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Clinical Pathology > Childhood Viral Infections > Flashcards

Childhood Viral Infections Flashcards

1
Q

What are the different types of childhood viral infections?

A
  • Asymptomatic / Subclinical infection
  • Fever and a rash
  • Respiratory tract infections
  • Gastro-intestinal infections
  • Others – mumps
    - meningitis/encephalitis
    - EBV/CMV
    - HIV and viral hepatitis
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2
Q

Which of the childhood viral diseases are notifiable?

A
  • Acute meningitis
  • Acute poliomyelitis
  • Measles
  • Mumps
  • Rubella
  • Smallpox
  • Report must be made upon clinical diagnosis by diagnosing clinician
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3
Q

Which Ig is produced in acute infection?

A

IgM

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4
Q

Which Ig is produced long-term following an infection?

A

IgG (IgA in breast milk)

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5
Q

Which of the viral diseases cause rashes?

A
  • Parvovirus
  • Measles
  • Chickenpox
  • Rubella
  • Non-polio enterovirus infection
  • EBV (with ampicillin)
  • (not forgetting bacterial causes such as Staphylococcus aureus, N. meningitidis)
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6
Q

To which family of viruses does measles belong?

A

Paramyxovirus

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7
Q

What type of virus is measles?

A

Enveloped single stranded RNA virus

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8
Q

What is the mode of transmission for measles?

A

Person to person

Droplet spread

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9
Q

What is the infectivity of measles?

A

From start of first symptoms (4 days before rash to 4 days after disappearance of rash.

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10
Q

What is the incubation period for measles?

A

7-18 days (average 10-12)

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11
Q

What are the clinical features of measles?

A
  • Prodrome - Fever, malaise, conjunctivitis, coryza and cough (3’c’s)
  • Rash - Erythematous, maculopapular, head – trunk,
  • Koplik’s spots - 1-2 days before rash.
  • Fever
  • Infection in the immunocompromised
  • Rash + fever + cough/coryza/conjunctivitis
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12
Q

What are Koplik’s spots?

A

prodromic viral enanthem of measles manifesting two to three days before the measles rash itself. They are characterized as clustered, white lesions on the buccal mucosa (opposite the lower 1st & 2nd molars) and are pathognomonic for measles.

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13
Q

What is coryza?

A

Rhinitis

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14
Q

What are the complications of measles?

A
  • Otitis media (7-9%)
  • Pneumonia (1-6%)
  • Diarrhoea (8%)
  • Acute encephalitis – rare but fatal (1 in 2000)
  • Rarer complications
    • Subacute sclerosing panencephalitis (SSPE)
      1/25000
      - Rare, fatal, late (7-30 years after measles)
      • Death – highest in
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15
Q

At what ages do most complications occur?

A

Under 5 years or over 20.

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16
Q

How may measles be diagnosed?

A
  • Clinical
  • Leukopenia
  • Oral fluid sample
  • Serology
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17
Q

What is the treatment for measles?

A
  • Supportive

- Antibiotics for superinfection

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18
Q

How can measles be prevented?

A
  • Vaccine – live MMR
    - 1 year / pre-school
  • Human normal immunoglobulin
    - pregnant
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19
Q

Which virus causes chicken pox?

A

Varicella zoster

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20
Q

What kind of virus is the varicella zoster virus?

A

DNA virus

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21
Q

What is the route of transmission for the varicella zoster virus?

A

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

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22
Q

What is the incubation period for chicken pox?

A

14-15 days

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23
Q

What is the period of infectivity for chicken pox?

A

2 days before onset of rash until after vesicles dry up.

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24
Q

Does chicken pox have any animals hosts?

A

No - only humans

25
Q

What are the clinical features of varicella?

A

Fever, malaise, anorexia
Rash – centripetal
macular > papular > vesicular > pustular

26
Q

What are the possible complications of chicken pox?

A
  • Pneumonitis (risk increased for smokers)
  • Central nervous system (CNS) involvement
  • Thrombocytopenic purpura
  • Foetal varicella syndrome
  • Congenital varicella
  • Zoster
27
Q

How is chicken pox diagnosed?

A
  • Clinical

- PCR –vesicle fluid/CSF

28
Q

How is serology used in chicken pox?

A
  • Immunity testing

- IgG in pregnant women in contact with VZV and no history of chickenpox

29
Q

How is chicken pox treated?

A
  • Symptomatic adults and immunocompromised children
  • Aciclovir oral, iv in severe disease or neonates.
  • Chlorpheniramine can relieve itch (>1 yr olds)
30
Q

How might chicken pox be prevented?

A
  • Vaccine – live, 2 doses (USA/Japan)
    • Health care workers
    • Susceptible contacts of immunocompromised pts
  • VZ Immunoglobulin (VZIG) given if:
    • significant exposure
    • a clinical condition that increases the risk of severe varicella e.g. immunosuppressed patients, neonates and pregnant women
    • no antibodies to VZ virus
    • Ig does not prevent infection in all, reduces severity
31
Q

What kind of virus is rubella?

A

Togavirus, RNA virus

32
Q

What is the route of transmission for rubella?

A

Droplet spread – air-borne

Less contagious

33
Q

What is the incubation period for rubella?

