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Paediatrics, Children's Hospital and Woman's Hospital
Malaria is an infectious disease caused by the parasitic protozoan Plasmodium.
It is transmitted through the bite of mosquitoes of the genus Anopheles. The mosquito acts as a vector or transmitter of the disease. The mosquito bites an already infected person. The parasite reproduces and develops inside the mosquito. The mosquito subsequently bites another person who in turn becomes infected.
It cannot be transmitted from one person to another without the presence of a mosquito, except in the case of an infected blood transfusion or from mother to foetus through the placenta.
Mosquitoes generally bite during hours of low light: dusk, during the night and dawn. They live in urban as well as rural areas. During the rainy season there are more mosquitoes, therefore the risk of being bitten and contracting the disease is higher.
Malaria was eradicated in Europe over 50 years ago, and so cases seen are due to travel to endemic countries for reasons such as immigration, tourism, and business. The majority of cases are seen in immigrants after having returned to their native countries to visit family. This occurs due to the fact that although they should be taking the same measures as tourists, more often than not they do not. 95% of cases are imported from Africa, 3% from Asia and 1% from South America.
The incubation period varies from one week to over a month. As such, symptoms may present themselves shortly after entering an endemic area or several months after having returned from one.
Symptoms generally include high fever, chills, headache, sweating, and generalised joint and muscle pain. Some patients experience symptoms every 2-3 days and others experience a persistent fever. If the disease is not diagnosed and treated accordingly it can develop rapidly and become life-threatening. Alterations in consciousness, convulsions, coma, difficulty breathing and haemorrhaging are signs of a bad prognosis. Requires immediate medical attention.
It is important to keep in mind that any child with a fever and history of travel to an endemic country should be suspected of having malaria unless proved otherwise.
Malaria is common in tropical and subtropical areas (both sides of the equator). The countries in which malaria is endemic have been grouped into 4 regions: Africa, America, Asia and the Pacific, and the Middle East and Eurasia. More than 90% of the malaria cases in Africa are caused by Plasmodium falciparum, the most serious and deadly. America and the Middle East and Eurasia are dominated by Plasmodium vivax. A much more common form of malaria with a lower mortality rate.
In Asia and the Pacific, infections are a mix of Pl. vivax and Pl. falciparum with a moderate number of cases of mortality. Generally speaking, the areas with the highest risk for travellers are Sub-Saharan Africa, South East Asia, Papua New Guinea and the Indian subcontinent.
A diagnosis is reached through detection of the parasite either in the red blood cells, or through processes of molecular biology.
Early diagnosis is crucial. The pharmaceuticals used in Europe differ from those used in endemic countries in places like Africa. Depending on the severity, certain intravenous drugs may be required immediately. Severe malaria is usually treated in Intensive Care Units in anticipation of serious complications.
In a case of suspected malaria, blood testing is crucial. If there are alterations in any organs, individual exploration of said organs is necessary; for example, brain image scanning in the event of nervous system impairment, which is very common in severe cases of malaria.
With malaria, prevention is crucial. The use of antimalarial medication before travelling to endemic countries is vital, as failure to do so means the probability of contracting the disease is very high due to the fact that it is almost impossible to avoid mosquito bites even by using insect repellent and mosquito nets.
Antimalarial medication, to be prescribed by a doctor in each case, should be started before beginning a trip up until a few days after returning.
The Escherichia coli (E. coli) bacteria is one of the most common causes of human illness. It forms part of the digestive flora and is always present in faecal matter.
By little known mechanisms it episodically causes disease in humans, either due to mutations that make it resistant to our body’s control mechanisms, or because it is present in places it should not normally be, such as the urinary tract or in the blood itself.
E. coli infections cover a range of severities, from a urinary tract infection which causes urinary discomfort, to infections from very aggressive strains such as the O157 strain: H7 causes Haemolytic Uraemic Syndrome (HUS).
A urinary infection caused by E. coli is the most common infection caused by the bacteria.
The low-severityE. coli infection that leads to a urinary tract infection is much more common than that which leads to HUS, which is considered a rare condition, and very uncommon in the general population.
In the case of HUS, a rare condition as previously stated, the E. coli bacteria causes bloody diarrhoea and blood clotting in the smallest veins (thrombotic microangiopathy). This leads to kidney failure and also the alteration of other organs such as the heart and brain.
HUS is a serious phenomenon, which, if is not diagnosed and treated early, can cause death.
Infection with E. coli, which primarily affects the urinary tracts, causes discomfort when urinating, pain and increased frequency of urination, and fever if the kidneys are affected.
