Measles
Measles is an acute viral disease characterized by fever, cough, coryza, and conjunctivitis, followed by a maculopapular rash beginning on the face and spreading cephalocaudally and centrifugally. During the prodromal period, a pathognomonic enanthema (Koplik spots) may be present. Complications include otitis media, bronchopneumonia, laryngotracheobronchitis (croup), and diarthea and occur commonly in young children and immunocompromised hosts. Acute encephalitis often results in permanent brain damage and ocours in approximately 1 of every 1,000 cases. Case-fatality rates are increased in children younger than 5 years and immunocompromised children. Sometimes,
the characteristic rash does not develop in immunocompromised patients.
Subacute sclerosing panencephalitis (SSPE) is a rare degenerative central nervous system disease characterized by behavioral and intellectual deterioration and seizures. Widespread measles immunization has led to the virtual disappearance of SSPE in the United States. The only natural host of measles virus is humans. Measles is transmitted by direct contact with infectious droplets or, less commonly, by airborne spread. Measles is one of the most highly communicable of all infectious diseases.
The childhood and adolescent immunization program in the United States has resulted in a greater than 99% decrease in the reported incidence of measles and interruption of endemic disease transmission since measles vaccine was first licensed in 1963.
From 1989 to 1991, the incidence of measles in the United States increased because of low immunization rates in preschool-aged children, especially in urban areas. Following improved coverage in preschool-aged children and implementation of a routine second dose of measles- mumps-rubella vaccine for children, the incidence of measles declined to extremely low levels (<1 case per 1 million population). The number of measles outbreaks (23 cases linked
in time and space) that occurred ranged from 2 to 16 per year. In the first half of 2014, 514 measles cases from 16 outbreaks were reported in 20 states.
Forty-eight separate importations occurred; 81% were in unvaccinated people, 12% of those infected had an unknown vaccination status (78% of those were adults), and 7%of those infected were vaccinated (including5% with 2 ormore doses).
Candidiasis
Mucocutaneous infection results in oropharyngeal (thrush) or vaginal or cervical candidiasis; intertriginous lesions of the gluteal folds; paronychia; and onychia. Dysfunction of T lymphocytes, other immunologic disorders are associated with chronic mucocutaneous candidiasis. Chronic or recurrent oral candidiasis can be the presenting sign of HIV infection or primary immunodeficiency. Esophageal and laryngeal candidiasis can occur in patients who are immunocompromised. Disseminated or invasive candidiasis occurs in very low birth weight neonates and, in immunocompromised or debilitated hosts, can involve virtually any organ or anatomic site and be rapidly fatal. Like other Candida species, C albicans is present on skin and in the mouth, intestinal tract, and vagina of immunocompetent people. Vulvovaginal candidiasis is associated with pregnancy, and newborns can acquire the organism in utero, during passage through the vagina, or postnatally. Personto-person transmission occurs rarely. Factors such as extreme prematurity, neutropenia, or treatment with corticosteroids increase the risk of invasive infection. Patients receiving broad-spectrum antimicrobial agents, especially extended-spectrum cephalosporins, carbapenems, and vancomycin have increased susceptibility to infection. Postsurgical patients can be at risk, particularly after cardiothoracic or abdominal procedures. The presumptive diagnosis of mucocutaneous candidiasis or thrush can usually be made clinically, but other organisms or trauma can also cause clinically similar lesions. Yeast cells and pseudohyphae can be found in C albicans-infected tissue and are identifiable by microscopic examination of scrapings. A definitive diagnosis of invasive candidiasis requires isolation of the organism from a normally sterile body site (eg, blood, cerebrospinal fluid, bonemarrow) or demonstration of organisms in a tissue biopsy specimen.
Pulpitis
Pulpitis is an inflammation of the dental pulp. Anatomical and physiological properties of the deciduous teeth pulp to a certain extent predetermine the features of the clinical course of pulpitis in children.
The pulp of tooth outwardly resembles its anatomical shape and is divided into coronal and root. In multi-rooted teeth, there is a pronounced border between them. The pulp is a loose fibrous tissue, consisting of intercellular base with fibers, cells, blood vessels and nerves included in it.
The pulp of deciduous teeth differs from the permanent teeth pulp in terms of anatomophysiological features. The pulp chamber of deciduous teeth is much larger. Histologically, the pulp of deciduous teeth practically does not differ from the permanent teeth pulp. It develops from the dental papilla and in its structure resembles embryonic tissue, which quickly differentiates in the direction of the connective tissue. The pulp of the formed tooth does not have mesenchyme. The intercellular substance contains a large number
of collagen fibrils and does not have elastic fibers. The cellular composition of the deciduous teeth pulp is characterized by the presence of poorly differentiated cellular elements.
The pulp composition includes such cellular elements as preodontoblasts, odontoblasts (cells with high secretory activity, their processes perform a transport function), fibroblasts – stellate, spindle-shaped, round and histiocytes, adventitial, etc. The coronal pulp under the microscope differs from the root pulp. If in the former the cellular components prevail over the argyrophilic and collagen fibers, in the latter the opposite relationship is observed.
Themost important role in the development of pulpitis is played by infectious factor, when a carious cavity is most often the site of infection entry. Rarely, infectious agent enters the pulp through the bloodstream. Retrograde spread of infection through the apical foramen is extremely rare in children. Pulpitis can be caused bymechanical trauma, for example, on the background
of the dental crown fracture with the damage to the pulp chamber.
Long-term thermal and chemical irritation can also cause the inflammatory process in the pulp: when amalgam filling is applied without liner or when using silicone and acrylate materials without liner.