Sandbox:Ifeoma Anaya: Difference between revisions

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{| class="wikitable"
{| class="wikitable"
|+
|+
!Type of Rash/Lesion
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Types of urinary incontinence
!Description
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Details
|-
|-
|Macule
| style="background:#DCDCDC;" + |Physiological
|It is expected and seen as a norm in the early years.
Requires a minimum age of 5 years, at least one event in a month, and a minimum period of 3 months.
 
Persisting beyond the age of 5 years is termed pathological.
 
However, there are the 'late developers' who continue to experience physiologic urinary incontinence beyond the age of 5 years.
 
Clinical evaluation of these kids remains normal.
|-
| rowspan="4"style="background:#DCDCDC;" +|Pathological
|Organic: usually uncommon. In-depth investigations needed to be identified more so in cases that have not responded to conventional treatment
|-
|Functional or psychosomatic urinary incontinence: includes all forms of pathological urinary incontinence without anatomic or neurologic defects. Manifestations of which have been subdivided into:
|-
|Monosymtomatic enuresis(MEN): These kids have never had a dry period of >6 months and in the absence of any bladder dysfunction or symptoms suggestive of lower urinary tract issues
|-
|Non-monosymptomatic enuresis Nocturna(Non-MEN): diurnal presentation with an urge, frequency, and enuresis.
|}
 
 
{| class="wikitable"
|+
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Non-Infectious
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Disease
|-
| align="center" style="background:#DCDCDC;" + |Immune-mediated/Autoimmune
|Kawasaki Disease
Henoch-Schönlein Purpura
 
Juvenile Rheumatoid Arthritis
 
Juvenile Dermatomyositis
|-
| align="center" style="background:#DCDCDC;" + |Drug-related eruptions
|Erythema multiforme
SJS
 
TEN
|}
 
{| class="wikitable"
|+
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Infectious
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Disease
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Causative Organism
|-
| align="center" style="background:#DCDCDC;" + |Viral
|Measles
German Measles
 
Erythema infectiosum
 
Roseola infantum
 
Herpangina
 
Hand-foot-and-mouth disease
 
Molluscum contagiosum
 
Chickenpox
|Rubeola
Rubella
 
Parvovirus B19
 
Human Herpes Virus 6 & 7
 
Coxsackie virus
 
Coxsackie virus
 
Poxvirus
 
Varicella Zoster virus
|-
| rowspan="8" align="center" style="background:#DCDCDC;" + |Bacterial
|Meningococcemia<br />
|Neisseria meningitidis
Hemophilus influenzae
 
Streptococcus pneumoniae
<br />
|-
|RMSF
|Rickettsia rickettsii
|-
|HUS
|Enterohemorrhagic E.coli (EHEC)
|-
|Scarlet Fever
|Streptococcus pyogenes (Group A Streptococci, GAS)
|-
|Disseminated gonococcal disease in adolescents
|Neiserria gonorrhoea
|-
|SSSS
 
TSS
|Staphylococcus aureus
|-
|Lyme disease
|Borrelia burgdorferi
|-
|Relapsing fever
|Borrelia recurrentis
|-
| align="center" style="background:#DCDCDC;" + |Protozoan
|Babesiosis
|Babesia microti
|-
| align="center" style="background:#DCDCDC;" + |Fungal
|Histoplasmosis
Blastomycosis
 
Coccidiodomycosis
 
Paracoccidiodomycosis
|Histoplasma capsulatum
Blastomyces dermatitidis
 
Coccidioides immitis
 
Paracoccidioides brasiliensis
|}
 
{| class="wikitable"
|+
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Fever + Rash Morphology
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Disease
|-
| align="center" style="background:#DCDCDC;" + |Non-blanching lesions
|a. Meningococcemia
b. Rocky Mountain Spotted Fever (RMSF)
 
c. Hemolytic Uremic Syndrome (HUS)
 
d. Henoch-Schőnlein Purpura (HSP)
|-
| align="center" style="background:#DCDCDC;" + |Blanching rash
|a. Kawasaki disease
b. Juvenile Rheumatoid Arthritis
 
c. Juvenile Dermatomyositis
|-
| align="center" style="background:#DCDCDC;" + |Vesicular or bullous lesions
|a. Erythema multiforme
b. Steven-Johnson-Syndrome (SJS) and Toxic Epridermal Necrolysis (TEN)
 
c. Staphylococcal Scalded Skin Syndrome (SSSS)
 
