilantin gingivitis. The hyperplasia is generalized and surgical removal of the overgrown tissue may be needed. The tissue is enlarged, pink, fibrous, and not inflamed.