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1. CP - Core Microbiology > (6) Childhood Viral Infections > Flashcards

(6) Childhood Viral Infections Flashcards

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1
Q

What are the classifications of viral illness in childhood?

A
  • asymptomatic/subclinical infection
  • fever and a rash
  • respiratory tract infections
  • gastro-intestinal infections
  • others (eg. mumps, meningitis etc)
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2
Q

What is a notifiable disease?

A

Any disease that is required by law to be reported to government authorities

Report to Public Health England

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3
Q

Give some examples of notifiable disease

A
  • acute meningitis
  • acute poliomyelitis
  • measles
  • mumps
  • rubella
  • smallpox
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4
Q

Which antibody is produced in acute infection (first antibody to appear in response to initial exposure to an antigen)?

A

IgM

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5
Q

Which antibody is involved in long term immunity ?

A

IgG

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6
Q

Which is the maternal antibody?

A

IgG

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7
Q

Which antibody is in breast milk?

A

IgA

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8
Q

Levels of which antibody increase significantly after 2nd exposure to an antigen?

A

IgG

involved in long term immunity

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9
Q

Give some viral causes of rash in children

A
  • parvovirus
  • measles
  • chickenpox
  • rubella
  • non-polio enterovirus infection
  • EBV (with ampicillin)

(bacterial causes = staph. aureus, n. meningitidis)

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10
Q

What is the measles virus?

A

Paramyxovirus

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11
Q

What type of virus is paramyxovirus (the measles virus)?

A

Enveloped single stranded RNA virus

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12
Q

How is measles transmitted?

A

Person to person

Droplet spread

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13
Q

What is the infectivity of measles?

A

From the start of first symptoms (4 days before rash)

To 4 days after disappearance of rash

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14
Q

What is an incubation period?

A

The time between exposure to a pathogenic organism and when symptoms and signs are first apparent

Signifies the period taken by the multiplying organism to reach a threshold necessary to produce symptoms in the host

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15
Q

How long is the incubation period for measles?

A

7-18 days (average 10-12 days)

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16
Q

What is the natural host for measles?

A

Humans are the only natural host

no animals have measles - so there is potential for eradication

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17
Q

What is the distribution of measles?

A

Worldwide

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18
Q

How long can paramyxovirus last in airspace?

A

2 hours

15 minutes contact time is considered highly significant

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19
Q

How many cases of measles were there in England in 2014?

A

Just over 100

all unvaccinated, most children/young adults

about half occur on return from abroad

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20
Q

What is a prodrome?

A

An early symptom (or set of symptoms) that might indicate the start of a disease before specific symptoms occur

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21
Q

What is the prodrome for measles?

A
  • fever
  • malaise
  • conjunctivitis
  • coryza
  • cough
    (3 Cs)
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22
Q

What is coryza?

A

Rhinitis or coryza is irritation and inflammation of the mucous membrane inside the nose. Common symptoms are a stuffy nose, runny nose, sneezing, and post-nasal drip

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23
Q

Describe the rash you get in measles

A
  • erythematous
  • maculopapular
  • head-trunk
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24
Q

What is a maculopapular rash?

A

A type of rash characterised by a flat, red area on the skin that is covered with small confluent bumps

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25
Q

What feature in the mouth is a prodromic sign of measles, 1-3 days before the appearance of rash?

A

Koplik’s spots

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26
Q

What are Koplik’s spots?

A

Early sign of measles, 1-3 days before rash

Clustered, white lesions on the buccal mucosa

Ulcerated mucosal lesions marked by necrosis, neutrophilic exudate, and neovascularization

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27
Q

As well as the prodrome, rash and Koplik’s spots, what are the other clinical features of clinical features of measles?

A
  • fever

- infection in the immunocompromised

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28
Q

Give the main clinical features of measles

A

Rash + fever + cough/coryza/conjunctivitis

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29
Q

What are the common potential complications of measles?

A
  • otitis media (7-9%)
  • pneumonia (1-6%)
  • diarrhoea (8%)
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30
Q

What is otitis media?

A

Otitis media is a group of inflammatory diseases of the middle ear

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31
Q

Which potential complication of measles is rare but fatal?

A
  • acute encephalitis (1 in 2000)

- subacute sclerosing panencephalitis (SSPE) (1 in 25000)

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32
Q

How long after measles does SSPE occur?

