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Paediatrics > VIRAL ILLNESSES IN CHILDREN > Flashcards

VIRAL ILLNESSES IN CHILDREN Flashcards

1
Q

What is does the term ‘exanthem’ mean when used in the context of viral exanthem?

A

Exanthem is applied to diseases in which a rash is a prominent manifestation.

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2
Q

What is the organism that causes measles?

A

Paramyxovirus

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3
Q

Why are outbreaks of measles increasingly being seen in the UK?

A

Because the immunization rate fell after public concerns about the safety of the MMR vaccine with regard to increase likelihood of developing autism. This was subsequently found to be a false link.

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4
Q

What are the clinical features of measles?

A

Prodrome: irritable, conjunctivitis, fever
Koplik spots: white spots (‘grain of salt’) on buccal mucosa
Rash: starts behind ears then to whole body, discrete erythematous maculopapular rash becoming blotchy & confluent

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5
Q

How is measles transmitted and what is the incubation period?

A

Droplet spread

10 days

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6
Q

What are the acute complications of measles?

A 
Febrile convulsions
Otitis media
Tracheobronchitis
Pneumonia
Rarely encephalitis
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7
Q

What is the very rare immune mediated neurodegenerative disease that can occur 7-10 years after measles infection?

A

Subacute sclerosing panencephalitis (SSPE)

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8
Q

How do you definitively diagnose measles?

A

Buccal swab analysis

Specific IgM in serum samples ideally taken 3 days after development of rash

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9
Q

How do you manage someone with measles?

A

This viral disease is managed purely symptomatically. It is however a notifiable disease.

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10
Q

What is the other name for rubella?

A

German measles

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11
Q

What is the virus that is responsible for rubella?

A

Rubivirus

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12
Q

What is the most important complication of rubella?

A

Devastating effect on the fetus in cases of maternal infection in early gestation

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13
Q

What are the clinical features of rubella?

A

Low-grade fever
Rash: pink maculopapular, initially on face before spreading to whole body, usually fades by the 3-5 day
Lymphadenopathy: suboccipital and postauricular

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14
Q

What are the rare complications of rubella in children?

A

Arthritis of small joints
Encephalitis
Thrombocytopenia

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15
Q

How is rubella diagnosed?

A

It is usually a clinical diagnosis based on features of the rash. However, this sometimes makes it difficult to differentiate from other viral exanthems.
Detection of rubella specific IgM can be used to confirm diagnosis if picture is unclear.

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16
Q

What are the main features of damage caused by congenital rubella where the mother contracted the virus in the first 10 weeks of gestation?

A 
Sensorineural deafness
Congenital heart disease (PDA, pulmonary stenosis)
Cataracts, glaucoma, retinopathy
Hepatosplenomegaly
Growth retardation
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17
Q

What are the main features of damage caused by congenital rubella where the mother contracted the virus in weeks 13-16?

A

An element of hearing impairment

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18
Q

How should women contemplating pregnancy be managed with regard to rubella?

A

Screened for antirubella IgG. Those pregnant women found to be seronegative should have the vaccine AFTER delivery. Those in whom you suspect a high likelihood of congenital rubella should be consulted with regard to termination.

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19
Q

What is the organism responsible for erythema infectiosum?

A

Parvovirus B19

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20
Q

What are the other names used for erythema infectiosum?

A

Slapped cheek syndrome

Fifth disease

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21
Q

How does transmission of parvovirus B19 (erythema infectiosum) occur?

A

Respiratory secretions

Vertically

Blood products

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22
Q

What are the clinical features of erythema infectiosum?

A

Lethargy

Fever

Headache

‘Slapped-cheek’ rash spreading to proximal arms and extensor surfaces

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23
Q

In what 2 groups of patients is erythema infectiosum (parvovirus B19) particularly dangerous?

A

Virus suppresses erythropoiesis for up to 7 days, therefore it is particular dangerous in children with haemolytic anaemias such as sickle cell or hereditary spherocytosis. In these patients, parvovirus infection can cause an aplastic crisis.

Pregnant women are another group in which this virus is dangerous. Infection during pregnancy can cause hydrops fetalis and death.

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24
Q

How is the diagnosis of erythema infectiosum (slapped-cheek disease) confirmed?

A

Specific IgM can be detected 2 weeks after exposure

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25
Q

How many human herpes viruses have been identified?

A

8

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26
Q

What is the most common clinical manifestation of human herpes simplex virus 1 (HSV-1) in childhood?

A

Gingivitis

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27
Q

Other than gingivitis, what are the common clinical features of an HSV-1 infection in a child?

A

Fever

Vesicular lesions on the lips, gums, tongue and hard palate which might progress to extensive ulceration

28
Q

What are the less common sites for a HSV-1 infection?

A

Eyes - dendritic ulcers in the cornea

Skin - causing eczema herpeticum in children with eczema

Fingers - causing herpetic whitlow

Brain - herpes simplex encephalitis (HSE)

29
Q

Would you use aciclovir to treat HSV-1 infection?

A

Only really if the presentation is herpes simplex encephalitis. Oral aciclovir has only marginal effects in gingivostomatitis and IV fluids are usually enough.

30
Q

When is herpes simplex virus 2 particularly dangerous?