d. Disseminated gonococcal disease in adolescents
 
e. HSV I & II
|-
| align="center" style="background:#DCDCDC;" + |Umbilicated papules and pustules
|a. Molluscum contagiosum
b. Varicella/Chickenpox
|-
| align="center" style="background:#DCDCDC;" + |Sandpaper rash
|a. Scarlet fever
|-
| align="center" style="background:#DCDCDC;" + |Viral syndromes
|a. Measles (Rubeola)
b. Rubella (German measles)
 
c. Erythema infectiosum (Parvovirus B-19)
 
d. Herpangina (Coxsackie)
 
e. Hand-foot-and-mouth disease (Coxsackie)
 
f. Roseola infantum (Human Herpes Virus types 6 or 7)
|-
| align="center" style="background:#DCDCDC;" + |Unclassified/Limited to certain geographical areas
|a. Babesiosis
b. Blastomycosis
 
c. Coccidiodomycosis
 
d. Histoplasmosis
 
e. Colorado Tick Fever
 
f. Lyme disease
 
g. Relapsing fever
 
h. Colorado Tick Fever
|}
There are several types of skin rashes classified based on size, consistency, color, etc. Below are some of the common ones encountered in clinical practice.
{| class="wikitable"
|+
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Type of Rash/Lesion
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Description
|-
| align="center" style="background:#DCDCDC;" + |Macule
|flat, circumscribed, usually <1cm in diameter
|flat, circumscribed, usually <1cm in diameter
|-
|-
|Papule
| align="center" style="background:#DCDCDC;" + |Papule
|raised/elevated lesion <1cm in diameter
|raised/elevated lesion <1cm in diameter
|-
|-
|Maculopapular
| align="center" style="background:#DCDCDC;" + |Maculopapular
|combination of both macules and papulus
|combination of both macules and papulus
|-
|-
|Nodule
| align="center" style="background:#DCDCDC;" + |Nodule
|papule in deeper dermis or subcutaneous tissue
|papule in deeper dermis or subcutaneous tissue
|-
|-
|Pustule
| align="center" style="background:#DCDCDC;" + |Pustule
|circumscribed raised lesion containing purulent material
|circumscribed raised lesion containing purulent material
|-
|-
|Vesicle
| align="center" style="background:#DCDCDC;" + |Vesicle
|circumscribed elevated skin lesion usually <1cm containing fluid
|circumscribed elevated skin lesion usually <1cm containing fluid
|-
|-
|Bulla
| align="center" style="background:#DCDCDC;" + |Bulla
|Bigger vesicle (>1cm and containing fluid)
|Bigger vesicle (>1cm and containing fluid)
|-
|-
|Purpura
| align="center" style="background:#DCDCDC;" + |Purpura
|non-blanching papules or macules due to extravasation of RBCs
|non-blanching papules or macules due to extravasation of RBCs
|-
| align="center" style="background:#DCDCDC;" + |Petechiae
|non-blanching pinpoint unraised spots usually measuring <2mm in size
|}
|}
{{SK}} Exanthema subitum; sixth disease; roseola infantilis; baby measles; three-day fever; rose rash of infants
==Roseola Infantum==
==Overview==
==Historical Perspective==
Previously known as "Roseola infantilis", the oldest known description of the disease dates as far back as 100 years ago by John Zahorsky, M.D in his publication in 1913  . Described as a symptom-complex of febrille erythema occuring in infants and not to be categorized alongside the erythema group of skin diseases. However, no clear-cut description was given to differentiate it from other pediatric skin eruptions <ref name="Zahorsky1913">{{cite journal|last1=Zahorsky|first1=John|title=ROSEOLA INFANTUM|journal=JAMA: The Journal of the American Medical Association|volume=61|issue=16|year=1913|pages=1446|issn=0098-7484|doi=10.1001/jama.1913.04350170028008}}</ref>. While the disease has been recognized for almost a century, Human Herpes Virus type 6 (HHV-6) was discovered in 1986 .
==Pathophysiology==
Mode of transmission is still not fully understood however it has been speculated that it is primarily via saliva and commonest form of transmission is from mother to child  . Viral replication occur mostly in CD4+ T cells and incubation period is between 9-10 days <ref name="pmid28846307">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=28846307 | doi= | pmc= | url= }} </ref>.
High levels of Metalloproteinase 9 and Tissue Inhibitor of Metalloproteinase 1 has been shown to disrupt the blood-brain barrier and thus, the cause of the febrille seizures observed in some infants infected with the virus .  More severe disease pathology can be seen in the immunocompromised because it remains latent in the lymphocytes and monocytes after primary infection  . 
==Causes==
Disease is caused by HHV-6 and less commonly by HHV-7 which are members of the '''''Herpesviridae''''' family <ref name="pmid28846307">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=28846307 | doi= | pmc= | url= }} </ref>. HHV-6 has a linear, double-stranded DNA genome <ref name="pmid28846307">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=28846307 | doi= | pmc= | url= }} </ref>. The HHV-6 has its primary variant, HHV-6B which is the associated with Roseola infantum while the other variant, HHV-6A has not been associated with any disease(s) <ref name="pmid28846307">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=28846307 | doi= | pmc= | url= }} </ref>.