A

7-30 years after measles

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33
Q

What is subacute sclerosing pan encephalitis (SSPE)?

A

A rare and chronic form of progressive brain inflammation caused by a persistent infection with measles virus

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34
Q

How serious is measles infection in pregnancy?

A

Severe

Up to 20% foetal loss

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35
Q

Most complications occur in measles in patients of what age?

A

Less than 5 years old or over 20 years old

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36
Q

Hearing loss can occur in patients with measles following what?

A

Measles related otitis media

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37
Q

Measles causes death in children following which complication?

A

Pneumonia

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38
Q

How is measles diagnosed?

A
  • clinical
  • leukopenia
  • oral fluid sample
  • serology
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39
Q

What is leukopenia?

A

A reduction in the number of white cells in the blood, typical of various diseases

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40
Q

What does treatment for measles involve?

A
  • supportive

- antibiotics for superinfection

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41
Q

How is measles prevented?

A
  • vaccine (live MMR) - 1 year, pre-school

- human normal immunoglobin

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42
Q

When was the measles vaccine introduced?

A

1968

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43
Q

Coverage of measles vaccination rose >90% following introduction of what?

A

MMR vaccine in 1988

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44
Q

What is the national MMR catch up programme?

A

Aims to vaccinate 10-16 year olds from 2013 onwards

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45
Q

How many cases of measles were there prior to 1968 when the first vaccine was introduced?

A

Up to 800,000 cases a year

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46
Q

Which virus causes chicken pox?

A

Varicella Zoster Virus

Herpes virus - DNA virus

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47
Q

How is chicken pox (varicella zoster virus) transmitted?

A

Respiratory spread/personal contact (face to face/15 mins)

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48
Q

What is the incubation period of chicken pox/varicella zoster virus)?

A

14-15 days

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49
Q

What is the infectivity of chicken pox?

A

2 days before onset of rash until after vesicles dry up

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50
Q

What is the host of chicken pox/varicella zoster virus?

A

Humans are the only host

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51
Q

What are the main clinical features of chicken pox?

A
  • fever
  • malaise
  • anorexia
  • rash
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52
Q

Describe the rash in chicken pox

A

Centripetal

macular - papular - vesicular - pustular

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53
Q

What are the potential complications in chicken pox/vzv?

A
  • pneumonitis (increased risk for smokers)
  • CNS involvement
  • thrombocytopenic purpura
  • foetal varicella syndrome
  • congenital varicella
  • zoster
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54
Q

What is thrombocytopenic purpura?

A

A disorder that can lead to easy or excessive bruising and bleeding - results from unusually low levels of platelets

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55
Q

What is congenital varicella syndrome?

A

Rare disorder in which affected infants have distinctive abnormalities at birth due to the mother’s infection with chickenpox early during pregnancy

  • low birth weight
  • characteristic abnormalities of the skin; the arms, legs, hands, and/or feet; the brain; the eyes
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56
Q

What is zoster commonly known as?

A

Shingles

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57
Q

What makes chicken pox patients at higher risk of severe disease/complication?

A

Smokers or those taking steroids

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58
Q

How is chicken pox/vzv diagnosed?

A
  • clinical

- PCR - vesicle fluid/CSF

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59
Q

When is chicken pox serology used?

A

In pregnant women who have come into contact with chicken pox and don’t think they have had it before - serious

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60
Q

What is used to test whether a pregnant woman already has immunity to chicken pox?

A

Serology

Test IgG

positive = good, have immunity

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61
Q

Why is chicken pox so serious in pregnant woman?

A

Likely the mother will get it very badly and can also affect the baby - limb abnormalities and scarring

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62
Q

Who is treatment for chicken pox used in?

A

Symptomatic adults and immunocompromised children

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63
Q

What is used as treatment for chicken pox?

A

Aciclovir (oral, IV in severe disease or neonates)

Chlorpheniramine can relive itch (>1 year olds)

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64
Q

Is chicken pox a notifiable disease?

A

Not in England but is in Scotland/NI

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65
Q

Why is treatment for chicken pox not recommended for healthy children? (is recommend in over 14 year olds)

A

Studies did not show a reduction in complications (though aciclovir did reduce the number of skin lesions and duration of fever)

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66
Q

Describe the chicken pox vaccine

A
  • live
  • 2 doses

(USA/Japan)

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67
Q

Who receives the chicken pox vaccine?