HUS is characterised by a feeling of general unwellness, bloody diarrhea, with or without a fever.
Infection by E. coli, normally a urinary infection, affects breastfeeding infants who do not have control of their sphincters, something which facilitates the extension of the intestinal flora into the urinary tract, and also in women of childbearing age.
HUS can occur at any age, but is most common between the ages of 4 and 12, after having consumed foods contaminated with E. coli O157, normally meat or dairy products from cows that are themselves infected with E. coli O157.
E. coli is diagnosed in the Microbiology laboratory, using cultures of a suitable medium, or through detection using techniques of molecular biology.
The treatment is an antibiotic, either oral or intravenous, depending on the extent of the infection and the patient’s general condition.
The treatment for HUS caused by E. coli is always hospitalisation, with the possibility of hemodialysis being prescribed to treat renal failure.
Patients with HUS produced by E. coli very often make a full recovery, despite it being a serious disease.
In the case of suspected E. coli, it is necessary to identify E. coli, generally in the blood or urine, through cultures, to confirm the diagnosis and prescribe the appropriate antibiotic.
Additionally, if infection by E. coli is confirmed, an image test such as an ultrasound is indicated in order to evaluate the state of the kidneys and urinary tracts.
If HUS is suspected, hospitalisation is always indicated to check for signs of thrombotic microangiopathy (TMA): anemia, renal failure, decreased platelet count, and broken or fragmented red blood cells.
A universally effective prevention for E. coli does not exist.
It is important to drink a lot of water in order to urinate every 2-3 hours, and above all not to hold pee in when you feel the urge to go.
Veterinary control of animals who carry E. coli O157 is fundamental for the prevention of HUS.
Paediatric age onset systemic autoimmune diseases are infrequent, complex entities that require a multi-disciplinary approach. The most frequent include juvenile onset systemic lupus erythematosus, mixed connective tissue disease, juvenile onset Sjögren’s syndrome, juvenile dermatomyositis, juvenile scleroderma, and paediatric age onset vasculitis, such as Kawasaki disease, IgA vasculitis (also known as Schönlein-Henoch purpura), polyarthritis nodosa and Takayasu disease.
The clinical manifestations of these diseases are highly varied. Juvenile systemic lupus erythematosus may affect several organs in the body, particularly the skin, joints, blood, kidneys and the central nervous system. In children, it is common for fever to appear without an infectious cause or an increase in the size of the lymph nodes.
Juvenile dermatitis is characterised by the presence of fatigue, muscle pain, weakness and the appearance of rashes that may affect the face, with inflammation around the eyes (periorbital oedema) There may also be reddening of the cheeks (malar rash) and other parts of the body (top part of the knuckles, knees and elbows), where the skin may become thicker (Gottron’s papules). Juvenile scleroderma, whose name comes from the Greek and means “hard skin”, is characterised by the presence of lesions on the skin and affects various organs. Two types can mainly be identified: localised scleroderma and systemic scleroderma.
Kawasaki disease is characterised by the presence of a high fever of unknown origin, irritability, reddening of the eyes and various skin lesions, such as a rash on the torso, flaking fingers and reddening of the tongue (normally called “strawberry tongue”). The involvement of the heart is the most serious manifestation of Kawasaki disease, due to the possibility of long-term complications.
Schönlein-Henoch purpura is characterised by a rash on the legs called “palpable purple” because the skin lesions can be touched, and painful and swollen joints, abdominal pain and kidney problems may appear.
All the conditions within the group are infrequent and have an incidence of less than 5 cases per 10,000 inhabitants, for which reason they are considered to be rare conditions. The spread is different depending on the disease. For example juvenile systemic lupus erythematosus, along with juvenile dermatomyositis and scleroderma, are more common in girls, while Schönlein-Henoch purpura is more common in boys.
Diagnosis of paediatric systemic autoimmune diseases is eminently clinical and we are guided by classification and diagnostics criteria in many of them. Blood tests are important for diagnosing the different systemic autoimmune diseases, as various autoantibodies can be identified that can help with the diagnosis and monitoring of these diseases. Supplementary tests, such as a capillaroscopy, chest X-ray, respiratory function tests, nuclear magnetic resonance and echocardiogram, amongst others, can be helpful when we come to approaching a paediatric patient with a suspected systemic disease.
Treatment fundamentally depends on the type of condition and the response to the therapy chosen. There is not currently any specific curative treatment for each one of the diseases, but the treatments available will help to control the signs and symptoms of the disease and prevent complications, including permanent damage to organs and tissue.
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