A

Transmission of HSV 2 from the genital tract of a mother who is often asymptomatic can result in neonatal death.

31
Q

What are the neonatal infection sites of HSV-2?

A

Pneumonia
Hepatitis
Encephalitis

32
Q

How do we treat HSV-2 infection?

A

High dose IV aciclovir and supportive care. Caesarian section is indicated when a mother with active genital herpes goes into labour.

33
Q

What is the other more commonly used name for herpes simplex virus 3?

A

Varicella zoster

34
Q

What is the common childhood disease caused by HSV-3 (varicella zoster)?

A

Chickenpox

35
Q

What is the incubation period of chickenpox?

A

14 days

36
Q

What are the clinical features of chickenpox?

A

Fever initially which disappears with development of an
Itchy, rash starting on head/trunk before spreading. Initially macular then papular then vesicular
Systemic upset is usually mild coryzal symptoms

37
Q

What are the complications of chickenpox?

A

Secondary bacterial infection of the skin
Encephalitis
Death in immunocompromised children and neonatal babies

38
Q

What might indicate that a secondary bacterial infection had developed on the back of chickenpox?

A

Fever persisting beyond the outbreak of the rash

39
Q

During what period of chickenpox infection are children infectious?

A

2 days before the eruption of the rash until all the vesicles have crusted over

40
Q

Chickenpox is normally treated symptomatically. Which children would you treat curatively and how would you treat them?

A

Immunosuppressed children - varicella zoster immune globulin (VZIG)

New born babies whose mother developed varicella in 7 days before or after birth - VZIG

Severe chickenpox - aciclovir

41
Q

What is the more common name for human herpes virus 4?

A

Epstein Barr virus (EBV)

42
Q

What are the main sites of infection by EBV?

A

EBV has a particular tropism for the epithelial cells of the oropharynx and nasopharynx
Also for B lymphocytes - hence why it is involved in the pathogenesis of Burkitt’s lymphoma

43
Q

What is the incubation period for EBV?

A

30-50 days

44
Q

What are the clinical features of glandular fever?

A 
Fever
Malaise
Pharyngitis
Cervical lymphadenopathy
Petechiae on the palate
Sparse maculopapular rash
Splenomegaly
Hepatomegaly
45
Q

What investigations might you do to confirm glandular fever?

A

Blood film - atypical lymphocytes
Slide agglutination test - Monospot
Specific EBV serology

46
Q

What are the other causes of infectious mononucleosis?

A

Cytomegalovirus

Toxoplasmosis

47
Q

What is the more common name for human herpes virus 5?

A

Cytomegalovirus (CMV)

48
Q

How is cytomegalovirus usually transmitted? Name 5 routes

A 
From mother to fetus via the placenta in utero
Via oral route
Via genital route
Blood transfusion
Organ donation
49
Q

What is CMV as a congenital infection a risk factor for?

A 
Sensorineural hearing loss
Microcephaly
Cerebral palsy
Epilepsy
Learning disability
50
Q

What is the organism that causes mumps?

A

Paramyxoviridae viruses

51
Q

How is mumps spread/

A

Droplet spread

52
Q

What are the clinical features of mumps?

A

Fever, malaise, muscular pain

Parotitis (‘earache’, ‘pain on eating’): unilateral initially then becomes bilateral in 70%

53
Q

When are patients with mumps infectious?

A

A few days before onset of symptoms until 3 after enlargement of parotid gland subsides.

54
Q

What are the important complications of mumps?

A

Pancreatitis
Epididymo-orchitis

Used to be one of the most common causes of aseptic meningitis.

55
Q

Where is poliovirus still endemic?

A

Africa and Indian subcontinent

56
Q

What is the route of transmission of poliovirus?

A

Faecal-oral route

57
Q

What are the clinical features of polio?

A

90% are asymptomatic
5% have fever, headache, malaise
2% aseptic meningitis
Under 2% - paralytic polio - virus attacks the anterior horn of the spinal cord

58
Q

What are the causes of viral hepatitis?

A 
Hepatitis virus A, B, C, D, E or G
Arbovirus 
Yellow fever virus
CMV
EBV

(For details of viral hepatitis, see the deck under Gastro)

59
Q

What is the disease seen in children that is characterised by a rash and caused by coxsackie A16 virus?

A

Hand, foot and mouth disease

60
Q

What are the features of hand, foot and mouth disease?

A

Mild systemic upset: sore throat, fever

Vesicles in the mouth and on the palms and soles of the feet

61
Q

What is the virus responsible for roseola infantum?

A

Normally human herpes virus 6

Can also be caused by herpes virus 7

62
Q

What are the other names for roseola infantum?

A

Exanthem subitum

6th disease

63
Q

What is the incubation period for roseola infantum?

A

5-10 days

64
Q

Children in what age range are typically affected by roseola infantum?

A

6 months to 2 years

65
Q

What are the features of roseola infantum?

A

High fever lasting a few days

Followed by a maculopapular rash

Febrile convulsions occur in around 10-15%

Diarrhoea and cough are also commonly seen

66
Q

What are the rare complications of roseola infantum?

A

Aseptic meningitis

Hepatitis

67
Q

How long should children diagnosed with roseola infantum be excluded from school?

A

They do not need to be excluded from school

Paediatrics (40 decks)

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