I
Ichthyosis
-
Definition: Group of inherited disorders characterized by dry, scaly skin due to abnormal keratinization.
-
Common Types:
-
Ichthyosis vulgaris (autosomal dominant, mild, flexural sparing).
-
X-linked ichthyosis (males, associated with steroid sulfatase deficiency).
-
Lamellar ichthyosis (autosomal recessive, generalized thick scales at birth).
-
-
Clinical Features: Dry, rough, thickened skin; scaling may be generalized or localized.
-
Investigations: Primarily clinical; genetic testing if severe or syndromic.
-
Management: Regular emollients, keratolytic agents, topical retinoids in severe cases.
Immune Thrombocytopenic Purpura (ITP)
-
Definition: Acquired autoimmune disorder causing isolated thrombocytopenia in children.
-
Clinical Features: Petechiae, purpura, mucosal bleeding; usually otherwise well child.
-
Etiology: Often follows viral infection; autoantibodies target platelet antigens.
-
Investigations: CBC (isolated low platelets), peripheral smear, bone marrow if atypical.
-
Management:
-
Most cases self-limiting: observation.
-
Severe bleeding: IV immunoglobulin, corticosteroids.
-
-
Prognosis: Excellent; chronic ITP rare in children.
Impetigo
-
Definition: Superficial bacterial skin infection caused by Staphylococcus aureus or Streptococcus pyogenes.
-
Clinical Features:
-
Non-bullous: Honey-colored crusts on face and extremities.
-
Bullous: Fluid-filled blisters that rupture easily.
-
-
Investigations: Clinical diagnosis; culture if atypical or resistant.
-
Management: Topical mupirocin for localized lesions; oral antibiotics (e.g., cephalexin) for extensive disease.
-
Complications: Post-streptococcal glomerulonephritis.
Inborn Errors of Metabolism (IEM)
-
Definition: Group of genetic disorders causing enzyme deficiencies leading to accumulation or deficiency of metabolites.
-
Examples:
-
Phenylketonuria (PKU): Phenylalanine hydroxylase deficiency → intellectual disability if untreated.
-
Maple Syrup Urine Disease: Branched-chain ketoacid dehydrogenase deficiency → neurologic crises.
-
Urea cycle defects: Hyperammonemia, poor feeding, lethargy.
-
-
Investigations: Newborn screening, plasma amino acids, urine organic acids, enzyme assays.
-
Management: Dietary restrictions, supplements, emergency metabolic management.
Infectious Mononucleosis
-
Definition: Acute lymphoproliferative disease caused by Epstein-Barr virus (EBV).
-
Clinical Features: Fever, pharyngitis, cervical lymphadenopathy, hepatosplenomegaly, fatigue.
-
Investigations:
-
Monospot test (heterophile antibodies), EBV serology.
-
CBC: atypical lymphocytosis.
-
-
Management: Supportive care, avoid contact sports due to splenomegaly.
-
Complications: Hemolytic anemia, thrombocytopenia, airway obstruction (rare).
Infective Endocarditis (Pediatric)
-
Definition: Infection of the endocardial surface of the heart, commonly affecting valves.
-
Etiology: Streptococcus viridans, Staphylococcus aureus, congenital heart disease predisposes.
-
Clinical Features: Fever, new murmur, malaise, splinter hemorrhages, Janeway lesions (rare in children).
-
Investigations: Blood cultures, echocardiography (vegetations), CBC, ESR.
-
Management: IV antibiotics (usually 4–6 weeks), surgical intervention for refractory cases.
Infant Colic
-
Definition: Recurrent, prolonged, and intense crying in otherwise healthy infants <3 months old.
-
Etiology: Multifactorial: gastrointestinal immaturity, gas, parental anxiety, diet.
-
Clinical Features: Episodes >3 hours/day, >3 days/week, >3 weeks.
-
Management:
-
Reassurance, soothing techniques, dietary adjustments (maternal elimination diet if breastfeeding).
-
Pharmacologic therapy rarely needed.
-
-
Prognosis: Self-limiting, usually resolves by 3–4 months of age.
Iron Deficiency Anemia
-
Definition: Anemia due to insufficient iron for hemoglobin synthesis, most common pediatric nutritional deficiency.
-
Etiology: Inadequate dietary intake, chronic blood loss, prematurity, cow’s milk overuse.
-
Clinical Features: Pallor, fatigue, irritability, pica, koilonychia in older children.
-
Investigations: CBC (microcytic hypochromic), serum ferritin, iron, TIBC.
-
Management: Oral iron supplementation, dietary counseling.
-
Complications: Developmental delay, growth retardation if prolonged.
Intussusception
-
Definition: Telescoping of one segment of intestine into another, causing bowel obstruction.
-
Epidemiology: Most common between 6–24 months.
-
Clinical Features: Sudden colicky abdominal pain, vomiting, “currant jelly” stools, palpable sausage-shaped mass.
-
Investigations: Ultrasound (target sign), contrast enema (diagnostic and therapeutic).
-
Management: Non-surgical reduction (air or contrast enema); surgery if perforation or failed reduction.
Intestinal Malrotation
-
Definition: Congenital abnormal rotation of midgut around superior mesenteric artery.
-
Clinical Features: Bilious vomiting, abdominal pain, failure to thrive, intermittent obstruction.
-
Investigations: Upper GI contrast study (corkscrew appearance for volvulus).
-
Management: Surgical correction (Ladd procedure), emergency if volvulus present.
Iron Overload / Hemochromatosis (Rare in Pediatrics)
-
Definition: Excessive iron accumulation leading to organ dysfunction.
-
Etiology: Rare hereditary forms, chronic transfusions (thalassemia, sickle cell).
-
Clinical Features: Hepatomegaly, cardiomyopathy, endocrinopathy, growth retardation.
-
Investigations: Serum ferritin, transferrin saturation, genetic testing.
-
Management: Phlebotomy or chelation therapy (deferoxamine, deferasirox).
Isolated Congenital Anomalies of Kidney and Urinary Tract (CAKUT)
-
Definition: Developmental anomalies affecting kidneys, ureters, bladder.
-
Examples: Renal agenesis, duplex kidney, ureteropelvic junction obstruction, posterior urethral valves.
-
Clinical Features: Often asymptomatic; recurrent UTIs, failure to thrive, hypertension.
-
Investigations: Ultrasound, VCUG, renal function tests.
-
Management: Observation, prophylactic antibiotics, surgical intervention if obstruction or recurrent infection.
Iron-Refractory Iron Deficiency Anemia (IRIDA)
-
Definition: Rare hereditary anemia resistant to oral iron due to TMPRSS6 mutation affecting hepcidin regulation.
-
Clinical Features: Chronic microcytic anemia unresponsive to oral iron; fatigue, pallor.
-
Investigations: Low MCV, low ferritin, low transferrin saturation, genetic testing.
-
Management: IV iron supplementation; avoid ineffective oral iron therapy.