Congenital and Neonatal Infections Congenital toxoplasmosis typically leads to calcif- of the Brain cations of the periventricular regions discount glucotrol xl american express diabetes type 2 in young adults, cortex and basal ganglia buy 10 mg glucotrol xl with amex diabetes mellitus type 2 autoimmune. The lateral ventricles are commonly dilated and Congenital infections of the brain are caused by an in- microcephaly can be present purchase 10 mg glucotrol xl managing diabetes 811. The fetal brain curs in the course of pregnancy, the less pronounced the reacts diferently to infectious agents than the neonatal changes usually are. The extent and pat- Congenital rubella infections have become rare tern of damage is also determined by the time of infec- in the Western world due to immunization programs tion during the in-utero development. In severe cases, fections can resemble the imaging appearance of leu- microcephaly and a dilatation of the lateral ventricles kodystrophies (Fig. Afected children patchy areas of hyperintensity on T2- and hypointensity commonly demonstrate developmental delay, micro- on T1-weighted sequences (Fig. In the further course, the grey The extent and pattern of cerebral afection again matter becomes involved as well. Ce- may be a pronounced dilatation of the lateral ventricles, rebral calcifcations are common as well. Pronounced signal alterations in the white matter as e well as polymicrogyria and microcephaly Specifics of Infectious Diseases of Childhood 201 a b c d Fig. If hydrocephalus is absent, microcephaly may be Clinically, afected children usually become symp- present. Calcifcations may be present, especially in a tomatic during the frst years of life. In addition, polymicrogyria infection leads to a cerebral atrophy in most afected may be found. Cere- Symptoms are ofen not noted until the children are bral ischaemia may occur. Epilepsy and inner-ear deafness are disease, a progressive multifocal leukencephalopathy common symptoms. When the mother is untreated, there is a 30% chance of transmission to the child; however, in 13. Initial symptoms can be largely sive atrophy ensues that eventually involves the entire unspecifc in children with mostly behavioural changes. It can occur in children and in adults and is rates are very high without treatment. An zoster virus the same virus that causes chicken pox and, asymmetric involvement is common. Afected children most commonly present sion-weighted sequences that may precede the changes with cerebellar symptoms such as ataxia or dysarthria. In this age group there typically is a cent outbreaks have occurred usually caused by parents focal or multifocal vascular distribution that may afect not immunizing their children. It Acute postinfectious encephalitis usually manifests may be caused by an autoimmune mechanism, a viral itself within 12 weeks from the onset of the measles infection or an immune-mediated response triggered rash. Afected children sufer from somnolence, Symptoms are commonly preceded by an infam- headaches and seizures. In the the basal ganglia, especially the caudate nucleus and the early stages of the disease, seizures usually occur with putamen, the thalami and the cerebral cortex with oe- a comparatively low frequency and a mild hemiparesis dema being present in the afected regions in the acute is noted. In the late stage of the disease there is perma- usually appear around 36 months afer the initial mea- nent hemiparesis. Hemispherectomy is a poten- sidered to be a late complication of an infection with tial treatment option. This type of In early stages of the disease, there is usually a swell- encephalitis is progressive in nature and eventually fa- ing of the gyri with a mild hyperintensity of the cortex tal usually in the course of 13 years. Hemiatrophy of the c lef hemisphere usually present with progressive mental deterioration, poral lobes are most commonly afected. In the further course, The Reye syndrome is an encephalopathy with a areas of increased signal intensity are usually noted in rather high mortality rate that tends to develop shortly the cortex and subcortical white matter on T2-weighted afer viral infections. The parietal and tem- tions and toxins, such as salicylates, has been discussed Specifics of Infectious Diseases of Childhood 205 a b Fig. Swelling and signal alterations in the cortical and subcortical regions mainly of the right but also of the lef hemisphere even though the mechanism has not yet been fully elu- Tere are multiple other causes of viral encephalitis, cidated; however, the incidence has been declining over including various enterovirus infections and infuenza the past years. Not infrequently, the cause of the encephali- Symptoms usually present acutely with headaches, tis is not identifed. The disease Children with cardiopulmonary malformations are tends to have a peal incidence in spring and early sum- more prone to sufer from cerebritis or cerebal abscesses. Afected children initially usually sufer from fu- A bacterial cerebritis can arise from an infection if the like symptoms, which