A
  • health care workers

- susceptible contacts of immunocompromised patients

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68
Q

When is VZ immunoglobin (VZIG) given?

A
  • a significant exposure
  • a clinical condition that increases the risk of severe varicella e.g. immunocompromised, neonates, pregnant woman
  • no antibodies to VZ virus

Ig does not prevent infection in all, but it reduces severity

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69
Q

Which virus causes rubella?

A

Togavirus, RNA virus

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70
Q

How is rubella/togavirus transmitted?

A

Droplet spread - airborne

Less contagious

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71
Q

How long is the incubation period for rubella?

A

14-21 days

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72
Q

When is the infectivity of rubella?

A

1 week before rash to 4 days after

73
Q

Is there a rubella problem in the UK?

A

Only reported cases in the UK last year were imported

74
Q

What are the general clinical features of rubella?

A
  • non-specific prodrome
  • lymphadenopathy
  • rash
75
Q

Lymphadenopathy is a clinical feature of rubella. Which lymph nodes does it affect?

A
  • post-auricular

- suboccipital

76
Q

Describe the rash in rubella

A

Very non-specific

Transient, erythematous, behind ears and face and neck

Starts on face and spread to rest of body

77
Q

Which symptom of rubella is particularly seen in young female patients?

A

Aching joints

78
Q

Give some complications of rubella

A
  • thrombocytopenia
  • post infectious encephalitis
  • arthritis
79
Q

How many children with rubella are asymptomatic?

A

50%

80
Q

Is rubella a severe disease?

A

It is a mild and usually self-limiting infection but can be devastating in pregnant women

81
Q

Is rubella risky in the immune-compromised?

A

Not particularly risky

82
Q

What is congenital rubella syndrome (CRS)?

A

Can occur in a developing foetus of a pregnant woman who has contracted rubella

83
Q

What are the symptoms of CRS?

A
  • cataracts and other eye defects
  • deafness
  • cardiac abnormalities
  • microcephaly
  • retardation of intra-uterine growth
  • inflammatory lesions of brain, liver, lungs and bone marrow
84
Q

When is CRS more severe?

A

When the rubella infection is contracted earlier in pregnancy

85
Q

What is the risk of intra-uterine transmission of rubella, less than 11 weeks of pregnancy?

A

90%

86
Q

What is the risk of intra-uterine transmission of rubella, 11-16 weeks into pregnancy?

A

20%

87
Q

What is the risk of intra-uterine transmission of rubella, 16-20 weeks into pregnancy?

A

Minimal risk, deafness only

88
Q

What is the risk of intra-uterine transmission of rubella, >20 weeks into pregnancy?

A

No increased risk

89
Q

How is rubella diagnosed?

A
  • oral fluid testing - IgM/G - PCR if within 7 days of rash

- serology - IgM and IgG - antibodies detectable from time of rash

90
Q

What is the treatment for rubella?

A

There is no treatment available

Immunoglobin given to exposed pregnant women

91
Q

Is there evidence that human normal immunoglobin is effective?

A

No, but may be given in confirmed rubella cases where termination of pregnancy is unacceptable

92
Q

How many women of child bearing age remain susceptible to rubella?

A

2-3%

93
Q

When was the rubella vaccine introduced?

A

1970

94
Q

When was the MMR vaccine introduced?

A

1988

95
Q

When was the catch up MR vaccine introduced?

A

1994

96
Q

Which virus causes ‘slapped cheek’ or ‘fifth disease’?

A

Parvovirus B19 - DNA virus

97
Q

How is parvovirus B19 transmitted?

A

By respiratory secretions or from mother to child

98
Q

What is the incubation period for parvovirus B19?

A

4 to 14 days

99
Q

What problem concerning pregnancy does parvovirus B19 cause?

A

Risk of miscarriage in early pregnancy, but the risk is low

Can cause foetal disease - foetal anaemia and foetal hydrops

100
Q

How many of those infected with parvovirus B19 are asymptomatic?

A

20%

101
Q

When are children with slapped cheek infective?

A

Before rash appears

No longer infective when they have the rash

102
Q

What are the clinical features of parvovirus B19?

A
  • minor respiratory illness
  • rash illness “slapped cheek” (can also get secondary itchy rash over body)
  • arthralgia
  • aplastic anaemia
  • anaemia in the immunosuppressed (this may be prolonged)
103
Q

What is arthralgia (a symptom of parvovirus B19)?

