6 - Childhood Viral Infections Flashcards
What diseases would you report for to PHE?
Acute meningitis
Acute poliomyelitis
MMR
Smallpox
IgM is made when
Acute infection
IgG is made when
long term immunity
Which Ig from breast milk
IgA
Measles - virus
Paramyxovirus - enveloped single stranded RNA virus
Measles - transmission
Person to person
Droplet spread
Measles - infectivity
From start of first symptoms to after rash
Measles - incubation
7-18 days average = 10-12
Measles - clinical features
Prodrome: Fever, malaise, conjunctivits, coryza and cough (3 c’s)
Rash: erythematous, maculopapular, head-trunk
Koplik’s spots 1-2 days before rash
Measles - diagnosis
Clinical
Leukopenia
Oral fluid sample
Serology
Varicella noster virus: virus type
Herpes virus - DNA virus
Varicella noster virus: transmission
Respiratory spread / personal contact (face to face/ 15mins)
Varicella noster virus: incubation period
14-15 days
Varicella noster virus: infectivity
2 days before onset of rash until after vesicles dry up
Varicella noster virus: clinical features
Fever, malaise, anorexia
Rash - centripetal - macular > papular > vesicular > pustular
Complications: pneumonia, CNS involvement, thrombocytopenic purpura, foetal varicella syndrome, congenital varicella, zoster
Varicella noster virus: diagnosis
Clinical via PCR of vesicle fluid/CSF
Varicella noster virus: serology
Immunity
IgG in pregnant women in contact with ZVZ and no history of chickenpox
Varicella noster virus: treatment
Symptomatic adults and immunocompromised children
Aciclover oral, IV in severe disease or neonates
Chlorpheniramine can relieve itch (>1yo)
Varicella noster virus: prevention
Vaccine - live
For healthcare workers + immunocompromised
Varicella noster virus: when would you give VZ Ig?
Significant exposure
Clinical condition that increases risk of severe varicella e.g. pregnant, neonates
No Ab to VZ virus
Ig does not prevent infection, reduces severity
Rubella: virus
Togavirus
RNA virus
Rubella: transmission
Droplet spread - air-bourne, less contagious
Rubella: incubation period
14-21 days
Rubella: infectivity
One week before rash to 4 days after
Rubella: clinical features
Prodrome - non-specific
Lymphadenopathy
Rash - non-specific
Complications: thrombocytopenia, post-infectious encephalitis, arthritis
50% of infectious children are asymptomatic
Rubella: in pregnancy
Congenital rubella syndrome (CRS)
What is CRS?
Congenital rubella syndrome?
Cataracts + eye defects, deafness, cardiac abnormalities, microcephaly, retardation of intra-uterine growth, inflammatory lesions of brain, liver, lungs and bone marrow
Severity based on weeks into pregnancy
Rubella: diagnosis
Oral fluid testing - IgM/G (PCR if within 7 days of rash)
Rubella: serology
IgM and IgG. Antibodies detectable from time of rash
Rubella: treatment
No treatment available
Ig given to exposed pregnant women
Rubella: prevention
Initially 11-14 yo.
Now part of MMR
Erythema infectiosum: virus
Parvovirus B19 - slapped cheek virus
DNA virus
Erythema infectiosum: transmission
Respiratory secretions from mother to child
Erythema infectiosum: incubation
4 to 14 days
Erythema infectiosum: symptoms
Risk of miscarriage in early pregnancy - but low
Asymptomatic in 20%
Foetal disease: anaemia;
Hydrops (foetal transfusion)
Erythema infectiosum: clinical features
Minor resp illness Rash (slapped cheek) Arthralgia Aplastic anaemia Anaemia in the immunosuppressed
Erythema infectiosum: diagnosis
Serology IgM/IgG
Amniotic fluid sampling
PCR is immunocompromised
Erythema infectiosum: treatment
None if self-limiting illness
Blood transfusion
No vaccine
Prevention: relies on infection control
Enteroviral infection e.g.
Coxsackie
Entero
Echoviral infections
Enteroviral prevalence
Worldwide, prevalent in under 5 yo
Enteroviral symptoms and transmission
90% asymptomatic
Transmission is faecal-oral and skin contact
Enteroviral diseases
Hand, foot and mouth
Fever, rash syndrome
Meningitis - PCR of CSF
Viruses associated with respiratory symptoms
Respiratory syncytial virus Parainfluenza Influenza Adenovirus Metapneumovirus Rhinovirus
What is respiratory syncytial virus?
Aka RSV
Pneumovirus, bronchiolitis (
What is metapneumovirus?
Paramyxovirus Nearly universal by aged 5 Respiratory illness similar to RSV Dx - PCR Rx - supportive only
What is adenovirus?
10% of childhood resp infection
Clinical disease: mild URTI, conjunctivitis, diarrhoea
Dx: resp panel PCR, eye swab PCR, serology possible
Rx: None/cidofovir if immunocompromised
Parainfluenza
Paramyxovirus
Transmission: person-to-person, inhalation
Clinical: croup, bronchioltis, URTI
Dx: multiplexed PCR
Rx: None
Rhinovirus
Member of picornaviridae
Found in 70% with mild URTI
Similar clinical features
Rotavirus features
RNA virus Transmission: faecal-oral + occasionally resp Low infective dose Incubation: 1-2days Epidemiology: seasonal in UK
Rotavirus clinical features
Diarhoea and vomiting
6/12 - 2 yrs
Severe disease
Increased mortality in poorer countries
Dx: PCR
Rx: Rehydration
Prevention: oral live vaccine
Norovirus
Winter vomiting bug Outbreaks Foodbourne Person-to-person High incidence of vomiting (>50%) Short course - 12-60 hrs Dx: PCR Rx: Rehydration
Mumps features
Paramyxoviridae virus
Transmission - direct contact, droplet, fomites
Infectivity - several days before parotid swelling to several days after
Incubation - 2-4 weeks
Mumps clinical features
Prodrome e.g. low-grade fever, anorexia, malaise and headache
24 hrs - earache, ipsilateral parotid
2-3 days - gradually enlarging parotid with severe pain
Pyrexia up to 40 degrees