are followed by signs of a menin- adjacent structures, e. Cerebritis and beginning abscess formation in a 14-year-old boy with sphenoid sinusitis. It is always important to control cerebral to occur in the basal ganglia or subcortical regions. A central ner- the abscess is usually hyperintense on T2-weighted and vous system infection with Mycoplasma pneumoniae can hypointense on T1-weighted sequences. The inner por- cranial neuropathy; however, encephalitis seems to be tion of this rim usually has a smooth border. A possible to brain neoplasms, the enhancing rim of an abscess is pattern of involvement is an acute striatal necrosis with usually comparatively thin. In a systemic nocardiosis there is a haematog- The diferential diagnosis between a cerebral neo- enous spread to various organ systems. A helpful distinc- third of cases, the central nervous system is afected as tion can be the diferent difusivity of these lesions. A cerebral nocardiosis usually leads to multiple contrast to cerebral neoplasms, the centre of an abscess brain abscesses with a ring-like enhancement and to usually shows a restricted difusivity with a decreased meningeal afection (Fig. Multiple foci of signal alterations with enhancement and perifocal oedema the Western world as well. Afected children Fungal and Parasitic Infections of the Brain ofen sufer from epileptic seizures; however, the clinical in Childhood presentation can be quite variable. This can occur anywhere in the Candida meningitis and cerebritis can occur in im- brain, but most commonly it is found in the grey matter. The basal meninges are preferentially in- tomeningeal cysticercal afection preferentially leads volved with pronounced enhancement. Tere can be to involvement of the basal meninges and may resem- adjacent abscesses; these usually have a comparatively ble tuberculous meningitis. Racematous cysticerci have a grape-like appearance A cryptococcal infection also preferentially leads to with septae. Tese cysts do not contain scolices but may an afection of the basal meninges but may also cause increase in size over time. Meningeal Infections of the Brain Again, there is a preferential afection of the basal me- in Childhood ninges. Cerebral cysticercosis is a comparatively common Meningitis is the most common intracranial infection infection worldwide. Tickening and an increased enhancement of the frontal meninges, as well c as a pronounced subcutaneous abscess formation 210 B.
His primary task was to look after the printing works that produced coloured prints purchase glucotrol xl 10 mg line diabete symptoms in dogs. For well over 20 years the work was done at a high pressure machine which gave off a lot of dye dust to the surroundings purchase glucotrol xl from india blood glucose exercise. He was diagnosed with a growth at the left side of his bladder purchase 10mg glucotrol xl amex homa diabetes definition, and a detailed cystoscopic examination showed that there was a bladder tumour without ingrowth, a benign bladder polyp (bladder papilloma). The Committee found that the benign bladder polyp had developed mainly as a result of the work as a printer for many years. The Committee took into consideration that surveys show an increased risk of developing a bladder polyp in connection with printing work, due to contact with dyes. Cancer diseases Example 1: Recognition of lymphatic cancer (non-Hodgkin lymphoma) (herbicides etc. In this connection he mixed 2-30 substances with water every day and occasionally was in direct contact with the substances. The Committee took into consideration that there is a medico-scientific suspicion of a correlation between non-Hodgkin lymphoma and herbicides, that the exposure was substantial and had stretched over many years, and that the onset of the disease occurred when he was relatively young. Example 2: Recognition of pharynx cancer (welding fumes, asbestos dust and other substances in a shipyard) A man worked for 18 years as a shipbuilder in a steel shipyard. He was then diagnosed with cancer on the left side of the pharynx/left tonsil (tonsil cancer). The Committee found that the pharynx cancer had been caused mainly by working for 18 years in a steel shipyard. The Committee took into consideration that the ship builder had not been a smoker or had any substantial alcohol consumption, factors which are known causes of this rather rare type of cancer. He had suffered a number of risky exposures in the workplace for some time, even though the research into causalities, and thus the medical documentation in the field, was limited. Example 3: Recognition of oral cavity cancer (glasshouse) A man worked for 20 years as a glassblower in a large glasshouse. The work involved exposure to excessive heat in connection with blowing of glass (hot glass steam), contact with glass dust and iron/metal dust as well as contact, for much of the period, with asbestos and manganese. He developed a cancer tumour in the oral cavity, starting from the tongue, and was given radiation therapy with a positive result. The Committee found that the oral cavity cancer