A

Pain in the joints

104
Q

Whats is aplastic anaemia?

A

Deficiency of all types of blood cell caused by failure of bone marrow development

105
Q

How is parvovirus B19 diagnosed?

A
  • serology IgM/IgG - 90% have IgM at time of rash
  • amniotic fluid sampling
  • PCR in immunocompromised
106
Q

What is the treatment for parvovirus B19?

A
  • none if self limiting illness
  • blood transfusion
  • no vaccine available
107
Q

Why is infection control for parvovirus B19 difficult?

A

It is infectious prior to the arrival of the rash and significant number of cases are subclinical

108
Q

Is parvovirus B19 a notifiable disease?

A

No

109
Q

Give some examples of enteroviral infections

A
  • coxsackie
  • entero
  • echviral infections
110
Q

How many cases of enteroviral infections are asymptomatic?

A

90%

111
Q

In what age group are enteroviral infections prevalent?

A

Under 5 year olds

112
Q

How are enter viral infections transmitted?

A

Faecal-oral

Skin contact

113
Q

Hand, foot and mouth disease is a type of what?

A

Enteroviral infection

114
Q

What type of syndrome do enteroviral infections cause?

A

Fever-rash syndromes

115
Q

What more serious condition can enteroviral infections cause?

A

Meningitis - diagnosed by PCR of CSF

116
Q

What treatment is given for enteroviral infections?

A

None

Supportive management and good hygiene to prevent transmission

117
Q

Which viruses may be the cause of respiratory symptoms in a child?

A
  • respiratory syncytial virus
  • parainfluenza
  • influenza
  • adenovirus
  • metapneumovirus
  • rhinovirus
118
Q

Bronchiolitis is caused by which virus?

A

Respiratory syncytial virus (RSV)

119
Q

What are the features of bronchiolitis?

A
  • under 1 year olds
  • annual winter epidemic
  • incubation = 4-6 days
  • can be life threatening
  • reinfections common
120
Q

How is RSV diagnosed?

A

PCR on secretions from nasopharyngeal aspirate

121
Q

How is RSV managed?

A
  • O2, manage fever and fluid intake
  • previous treatment eg. bronchodilators/steroids no longer recommended
  • vulnerable cases eg. neonates, palivizumab is given (immunoglobin and monoclonal antibodies - very expensive)
122
Q

What is metapneumovirus?

A
  • recently discovered virus
  • paramyxovirus
  • nearly universal by aged 5
123
Q

What symptoms does metapenumovirus cause?

A

Respiratory illness similar to RSV - ranges from respiratory tract infection to pneumonia

124
Q

How is metapneumovirus diagnosed?

A

PCR

125
Q

How is metapneumovirus managed?

A

Supportive only

126
Q

Adenovirus accounts for how many childhood respiratory infections?

A

10%

127
Q

What are the clinical features of adenovirus?

A
  • mild URTI (occ. severe penumonia)
  • conjunctivitis
  • diarrhoea (serotypes 40/41)
128
Q

How is adenovirus diagnosed?

A
  • respiratory panel PCR
  • eye swab OCR
  • serology if possible
129
Q

How is adenovirus treated/managed?

A

No treatment

But cidofovir in immunocompromised

130
Q

What is parainfluenza?

A
  • paramyxovirus

- 4 types (1 in winter, 3 in summer)

131
Q

How is parainfluenza transmitted?

A

Person to person

Inhalation

132
Q

What are the clinical features of parainfluenza?

A
  • croup
  • bronchiolitis
  • URTI
133
Q

How is parainfluenza diagnosed?

A

Multiplexed PCR

134
Q

What is the treatment for parainfluenza?

A

None

135
Q

Rhinovirus is a member of which family?

A

Picornaviridae

136
Q

Which virus causes the common cold?

A

Rhinovirus

137
Q

Which virus is found in approximately 70% of children with mild upper respiratory tract symptoms?

A

Rhinovirus

138
Q

Rhinovirus causes similar clinical features to which other viruses?

A
  • coronavirus
  • human bocavirus
  • enterovirus
  • adenovirus
139
Q

Which viruses may be responsible for a child with diarrhoea?

A
  • rotavirus

- norovirus

140
Q

What type of virus is rotavirus?

A

Reovirus (RNA virus)

141
Q

How is rotavirus transmitted?

A

Faecal-oral and occasionally respiratory

Low infectious dose!

142
Q

What is the incubation period for rotavirus?

