Before the advent of widespread vaccination, the diagnosis, differential diagnosis, and management of many childhood illnesses relied heavily on clinical presentation and available supportive care, as specific treatments were often limited. Here is a summary of the approach to each of these illnesses:
- Measles (1st disease):
- Diagnosis: High fever, cough, coryza, conjunctivitis, Koplik spots, followed by maculopapular rash.
- Differential Diagnosis: Rubella, roseola, enterovirus infections, drug eruptions.
- Management: Supportive care, hydration, antipyretics, vitamin A x 2 doses
- Mumps:
- Diagnosis: Swelling of parotid glands, fever, headache, muscle aches.
- Differential Diagnosis: Parotid tumors, other viral parotitides.
- Management: Supportive care, analgesia, hydration, and soft foods.
- Rubella (3rd disease):
- Diagnosis: Low-grade fever, pink rash starting on face, lymphadenopathy.
- Differential Diagnosis: Measles, fifth disease, scarlet fever.
- Management: Supportive care, isolation to prevent exposure to pregnant women.
- Diphtheria:
- Diagnosis: Sore throat, low fever, pseudomembrane on tonsils/pharynx/nose, neck swelling.
- Differential Diagnosis: Bacterial pharyngitis, infectious mononucleosis.
- Management: Antitoxin and antibiotics, airway management.
- Tetanus:
- Diagnosis: Stiffness in neck/jaw muscles, difficulty swallowing, muscle spasms.
- Differential Diagnosis: Meningitis, strychnine poisoning, hypocalcemia.
- Management: Tetanus immunoglobulin, muscle relaxants, wound care, antibiotics.
- Pertussis:
- Diagnosis: Severe coughing spasms, “whoop” sound, post-cough vomiting.
- Differential Diagnosis: Viral bronchitis, croup.
- Management: Macrolide antibiotics, supportive care, oxygen if needed.
- Polio:
- Diagnosis: Asymptomatic; minor illness or non-paralytic aseptic meningitis; paralytic polio with muscle weakness.
- Differential Diagnosis: Guillain-Barre syndrome, transverse myelitis.
- Management: Supportive care, physical therapy for paralysis.
- Hepatitis B:
- Diagnosis: Jaundice, dark urine, extreme fatigue, nausea, abdominal pain.
- Differential Diagnosis: Hepatitis A, C, other causes of liver dysfunction.
- Management: Supportive care, antivirals for chronic cases.
- Haemophilus influenzae type b (Hib):
- Diagnosis: Depending on syndrome: meningitis, epiglottitis, pneumonia, arthritis.
- Differential Diagnosis: Other bacterial/viral meningitis, viral croup.
- Management: Antibiotics, supportive care.
- Meningococcal Disease:
- Diagnosis: Fever, headache, neck stiffness, petechial rash.
- Differential Diagnosis: Other bacterial meningitides, sepsis.
- Management: Immediate antibiotics, supportive care.
- Pneumococcal Disease:
- Diagnosis: Pneumonia with fever, cough, chest pain; meningitis; otitis media.
- Differential Diagnosis: Other bacterial/viral pneumonia, other causes of meningitis.
- Management: Antibiotics, supportive care.
- Rotavirus:
- Diagnosis: Severe watery diarrhea, vomiting, fever, dehydration.
- Differential Diagnosis: Other viral/bacterial gastroenteritis.
- Management: Rehydration therapy, electrolyte replacement.
- Chickenpox:
- Diagnosis: Itchy rash that turns to blisters, fever.
- Differential Diagnosis: Herpes zoster, impetigo, scabies.
- Management: Supportive care, calamine lotion, antihistamines, antipyretics.
- Influenza:
- Diagnosis: Sudden onset fever, cough, sore throat, body aches.
- Differential Diagnosis: Common cold, other viral respiratory infections.
- Management: Supportive care, antiviral drugs within 48 hours of symptom onset if severe.
Management of these conditions historically involved supportive care, as specific antiviral treatments were not available for most of these illnesses. Prevention of spread through quarantine and isolation was common, and in the case of bacterial infections, antibiotics were used when available. Public health measures including hygiene and sanitation were important