had been caused mainly by the work as a glassblower for many years. Medical knowledge points to a correlation between the exposures from glassblowing and the development of the disease in question, and furthermore he was a non-smoker. Example 4: Recognition of breast cancer after night-shift work (nurse for 21 years) A 57-year-old woman was diagnosed with cancer in her left breast and underwent an operation to have her breast removed. She had had 24-hour shifts and combined evening/night shifts stretching from 13:00 till 07:30. Previously, in other employments as a nurse, she had had night-shifts once or twice a week for about 10 years. In connection with this case the National Board of Industrial Injuries obtained an assessment from an expert from the Danish Cancer Society, from which the following appeared. About breast cancer in general With about 4,000 new cases each year, breast cancer in women is the most rapidly increasing cancer disease in Denmark. Among women the disease constitutes almost 25 per cent of all cancer cases, not including general skin cancer. The risk of cancer in women has been on a steady increase since the Cancer Registry was established in 1943, the age-adjusted prevalence today being twice as high as in the 1940s. Part of the prevalence seems to be the result of a carcinogenic effect of the female hormone estrogen, which a woman generates in her body. Accordingly, the risk of breast cancer is significantly reduced when the strength or duration of estrogen in a womans body is reduced, for instance in case of a late first menstrual bleeding or an early menopause. The risk is also reduced as a consequence of one or more pregnancies, in particular if the first pregnancy occurred at an early age. The use of sex hormones (contraceptive pills and medication for menopausal symptoms) implies an increased risk of breast cancer, as is also the case for natural estrogen. However, the negative effect of estrogen medication ceases already a few years after cessation of the treatment. Furthermore a daily, moderate to large consumption of alcohol has been linked with an increased risk of breast cancer, and a small number of cases in the population were caused by exposure to ionising radiation (x-rays and gamma rays). However, only a minor part of the increase in breast cancer since the 1940s can be explained by changes in the known risk factors over time. The major part of the increase was caused by factors which have been inadequately mapped or are unknown. One of these factors is regular and long-lasting night work, which now is suspected of being able to increase the risk of breast cancer. Night-shift work with interruptions in the circadian rhythm In the course of the past 10 years surveys have indicated that work during the dark hours can be a risk factor for breast cancer in women. Researchers have found that the increased risk might have been caused by the sleep hormone melatonin, which possibly offers protection against the development of cancer. Melatonin is generated during the night, when you are asleep, in a gland in the brain. The secretion of this hormone is restricted or interrupted if you are awake and are somewhere with artificial lighting. There are many types of shift work, but those including recurring night work seem to cause the most significant upsets in the natural, biological circadian rhythm. Against the background of the current research on breast cancer and night shift work, including in particular a survey report from 2013, the Committee has set up a practice for recommending recognition. According to practice, the Committee will in principle recommend recognition of a claim if the person in question has worked many hours during the night (between 23:00 and 06:00) for at least 25-30 years and at least once a week on average. There may possibly be an increased risk of developing breast cancer in connection with several night shifts per week in relation to one night shift per week. A majority on the Committee therefore found that several night shifts per week will also in future be included in the assessment of the concrete claim and may be in favour of recognition despite less than 25 years of night shift work. On the basis of this practice the Committee decided that the nurses left-sided breast cancer was caused mainly by the recurrent night-shift work (section 7(1)(ii)). The Committee took into account that the nurse had had night work more than once a week for more than 20 years and that there was no information of other substantial risk factors that might explain the development of the disease. Example 5: Recognition of skin cancer (auxiliary nurse exposed to x-rays) A 65-year-old auxiliary nurse had worked with x-rays for more than 30 years in a hospital. More than half the time she was in the examination room and nearly every day she helped fixate patients on the plinth during the x-ray process. A couple of years after she had ceased doing this work she developed skin cancer of the rd th squamous cell carcinoma type on the 3 and 4 finger of her right hand.
P. Pakwan. Smith College.