A

1-2 days

143
Q

What is the epidemiology of rotavirus?

A
  • seasonal in UK (winter/spring)
  • worldwide
  • 440,000 deaths per year
144
Q

What are the clinic features of rotavirus?

A
  • diarrhoea
  • vomiting

Seasonal variation
Increased mortality in poorer countries

145
Q

How is rotavirus diagnosed?

A

PCR

146
Q

How is rotavirus treated?

A

Rehydration

147
Q

How is rotavirus infection prevented?

A

Oral live vaccine - UK introduction in 2013 - given at 2 and 3 months of age

148
Q

What is norovirus known as?

A

“winter vomiting bug”

High incidence of vomiting (>50%)

149
Q

Where are norovirus outbreaks seen?

A
  • nurseries
  • hospitals
  • cruise ships
150
Q

How is norovirus spread?

A

Person to person

Foodborne disease

151
Q

Does norovirus have a long or short course?

A

Short course - 12-60 hours

152
Q

How is norovirus diagnosed?

A

PCR

153
Q

How is norovirus treated?

A

Rehydration

154
Q

Which family does the mumps virus belong to?

A

Paramyxoviridae family

155
Q

How is mumps transmitted?

A

Direct contact
Droplet spread
Fomites

156
Q

Describe the infectivity of mumps?

A

Several days before parotid swelling to several days after

157
Q

What is the incubation period for mumps?

A

2-4 weeks (mostly 16-18 days)

158
Q

When was the MMR vaccine introduced?

A

1988

Catch up in 1994

159
Q

How has the epidemiology of mumps changed?

A

In the pre-vaccine era..

  • 90% of infections in 85% of adults immune because of previous childhood infection

In 2001…

  • 49% of infections were in >15s
  • no natural immunity
160
Q

How common is mumps?

A

More common in the UK than measles or rubella (2013) - cases occurred in young adults of 17-28 years of age

161
Q

More than half of cases of mumps have had one dose of MMR. Why is this?

A

Waning immunity

162
Q

What is the mumps prodrome?

A

Non-sepcific

eg. low-grade fever, anorexia, malaise, and headache

163
Q

What happens in the next 24 hours after mumps prodrome?

A

Earache, tenderness over ipsilateral parotid

164
Q

What happens in the next 2-3 days after initial symptoms of mumps?

A

Gradually enlarging parotid with severe pain

165
Q

Is mumps unilateral or bilateral?

A

Normally bilateral but can be unilateral in at least 25%

166
Q

Give another symptom of mumps other than fever, earache and parotid swelling and pain

A

Pyrexia up to 40c

167
Q

What happens 1 week after initial mumps symptoms?

A

After peak swelling, pain, fever and tenderness rapidly resolve, and the parotid gland returns to normal size within 1 week

168
Q

What are some rare manifestations of mumps?

A
  • submandibular and/or sublingual sialadenitis
  • epididymo-orchitis
  • oophoritis
  • meningitis
  • encephalitis
  • renal function abnormalities (mild)
  • pancreatitis
169
Q

What is sialadentitis?

A

Inflammation of a salivary gland

170
Q

What is epididymo-orchitis?

A

Inflammation of the epididymis and/or testis

171
Q

What is oophoritis?

A

Inflammation of an ovary

172
Q

What is the most common extra salivary gland manifestation of mumps?

A

CNS involvement

173
Q

What is the most common extra salivary gland manifestation of mumps in the adult?

A

Epididymo-orchitis

174
Q

What happens if mumps infection occurs in the first trimester?

A

Increased foetal death

175
Q

What investigations would be carried out in mumps?

A
  • normal WCC

- raised serum amylase (salivary or pancreatic)

176
Q

How is mumps diagnosed?

A

Normally clinical diagnosis

Serology (IgM)

  • blood
  • saliva

(PCR)

177
Q

What is the treatment for mumps?

A

Symptomatic only

178
Q

Is mumps vaccine preventable?

A

Yes, live attenuated vaccine

179
Q

Which viruses can cause a problem in neonates/congenital infection?

A
  • VZV
  • rubella
  • CMV - growth retardation, deafness, blindness
  • toxoplasma - chorioretinits, hydrocephaly
  • HSV - severe neonatal disease
  • HBV - HBIG/vaccine for neonate
  • HIV - see BHIVA guidelines etc

1. CP - Core Microbiology (8 decks)

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