==Epidemiology and Demographics==
Children are the most commonly infected. Newborns have passive antibodies to HHV-6 passed on to them from their mother which wanes by 4-6 months . By 12 months of age, incidence of the disease is about 40%, this increases to 77% by 24 months <ref name="pmid25462439">{{cite journal| author=Tesini BL, Epstein LG, Caserta MT| title=Clinical impact of primary infection with roseoloviruses. | journal=Curr Opin Virol | year= 2014 | volume= 9 | issue=  | pages= 91-6 | pmid=25462439 | doi=10.1016/j.coviro.2014.09.013 | pmc=4267952 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25462439  }} </ref>. Primary infection peaks between 9-21 months of age <ref name="pmid25462439">{{cite journal| author=Tesini BL, Epstein LG, Caserta MT| title=Clinical impact of primary infection with roseoloviruses. | journal=Curr Opin Virol | year= 2014 | volume= 9 | issue=  | pages= 91-6 | pmid=25462439 | doi=10.1016/j.coviro.2014.09.013 | pmc=4267952 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25462439  }} </ref>.
==Natural History, Complications and Prognosis==
Classical finding of Roseola infantum is very high fever which can be higher than 39°C <ref name="pmid28846307">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=28846307 | doi= | pmc= | url= }} </ref>. This fever lasts for 3-5 days and can be accompanied by other symptoms like malaise, conjuctivitis, inflammed tympanum, anorexia, irritability, lymphadenopathy, cough, etc <ref name="pmid28846307">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=28846307 | doi= | pmc= | url= }} </ref>. On sudden disappearance of the fever (3-5 days later), small, rose-pink, non-pruritic, blanching, maculopapular rashes appear first on the trunk and then spreads to the neck, face and extremities <ref name="pmid28846307">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=28846307 | doi= | pmc= | url= }} </ref>. This usually lasts 1-2 days and ends the infection period <ref name="pmid28846307">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=28846307 | doi= | pmc= | url= }} </ref>.
Complications seen during primary infection include febrille seizures, rhabdomyolysis, myocarditis, Guillain-Barre Syndrome <ref name="pmid28846307">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=28846307 | doi= | pmc= | url= }} </ref>. Limbic encephalitis seen in immunocompromised individuals post stem cell transplantation is an established long-term complication as a result of reactivation of HHV-6B virus <ref name="pmid25462439">{{cite journal| author=Tesini BL, Epstein LG, Caserta MT| title=Clinical impact of primary infection with roseoloviruses. | journal=Curr Opin Virol | year= 2014 | volume= 9 | issue=  | pages= 91-6 | pmid=25462439 | doi=10.1016/j.coviro.2014.09.013 | pmc=4267952 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25462439  }} </ref>.
Roseola infantum is a self limiting infection with very good prognosis and few complications <ref name="pmid28846307">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=28846307 | doi= | pmc= | url= }} </ref>.
==Diagnosis==
This is basically clinical. A well taken history and physical exam gives away the diagnosis of Roseola infantum and differentiates it from other viral exanthems.
==Treatment==
Usually supportive with antipyretics for fever and general discomfort, continued fluid intake to replace insensible losses from high temperatures, and rest. There is currently no vaccine for HHV-6 and no antiviral treatment for primary infection <ref name="pmid28846307">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=28846307 | doi= | pmc= | url= }} </ref>.
==Prevention==
Hand washing is encouraged to prevent spread <ref name="pmid28846307">{{cite journal| author=| title=StatPearls | journal= | year= 2020 | volume=  | issue=  | pages=  | pmid=28846307 | doi= | pmc= | url= }} </ref>.
==Differentiating Roseola Infantum from other Diseases==




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'''Urinary incontinence in children Microchapters'''
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Latest revision as of 02:05, 21 February 2021

Types of urinary incontinence Details
Physiological It is expected and seen as a norm in the early years.

Requires a minimum age of 5 years, at least one event in a month, and a minimum period of 3 months.

Persisting beyond the age of 5 years is termed pathological.

However, there are the 'late developers' who continue to experience physiologic urinary incontinence beyond the age of 5 years.

Clinical evaluation of these kids remains normal.

