Distance education courses child health course

AMREF DIRECTORATE OF LEARNING SYSTEMS
DISTANCE EDUCATION COURSES

CHILD HEALTH COURSE

Unit 21

Other Conditions

Allan and Nesta Ferguson Trust

Unit 21: Other Conditions

A distance learning course of the Directorate of Learning Systems (AMREF)

© 2007 African Medical Research Foundation (AMREF)

This work is distributed under the Creative Common Attribution-Share Alike 3.0 license. Any part of this unit including the illustrations may be copied, reproduced or adapted to meet the needs of local health workers, for teaching purposes, provided proper citation is accorded AMREF. If you alter, transform, or build upon this work, you may distribute the resulting work only under the same, similar or a compatible license. AMREF would be grateful to learn how you are using this course and welcomes constructive comments and suggestions. Please address any correspondence to:

The African Medical and Research Foundation (AMREF)

Directorate of Learning Systems

P O Box 27691 – 00506, Nairobi, Kenya

Tel: [phone]

Fax: [phone]

Email: [e-mail]

Website: www.amref.org

Writer: Dr Daniel Njai

Cover design: Bruce Kynes

Technical Co-ordinator: Joan Mutero

The African Medical Research Foundation (AMREF wishes to acknowledge the contributions of the Commonwealth of Learning (COL) and the Allan and Nesta Ferguson Trust whose financial assistance made the development of this course possible.

UNIT 21: OTHER CONDITIONS

INTRODUCTION
Congratulations for coming this far! You are now in the last unit of this course on child health. In the last two units, you learnt how to diagnose, manage and rehabilitate children with various types of disabilities. In this unit, you will learn about other conditions which affect children. Although these conditions are not very common, they have serious consequences on the health and normal growth and development of the children. These other conditions are:

1. 
   Bacterial meningitis
   
2. 
   Urinary tract infection
   
3. 
   Diabetes mellitus
   
4. 
   Typhoid
   
5. 
   Osteomyelitis
   
6. 
   Septic arthritis
   
7. 
   Acute rheumatic fever
   
8. 
   Nephrotic syndrome
   
9. 
   Viral hepatitis
   

If these conditions are not recognized early and treated promptly, they can cause very high mortalities or serious complications in those who survive. That is why you need to equip yourself with the necessary knowledge and skills so that you can effectively contribute towards the reduction of deaths and complications associated with these conditions. Unfortunately, as you will discover, some of the above conditions do not have a cure. However, they can be prevented. And as you know, prevention is better than cure! So it is worth learning how to recognize all them.

LEARNING OBJECTIVES:

By the end of this unit you should be able to:

• 
  Describe each of the above conditions;
  
• 
  Describe the causes, mode of transmission or contributing factors of each of the above conditions;
  
• 
  Describe the clinical manifestations and how to diagnose each of the above conditions;
  
• 
  Outline the management of each of the above conditions;
  
• 
  Explain the prevention and control, where available, of some of these diseases.
  

21.1 BACTERIAL MENINGITIS

What is Bacterial Meningitis?

Bacterial meningitis is the infection of the meninges, the membranes enclosing the brain and the spinal cord, by bacteria. Bacterial meningitis is among the most common and the most important causes of disturbed consciousness and coma in children. If meningitis is not recognized early and promptly treated, it is associated with high morbidity and mortality.

Before you proceed do the following activity. It should take you 5 minutes to complete.

ACTIVITY Think of the ways by which the bacteria reach the meninges and write them down: _______________________________________________________ ______________________________________________________ ______________________________________________________

Now read through the following discussion and see if your answers were correct.
Bacteria reach the meninges through the following ways:

1. 
   through the blood from such sites as lobar pneumonia, otitis media, septic arthritis bowel infection, and urinary tract infection;
   
2. 
   through direct spread from infected ear, mastoid or sinuses;
   
3. 
   through congenital or traumatic defects of the skull;
   
4. 
   through neurosurgical shunts.
   

Causes
The causes of bacterial meningitis are different in different ages.
a) In the newborn, the causes of bacterial meningitis are:

• 
  E. coli
  
• 
  Group B beta streptococcus
  
• 
  Listeria monocytogenes
  
• 
  Staphylococcus aureus.
  

2. 
   In older children, the causes of bacterial meningitis are:
   

• 
  Pneumococcus,
  
• 
  Haemophilus influenzae
  
• 
  Meningococcus,
  
• 
  Mycobacterium tuberculosis.
  

At an increased risk of developing pneumococcal, Haemophilus influenzae

and meningococcal meningitis are children with sickle cell disease, nephrotic syndrome, and those who have had the spleen removed.
Clinical Manifestations

A child with meningitis presents with the following symptoms:

• 
  fever,
  
• 
  vomiting,
  
• 
  inability to breastfeed or drink,
  
• 
  headache or pain in the back of the neck,
  
• 
  convulsions,
  
• 
  irritability.
  

The signs of meningitis are as follows:

• 
  stiff neck which may be absent or appear late in infants,
  
• 
  repeated convulsions,
  
• 
  lethargy,
  
• 
  irritability,
  
• 
  bulging anterior fontanelle,
  
• 
  petechial rash or purpura,
  
• 
  a recent head trauma,
  
• 
  unequal pupil size,
  
• 
  rigid posture and opisthonos,
  
• 
  focal paralysis in any limb and
  
• 
  irregular breathing.
  

These last four signs show that the intracranial pressure is raised. Meningism means occurrence of neck stiffness without cerebrospinal fluid changes. Meningism is often seen in children with pneumonia, tonsillitis, retropharyngeal abscess, and severe otitis media and less commonly in children with hepatitis and urinary tract infection.

(a) Unequal pupil size

b) Rigid Posture

Figure. 1 Signs of meningitis

Investigations

When there are no signs of raised intracranial pressure, a lumbar puncture is done to obtain cerebrospinal fluid. A cloudy cerebrospinal fluid suggests meningitis. Microscopy shows more than 1000 leukocytes / mm³. Biochemistry shows more than 100mg of protein per deciliter. The glucose is less than 40% of the blood sugar which should be measured simultaneously. The culture of the cerebrospinal fluid shows the type of bacteria causing the meningitis.

Management

A child with meningitis should be urgently referred to the hospital. In the hospital, meningitis is treated with chloramphenicol 25 mg/kg intramuscularly or intravenously every 6 hours and benzyl penicillin 100,000/kg units intramuscularly or intravenously every 6 hours for a total duration of 10 days.

Complications

Complication of meningitis include the following:

• 
  cerebral edema,
  
• 
  hydrocephalus,
  
• 
  brain abscess,
  
• 
  hypoglycemia,
  
• 
  deafness,
  
• 
  blindness,
  
• 
  convulsions,
  
• 
  subdural effusion,
  
• 
  subdural empyema,
  
• 
  mental retardation,
  
• 
  cerebral palsy and
  
• 
  syndrome of inappropriate ADH secretion.
  

The syndrome of inappropriate ADH secretion is characterized by low level of sodium in the blood (hyponatraemia) with excess water. This syndrome presents with restlessness, irritability, and convulsions. The treatment of a child with this syndrome consists of water restriction.