Forensic Nursing Guide: Pediatric Diseases

The number one world-wide killer is infectious disease caused by bacteria, viruses, fungi, and protozoa. These diseases are spread by both direct and indirect contact with the contagion. Children are particularly susceptible to infection since their immune systems are still developing the resistance to fight off invasive viruses and bacteria. It can be difficult to spot the difference between infections caused by bacteria and viruses, and some conditions could potentially be caused by both bacteria and viruses. However, the two are quite different microorganisms whose detrimental effects require health care professionals to use specialized forms of treatment.

Vaccination and Immunization

They say an ounce of prevention is worth a pound of cure, and that is certainly the case with certain infectious diseases. When possible, it is recommended that children be vaccinated against the more prevalent and harmful infectious diseases.

The immune system is the body’s defense against infection. When a body is attacked by infectious microorganisms, it takes approximately two weeks for the immune system to produce antibodies. Antibodies are employed to recognize infectious organisms and kill them. Future antibodies then have the ability to recognize and destroy that specific infection, so that if it enters the body again, it will immediately be targeted and destroyed. This process is called acquired immunity, and it explains why people never get the chicken pox twice, to take a common example.

Thankfully, research conducted since the eighteenth century has made it so that people don’t necessarily have to survive every infection in order to acquire immunity to it. We can use vaccines to protect ourselves from certain diseases. Vaccines are weakened or incomplete forms of microorganisms that are incapable of causing disease. When these lesser forms are introduced into the body, it stimulates the immune system to produce antibodies as if they were the real thing. These antibodies will effectively repel the actual disease should it attempt to infect your system. Vaccines are available for both viral and bacterial infections, but only for specific kinds of diseases.

Bacterial Infections

Bacterial infections are caused by single-celled microorganisms called bacteria. Bacteria has gotten a bad rap among most people; although both helpful and harmful strains of bacteria exist all around us, most people only think of the harmful type. While bacteria in general are overwhelming helpful microorganisms that assist in the digestion of food, acquisition of vitamins, and staving off of disease, it’s true that about one percent of bacteria can cause infection in humans.

Bacteria are complex in structure because they contain all the genetic information necessary for independent reproduction inside their cell walls. Bacterial infections stem from two causes. When infectious bacteria gets into the human body, it reproduces rapidly and crowds out healthy bacteria in places like the mouth. Sometimes, harmful, or pathogenic bacteria, releases toxins into the body. Alternatively, if pathogenic bacteria gets into an area that is normally sterile, like the bladder.

Once bacteria enters the body, either directly or indirectly, a healthy immune system recognizes the alien bacteria and attempts to destroy it. If that attempt is unsuccessful, an infection occurs as pathogenic bacteria multiplies and spreads. Typically, bacterial infections are symptomatic of localized pain, such as that occurring in conjunction with an ear or throat infection. Additionally, a fever often accompanies bacterial infections, though a wide range of symptoms may occur, which will vary depending on what part of the body is infected, and by what specific kind of bacteria.

Bacterial infections are treatable with antibiotics, which work by either inhibiting the spread and reproduction of pathogenic bacteria, or by killing it outright. Antibiotics can be taken orally or by injection. Some types of bacterial infection require hospital stays, particularly if complications arise. Further treatments for bacterial infection include rest, good nutrition, and increased fluids.

Some bacterial infections common to children are listed below, along with symptoms and treatment options.

Tuberculosis (TB) is a serious bacterial lung infection spread through coughs or sneezing. TB can also affect a person’s spine, brain, and kidneys. Doctors distinguish between Latent TB, which is an inactive infection, and Active TB, which makes you sick.

• Symptoms of Active TB are coughing, inexplicable weight loss, loss of appetite, fatigue, fever, night sweats, and chills.

• Treatment for Active TB involves taking several medications, such as Isoniazid, Rifampin, Ethambutol, and Pyrazinamide, for six to nine months. A person ceases to be contagious after a few weeks of treatment, but it is essential to finish the prescribed treatment plan so the infection won’t recur.

Bacterial pneumonia, an inflammation of the lungs, can be caused by bacterial or viral infections, as well as certain kinds of fungi or parasites. It can be life-threatening in children and the elderly.

• Symptoms: Pneumonia is often overlooked at first because its symptoms are similar to that of the flu, including a fever, cough, shaking chills, shortness of breath, chest pain, muscle pain, and fatigue.
• Treatment may take some trial and error to determine the best type of antibiotic to be prescribed. Children should not take aspirin, but may use fever-reducers specifically formulated for children. Cough suppressants, rest, and fluids are recommended.

Streptococcal infections fall into two categories: Group A strep and Group B strep.

Group A strep (GAS) diseases, which result from bacteria found in the throat and on the skin, include relatively mild diseases like strep throat and impetigo, though occasionally this bacteria causes very rare, serious diseases like streptococcal toxic shock syndrome (not the kind associated with tampon use) and necrotizing fasciitis.

Group B strep does not usually present a problem in adults, who frequently carry the bacteria without negative effects, but it is a serious issue for infants, who can contract it during labor. Onset of group B strep can be early (within 12 hours of birth) or late (between a week and several months from birth). Early onset is both more common and serious.

• Early onset group B strep is characterized by fever, difficulty feeding, and lethargy; late onset has all the above symptoms with the addition of coughing, congestion, and seizures.
• Treatment for an infant consists of intravenous antibiotics.

Staph Infection can be deadly if the staphylococcus bacteria enters a person’s bloodstream, joints, bones, lungs, or heart.