Pathological Organic: usually uncommon. In-depth investigations needed to be identified more so in cases that have not responded to conventional treatment
Functional or psychosomatic urinary incontinence: includes all forms of pathological urinary incontinence without anatomic or neurologic defects. Manifestations of which have been subdivided into:
Monosymtomatic enuresis(MEN): These kids have never had a dry period of >6 months and in the absence of any bladder dysfunction or symptoms suggestive of lower urinary tract issues
Non-monosymptomatic enuresis Nocturna(Non-MEN): diurnal presentation with an urge, frequency, and enuresis.


Non-Infectious Disease
Immune-mediated/Autoimmune Kawasaki Disease

Henoch-Schönlein Purpura

Juvenile Rheumatoid Arthritis

Juvenile Dermatomyositis

Drug-related eruptions Erythema multiforme

SJS

TEN

Infectious Disease Causative Organism
Viral Measles

German Measles

Erythema infectiosum

Roseola infantum

Herpangina

Hand-foot-and-mouth disease

Molluscum contagiosum

Chickenpox

Rubeola

Rubella

Parvovirus B19

Human Herpes Virus 6 & 7

Coxsackie virus

Coxsackie virus

Poxvirus

Varicella Zoster virus

Bacterial Meningococcemia
 Neisseria meningitidis

Hemophilus influenzae

Streptococcus pneumoniae

RMSF Rickettsia rickettsii
HUS Enterohemorrhagic E.coli (EHEC)
Scarlet Fever Streptococcus pyogenes (Group A Streptococci, GAS)
Disseminated gonococcal disease in adolescents Neiserria gonorrhoea
SSSS

TSS

Staphylococcus aureus
Lyme disease Borrelia burgdorferi
Relapsing fever Borrelia recurrentis
Protozoan Babesiosis Babesia microti
Fungal Histoplasmosis

Blastomycosis

Coccidiodomycosis

Paracoccidiodomycosis

Histoplasma capsulatum

Blastomyces dermatitidis

Coccidioides immitis

Paracoccidioides brasiliensis

Fever + Rash Morphology Disease
Non-blanching lesions a. Meningococcemia

b. Rocky Mountain Spotted Fever (RMSF)

c. Hemolytic Uremic Syndrome (HUS)

d. Henoch-Schőnlein Purpura (HSP)

Blanching rash a. Kawasaki disease

b. Juvenile Rheumatoid Arthritis

c. Juvenile Dermatomyositis

Vesicular or bullous lesions a. Erythema multiforme

b. Steven-Johnson-Syndrome (SJS) and Toxic Epridermal Necrolysis (TEN)

c. Staphylococcal Scalded Skin Syndrome (SSSS)

d. Disseminated gonococcal disease in adolescents

e. HSV I & II

Umbilicated papules and pustules a. Molluscum contagiosum

b. Varicella/Chickenpox

Sandpaper rash a. Scarlet fever
Viral syndromes a. Measles (Rubeola)

b. Rubella (German measles)

c. Erythema infectiosum (Parvovirus B-19)

d. Herpangina (Coxsackie)

e. Hand-foot-and-mouth disease (Coxsackie)

f. Roseola infantum (Human Herpes Virus types 6 or 7)

Unclassified/Limited to certain geographical areas a. Babesiosis

b. Blastomycosis

c. Coccidiodomycosis

d. Histoplasmosis

e. Colorado Tick Fever

f. Lyme disease

g. Relapsing fever

h. Colorado Tick Fever

There are several types of skin rashes classified based on size, consistency, color, etc. Below are some of the common ones encountered in clinical practice.

Type of Rash/Lesion Description
Macule flat, circumscribed, usually <1cm in diameter
Papule raised/elevated lesion <1cm in diameter
Maculopapular combination of both macules and papulus
Nodule papule in deeper dermis or subcutaneous tissue
Pustule circumscribed raised lesion containing purulent material
Vesicle circumscribed elevated skin lesion usually <1cm containing fluid
Bulla Bigger vesicle (>1cm and containing fluid)
Purpura non-blanching papules or macules due to extravasation of RBCs
Petechiae non-blanching pinpoint unraised spots usually measuring <2mm in size


classification
SCC
BCC
Melanoma

Practice here


Mitosis in neuroendocrine tumor. Source: Wikimedia commons
Classification of Waldenstrom macroglobulinemia (WM) and Related Disorders
Criteria Symptomatic WM Asymptomatic WM IgM-Related Disorders MGUS
IgM monoclonal protein + + + +
Bone marrow infiltration + + - -
Symptoms attributable to IgM + - + -
Symptoms attributable to tumor infiltration + - - -

Urinary incontinence in children Microchapters

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differential Diagnosis

Epidemiology and Demographics

Risk factors

Natural History, Complications and Prognosis

Diagnosis

Treatment

Prevention






References

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