A

14-21 days

34
Q

What is the period of infectivity for rubella?

A

One week before rash to 4 days after.

35
Q

What are the clinical features of rubella?

A
  • Prodrome – non-specific
  • Lymphadenopathy – post-auricular, suboccipital
  • Rash - very non specific transient, erythematous, behind ears and face and neck.
  • Complications
    • thrombocytopenia;
    • post infectious encephalitis;
    • arthritis
    • 50% of infectious children are asymptomatic.
36
Q

What are the features of congenital rubella syndrome?

A

Congenital rubella syndrome (CRS)

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

CRS more severe when infection contracted earlier in pregnancy.

Foetal damage rare after 16/40; only deafness reported up to 20/40

37
Q

What are the risks of intra-uterine transmission during different stages of pregnancy?

A

Less than 11 weeks - 90%
11-16 weeks - 20%
16-20 weeks - minimal risk, deafness only
>20 weeks - no increased risk

38
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.
  • IgM positive for 1-3 months – implications in pregnancy.
39
Q

What treatment is available for rubella?

A
  • No treatment available – immunoglobulin given to exposed pregnant women.
  • Vaccine - initially 11-14 year olds. Now part of MMR.
  • 2-3% women of child bearing age remain susceptible.
40
Q

What disease is caused by parvovirus B19?

A

‘Slapped cheek’ or ‘fifth disease’.

41
Q

What kind of virus is parvovirus B19?

A

DNA virus

42
Q

How is parvovirus B19 transmitted?

A

Respiratory secretions or from mother to child.

43
Q

What’s the incubation period for parvovirus B19?

A

4 to 14 days

44
Q

Why should pregnant women avoid parvovirus B19?

A

Risk of miscarriage in early pregnancy - but low

45
Q

What are the symptoms of foetal parvovirus B19

A
  • Anaemia

- Hydrops

46
Q

What are the clinical features of parvovirus B19?

A
  • Minor respiratory illness
  • Rash illness ‘slapped cheek’
  • Arthralgia
  • Aplastic anaemia
  • Anaemia in the immunosuppressed
47
Q

How is parvovirus B19 diagnosed?

A
  • Serology IgM/IgG – 90% have IgM at time of rash
  • Amniotic fluid sampling
  • PCR in immunocompromised
48
Q

How is parvovirus B19 treated?

A

None if self limiting illness
Blood transfusion
No vaccine available

Infection control – difficult as infectious prior to arrival of the rash and significant number of cases are subclinical.

Pregnant HCWs should avoid chronic cases.

Not a notifiable disease

49
Q

What are the features of enteroviral infections?

A
  • Coxsackie, entero, echoviral infections.
  • Worldwide, prevalent in under 5 year olds.
  • 90% asymptomatic.
  • Transmission is faecal-oral and by skin contact.
  • Hand, foot and mouth disease.
  • Fever-rash syndromes.
  • Meningitis – PCR of CSF.
  • Supportive management and good hygiene to prevent transmission.
50
Q

Which viruses cause respiratory disease in children?

A
  • Respiratory Syncytial Virus
  • Parainfluenza
  • Influenza
  • Adenovirus
  • Metapneumovirus
  • Rhinovirus
51
Q

What kind of virus is respiratory syncytial virus (RSV)?

A

Pneumovirus

52
Q

What are the clinical features of RSV?

A
  • Bronchiolitis
    • Under 1 year olds (0-24 months)
    • Annual winter epidemics, incubation 4-6 days.
    • Can be life threatening
    • Reinfections common
53
Q

How is RSV diagnosed?

A

PCR on secretions from nasopharyngeal aspirate.

54
Q

What is the treatment for RSV?

A
  • O2, manage fever and fluid intake.
  • Previously used treatment such as Bronchodilators/steroids are no longer recommended.
    (immunoglobulin and monoclonal abs - Palivizumab)
55
Q

What are the features of metapneumovirus?

A
  • Recently discovered virus
  • Paramyxovirus
  • Nearly universal by aged 5.
  • Causes respiratory illness similar to RSV – ranges from mild upper respiratory tract infection to pneumonia.
  • Dx – PCR
  • Rx – supportive only
56
Q

What are the features of adenovirus?

A
  • Accounts for 10% childhood respiratory infection.
  • Clinical disease mild URTI (occ. Severe pneumonia)
    conjunctivitis
    (diarrhoea – serotypes 40/41)
  • Dx Respiratory panel PCR
    Eye swab PCR
    Serology possible
  • Rx None/ cidofovir in immunocompromised
57
Q

What are the features of parainfluenza?

A
  • Paramyxovirus
  • 4 types 1-4 1 in winter
    3 in summer
  • Transmission - person to person; inhalational
  • Clinical - croup/bronchiolitis/URTI
  • Dx - Multiplexed PCR
  • Rx - none (unlike influenza)
58
Q

What are the features of rhinovirus?

A
  • Member of picornaviridae
  • ‘The common cold’
  • Found in approximately 70% children with mild upper respiratory tract symptoms.
  • Similar clinical features – coronavirus, human bocavirus, enterovirus, adenovirus

Clinical Pathology (65 decks)

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