VIRAL ILLNESSES IN CHILDREN Flashcards by

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

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

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What is the organism that causes measles?

Paramyxovirus

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

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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What are the clinical features of measles?

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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How is measles transmitted and what is the incubation period?

Droplet spread

10 days

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What are the acute complications of measles?

Febrile convulsions
Otitis media
Tracheobronchitis
Pneumonia
Rarely encephalitis

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

Subacute sclerosing panencephalitis (SSPE)

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How do you definitively diagnose measles?

Buccal swab analysis

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

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How do you manage someone with measles?

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

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What is the other name for rubella?

German measles

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What is the virus that is responsible for rubella?

Rubivirus

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What is the most important complication of rubella?

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

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What are the clinical features of rubella?

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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What are the rare complications of rubella in children?

Arthritis of small joints
Encephalitis
Thrombocytopenia

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How is rubella diagnosed?

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

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

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

An element of hearing impairment

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

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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What is the organism responsible for erythema infectiosum?

Parvovirus B19

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What are the other names used for erythema infectiosum?

Slapped cheek syndrome

Fifth disease

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

Respiratory secretions

Vertically

Blood products

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What are the clinical features of erythema infectiosum?

Lethargy

Fever

Headache

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

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

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

Specific IgM can be detected 2 weeks after exposure

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How many human herpes viruses have been identified?

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

Gingivitis

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

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

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

Eyes - dendritic ulcers in the cornea Skin - causing eczema herpeticum in children with eczema Fingers - causing herpetic whitlow Brain - herpes simplex encephalitis (HSE)

Would you use aciclovir to treat HSV-1 infection?

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

When is herpes simplex virus 2 particularly dangerous?

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

What are the neonatal infection sites of HSV-2?

Pneumonia Hepatitis Encephalitis

How do we treat HSV-2 infection?

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

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

Varicella zoster

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

Chickenpox

What is the incubation period of chickenpox?

14 days

What are the clinical features of chickenpox?

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

What are the complications of chickenpox?

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

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

Fever persisting beyond the outbreak of the rash

During what period of chickenpox infection are children infectious?

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

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

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

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

Epstein Barr virus (EBV)

What are the main sites of infection by EBV?

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

What is the incubation period for EBV?

30-50 days

What are the clinical features of glandular fever?

``` Fever Malaise Pharyngitis Cervical lymphadenopathy Petechiae on the palate Sparse maculopapular rash Splenomegaly Hepatomegaly ```

What investigations might you do to confirm glandular fever?

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

What are the other causes of infectious mononucleosis?

Cytomegalovirus | Toxoplasmosis

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

Cytomegalovirus (CMV)

How is cytomegalovirus usually transmitted? Name 5 routes

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

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

``` Sensorineural hearing loss Microcephaly Cerebral palsy Epilepsy Learning disability ```

What is the organism that causes mumps?

Paramyxoviridae viruses

How is mumps spread/

Droplet spread

What are the clinical features of mumps?

Fever, malaise, muscular pain | Parotitis ('earache', 'pain on eating'): unilateral initially then becomes bilateral in 70%

When are patients with mumps infectious?

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

What are the important complications of mumps?

Pancreatitis Epididymo-orchitis Used to be one of the most common causes of aseptic meningitis.

Where is poliovirus still endemic?

Africa and Indian subcontinent

What is the route of transmission of poliovirus?

Faecal-oral route

What are the clinical features of polio?

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

What are the causes of viral hepatitis?

``` 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)

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

Hand, foot and mouth disease

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

Mild systemic upset: sore throat, fever | Vesicles in the mouth and on the palms and soles of the feet

What is the virus responsible for roseola infantum?

Normally human herpes virus 6 Can also be caused by herpes virus 7

What are the other names for roseola infantum?

Exanthem subitum 6th disease

What is the incubation period for roseola infantum?

5-10 days

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

6 months to 2 years

What are the features of roseola infantum?

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

What are the rare complications of roseola infantum?

Aseptic meningitis Hepatitis

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

They do not need to be excluded from school