Clinical Manifestations: The symptoms of hepatitis D resemble those of other hepatitis viruses but are more severe. The coinfection is common and manifests as an acute infection that is more severe than hepatitis B alone. The risk of coinfection resulting in fulminant hepatitis is 10%. However, the risk of a patient with coinfection to develop chronic hepatitis is low. In contrast, the risk of superinfection resulting in fulminant hepatitis is 20%. The superinfection may manifest with a severe chronic hepatitis that rapidly progresses to cirrhosis. The superinfection also leads to hepatocarcinoma at a younger age and at a higher rate than HBV infection alone.
Diagnosis
The diagnosis is based on the detection of anti-HDV IgM antibodies, HDV antigen and or HDV RNA by polymerase chain reaction.
Prevention
HDV infection is prevented through hepatitis B vaccine. This is because HDV only infects humans who are infected with HBV. HDV infection cannot be prevented in those already infected with HBV.
e) Hepatitis E.
HEV is transmitted through the faecal oral route. Hepatitis E virus may cause outbreaks associated with contamination of water supplies. Hepatitis E virus causes acute hepatitis primarily after the first decade of life. The incubation period is 2-6 weeks
Clinical manifestations
The clinical manifestations of hepatitis E are anorexia, nausea, vomiting, fever, pruritus, hepatomegaly and abdominal pain. These symptoms may persist for weeks before the jaundice appears. The acute infection resolves 1-6 weeks after the onset. Chronic disease does not occur.
Diagnosis:
The diagnosis is based on ELISA for detection of anti-HEV IgM antibodies.
Treatment and Prevention
No treatment is available and there is no vaccine available for its prevention.
F) Hepatitis G Hepatitis G virus was discovered recently. It is transmitted parenterally and is found more commonly in patients who have received blood products, clotting factors concentrates given to patients with bleeding disorders, haemodialysis or transplants. Hepatitis G is also spread through intravenous drug abuse, sexual contact and vertically from mother to child.
Symptoms
Infection with hepatitis G virus is mostly asymptomatic despite the very high level viremia. There is little evidence of direct hepatic involvement. It is not associated with fulminant or chronic liver disease
Diagnosis: The diagnosis of hepatitis G virus infection is based on the detection of HGV RNA by polymerase chain reaction.
Treatment:
No treatment is available.
Prevention:
No vaccine is available.
SUMMARY
In this unit, we have discussed other important common conditions that affect children. We have looked at Bacterial meningitis, Urinary tract infection, Diabetes mellitus, Typhoid, Osteomyelitis, Septic arthritis, Acute rheumatic fever, Nephrotic syndrome, and Viral hepatitis. We hope you are now able to diagnose, manage and prevent these conditions as some of their complications are not only life threatening but can also cause lifelong disability, failure to thrive and hepatocellular carcinoma.
This Unit is also the last one in this course on child health. It has been a long journey to get here and we congratulate you for your dedication. We hope you have found this course interesting and that it has equipped you with all the information you need to effectively manage and prevent ill health in children.
You can now take a well deserved break before you complete the attached Tutor Marked Assignment. Good Luck!
DIRECTORATE OF LEARNING SYSTEMS
DISTANCE EDUCATION COURSES
Student Number: ________________________________
Name: _________________________________________
Address: _______________________________________
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CHILD HEALTH COURSE
Tutor Marked Assignment
Unit 20 Assignment: Other Conditions
Instructions: Answer all the questions in this assignment.
1 a) A one and a half old child is brought for excessive crying and refusal to feed. You examine him and find that he has a stiff neck. Outline how you would investigate and manage this child.
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b) List any five complications the child may get.
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2. A child whose mother died recently of a disease characterized by a bloody cough is brought because of night sweats. Examination reveals wasting. Which 6 factors will you consider for establishing the diagnosis?
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3. a. A one year old boy has dribbling of urine from birth. What are the 5 likely complications of the above condition.
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b. A young girl cries when passing urine. She has had similar attacks in the past. State all the essential investigations for establishing the diagnosis.
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4. Match the terms in list A with the corresponding ones in list B by writing the letters corresponding with the correct term in List B in the space provided next to the terms in List A....................
List A
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List B
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Nephrotic syndrome ________
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Osteomyelitis _______
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Urinary tract infection _____
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Hepatitis B _______
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Delayed type hypersensitivity _____
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Ketoacidosis ________
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Typhoid fever _________
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Acute rheumatic fever _______
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Raised intracranial pressure ______
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Hyperlipidemia ___________
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a. unequal pupil size
b. serum lipase
c. polyarthritis
d intestinal perforation
e. hepatitis A
f lente insulin
g. hepatocellular carcinoma
h. vescicourethral reflux
i. staphyllococcus
j. schistosomiasis
k. primary complex.
l. glucagon
m. hypoglycaemia
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5. a. A 4 year-old boy known to be diabetic is admitted with deep sighing breathing. His blood glucose is 30mmol/l .List the 5 essential activities to carried out in managing the child’s condition.
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b. The blood of a nursery going child has been found to contain anti-HAC IgM. How would you manage this child?
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Once you complete this assignment, post or bring it in person to AMREF Training Centre. We will mark it and return it to you with comments.
Our address is as follows:
Directorate of Learning Systems
AMREF Headquarters
P O Box 27691-00506
Nairobi, Kenya
Email: amreftraining@amrefhq.org
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