• Symptoms vary widely depending on the severity and location of the infection. A child should see a doctor if he or she has areas of irritated skin, pus-filled blisters, or fever. Specific symptoms of skin infection might include boils under the arms or around the groin or buttocks; oozing blisters around the nose and mouth; skin redness and swelling called cellulitis (though most often this does not occur in children); and staphylococcal scalded skin syndrome in infants. It can also result in blood poisoning, toxic shock syndrome and septic arthritis.
• Treatment may include antibiotics and drainage of the wound.

Viral Infections

Viral infections are caused by microorganisms even smaller than bacteria called viruses. Many types of virus are so small that they can only be seen using electron microscopy techniques. Unlike bacteria, which can replicate independently, a virus requires a living host cell to reproduce itself. Thus, a virus enters the body, invades the cells, and takes them over, redirecting the cells to produce the next generation of the virus.

A virus has a much simpler structure than bacteria, composed of a gene and some protein enzymes, and sometimes encapsulated in a protective lipid envelope, or layer of fat. Researchers have identified over 2,000 kinds of virus. Some kinds are benign, or harmless. Others, however, are virulent, or harmful. Virulent viruses are systematic, meaning that unlike bacterial infections, which tend to be localized, viral infections attack many parts of the body at one time.

Many viruses are not yet curable, and if a person contracts one of those viruses, he or she must simply wait it out, as in the case of the common cold. However, during the last two decades, scientists spurred on by the AIDS pandemic have developed several antiviral drugs. Antivirals target different stages of the life cycle of a virus to stop it from functioning. Some drugs prevent the virus from attaching itself to healthy cells, while others destroy the enzymes the virus needs in order to reproduce or halt the virus’ DNA production.

Some viral infections common to children are listed below, along with symptoms and treatment options.

Chickenpox is an exceptionally contagious viral infection that used to be “considered a rite of passage” of childhood, as the Mayo Clinic aptly states. It can be vaccinated against now, but when it does occur, it is very uncomfortable.

• Chickenpox is characterized by the appearance of a red, itchy rash consisting of bumps called papules that breaks out over the upper body. After about a day, the bumps will turn into vesicles, or fluid-filled blisters, which will eventually burst and leak. After they do so, they will scab over and take several more days to heal. New spots may continue to appear for several days.
• Doctors might prescribe an antihistamine to reduce itching, but chickenpox ought to run its course naturally.

Parvovirus infection is also called Fifth disease or slapped-cheek disease due to the distinct red markings that appear on the cheeks of infected persons.

• In addition to the face rash, this virus causes a sore throat, fever, upset stomach, headache, fatigue, and itching.
• Parvovirus infection is usually mild. Children should recover with rest and at-home care.

Hand-foot-and-mouth-disease is a mild, contagious disease that can usually be avoided by practicing proper hygiene.

• Symptoms of hand-foot-and-mouth-disease are mouth sores and a rash on the hands and feet. Diagnosis is usually straightforward due to these symptoms.
• No specific treatment is needed for this infection, although doctors may prescribe oral painkillers to ease soreness in the mouth. Symptoms will clear up in seven to ten days.

Influenza attacks the respiratory system, affecting the nose, throat and lungs. Thousands of people die each year in the United States from complications of “the flu”. Young children are especially vulnerable to the flu.

• Influenza tends to come on suddenly. Chills, headache, cough, congestion, fatigue, muscle soreness, and fever are all indicators of the flu. It may feel like an extreme rendition of the common cold.
• Bed rest and lots of fluids are the best way to recover from the flu. For a particularly difficult case, doctors might prescribe antivirals such as oseltamivir and zanamivir.

HIV/AIDS HIV is a sexually-transmitted disease that can be spread to children during childbirth or through breastfeeding. HIV stands for human immunodeficiency virus, and it destroys a body’s ability to fight other infectious diseases. After several years, HIV weakens a person’s immune system to the point where they have AIDS: acquired immune deficiency syndrome. AIDS is considered a worldwide pandemic. In 2009, more than 33 million people in the world were living with AIDS.

• When a person is initially infected with HIV, they make experience flu-like symptoms within the first few weeks. He or she may remain entirely without symptoms for several years, but could develop chronic symptoms like swollen lymph nodes, diarrhea, weight loss, fever, and shortness of breath. After about ten years, HIV can weaken the immune system to the point of AIDS. Symptoms typical of AIDS are night sweats and chills; a high fever lasting several weeks; unusual spots or lesions in the mouth; persistent fatigue; headaches; blurred vision; weight loss; and skin rashes.

• There is no cure for HIV/AIDS, but several drugs can be used in combination to slow the progression of the disease. Treatment can be a difficult, lifelong process with side effects including, but not limited to, nausea, weakened bones, and abnormal heartbeats.

Fungal and Protozoan Infections

Fungal infections like athlete’s foot or yeast infection are caused by fungi like mushrooms, mold, and mildew that reproduce through minuscule spores in the air. Very occasionally, children can develop fungal diseases. However, it is so rare an occurrence that proper treatment may not be clear.

Protozoan infections are parasitic infections like giardia and malaria. They are caused by protozoa or helminths. See the CDC: Parasites website for more information.

Additional Resources

Medicine Plus is a service of the National Institutes of Health. There, you can find resources on childhood immunization, as well as the childhood immunization schedule. Some parents worry about the safety of vaccinating their children; direct them towards the American Academy of Pediatrics Immunization Safety Handout.

For general information on infectious disease, see the Infectious Disease Society of America. You can also read an online booklet called “Understanding Microbes in Sickness and in Health“. Additionally, Microbe World and The Virtual Museum of Bacteria contain information about the structure of micro-bacteria and the effects they have on humans.

The Center for Disease Control lists information about specific conditions in a Disease and Conditions Index. CDC produces useful professional journals entitled Emerging Infectious Diseases and Preventing Chronic Disease, and to keep up with current statistics, see the CDC Morbidity and Mortality Weekly Report.