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Clinical Pathology G > Childhood Viral Infections > Flashcards

Childhood Viral Infections Flashcards

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

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2
Q

Which diseases are you requited to report to Public Health England?

A

Acute meningitis Acute poliomyelitis Measles Mumps Rubella Smallpox

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3
Q

When is IgM produced?

A

in acute infection

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4
Q

When is IgG produced?

A

Long term immunity

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5
Q

What are the differential diagnoses for a child with a rash?

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

Which virus causes measles

A

Paramyxovirus Enveloped single stranded RNA virus

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7
Q

How is measles transmitted?

A

Person to person Droplet spread

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8
Q

When 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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9
Q

What is the incubation period of measles?

A

7-18 days (average 10-12)

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10
Q

How contagious is measles?

A

90% unprotected contacts will acquire active infection

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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 the possible complications of measles?

A
  • Otitis media (7-9%)
  • Pneumonia (1-6%)
  • Diarrhoea (8%)
  • Acute encephalitis – rare but fatal (1 in 2000)
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13
Q

Which rare (1/25000) complication of measles can cause death up to 30 years after contracting the disease?

A

Subacute sclerosing panencephalitis (SSPE)

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14
Q

How is measles diagnosed?

A
  • Clinical
  • Leukopenia
  • Oral fluid sample
  • Serology
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15
Q

What is the treatment for measles?

A
  • Supportive
  • Antibiotics for superinfection
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16
Q

What is the prevention for measles?

A

•Vaccine – live MMR

1 year / pre-school

•Human normal immunoglobulin

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17
Q

What disease has caused this rash?

A

Measles

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18
Q

What virus causes chicken pox?

A

Varicella zoster virus

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19
Q

How is chicken pox spread?

A

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

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20
Q

What is the incubation period of chicken pox?

A

14-15 days

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21
Q

What is the duration of infectivity of chicken pox?

A

2 days before onset of rash until after vesicles dry up

22
Q

What are the clinical features of chicken pox?

A
  • Fever, malaise, anorexia
  • Rash – centripetal

macular > papular > vesicular > pustular

23
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

24
Q

How is chicken pox diagnosed?

A

•Diagnosis

–Clinical

–PCR –vesicle fluid/CSF

•Serology

–Immunity

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

25
Q

What is the treatment for chicken pox?

A

–Symptomatic adults and immunocompromised children

–Aciclovir oral, iv in severe disease or neonates.

–Chlorpheniramine can relieve itch (>1 yr olds)

26
Q

What are the potential prevention methods for chicken pox?

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
27
Q

What disease caused this rash?

A

chicken pox

28
Q

What virus causes rubella?

A

•Togavirus, RNA virus

29
Q

How is rubella transmitted?

A

•Droplet spread – air-borne

Less contagious

30
Q

What is the incubation period for rubella?

A

14-21 days

31
Q

When is rubella infective?

A

•One week before rash to 4 days after.

32
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.

Rash starts on face, spreads to rest of body.

Aching joints particularly frequent in young female patients.

33
Q

What are the risks of rubella in pregnancy?

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

34
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.
35
Q

What is the treatment 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.
36
Q

What is Parvovirus B19 also known as?

A

–’slapped cheek’ or ‘fifth disease’

37
Q

How is parvovirus B19 transmitted?

A

•Transmitted by respiratory secretions or from mother to child

38
Q

What is the incubation period of parvovirus B19?

A

4-14 days

39
Q

What are the clinical features of parvovirus B19?

A

Minor respiratory illness
Rash illness ‘slapped cheek’
Arthralgia
Aplastic anaemia
Anaemia in the immunosuppressed
- this may be prolonged

40
Q

How is parvovirus B19 diagnosed?

A
  • Serology IgM/IgG – 90% have IgM at time of rash
  • Amniotic fluid sampling
  • PCR in immunocompromised.
41
Q

How is parvovirus B19 treated?

A
  • None if self limiting illness
  • Blood transfusion
  • No vaccine available
42
Q

What are enteroviral infections?

A
  • Coxsackie, entero, echoviral infections.
  • Hand, foot and mouth disease.
  • Fever-rash syndromes.
  • Meningitis – PCR of CSF.
43
Q

What diseases might cause respiratory symptoms in a child?

A
  • Respiratory Syncytial Virus
  • Parainfluenza
  • Influenza
  • Adenovirus
  • Metapneumovirus
  • Rhinovirus
44
Q

Rhinovirus is a member of which classification?

A

“picornaviridae”

45
Q

What are the two main viruses that cause diarrhoea in children?

A

Rotavirus

Norovirus

46
Q

What family does mumps belong to?

A

Paramyxoviridae family

47
Q

How is mumps spread?

A
  • direct contact,
  • droplet spread,
  • fomites
48
Q

What is the incubation period of mumps?

A

•2-4 weeks (mostly 16-18 days)

49
Q

What are the clinical features of mumps?

A
  • Prodrome – nonspecific e.g. low-grade fever, anorexia, malaise, and headache
  • Next 24 hours – earache, tenderness over ipsilateral parotid
  • Next 2-3 days – gradually enlarging parotid with severe pain
  • Normally bilateral but can be unilateral in at least 25%.
  • Pyrexia up to 40°C.

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

50
Q

What are the rare complications of mumps?

A

•Rare manifestations :-

–Submandibular and/or sublingual sialadenitis

–Epididymo-orchitis

–Oophoritis

–Meningitis

–Encephalitis

–Renal function abnormalities (mild)

–Pancreatitis

  • CNS involvement is the most common extrasalivary gland manifestation of mumps
  • Epididymo-orchitis is the most common extrasalivary gland manifestation in the adult
  • Infection in first trimester - increased foetal death
51
Q

What disease does this child have?

A

Mumps

Clinical Pathology G (23 decks)

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