What are the classifications of viral illness in childhood?
♦ Asymptomatic / Subclinical infection ♦ Fever and a rash ♦ Respiratory tract infections ♦ Gastro-intestinal infections ♦ Others
Which diseases are you requited to report to Public Health England?
Acute meningitis Acute poliomyelitis Measles Mumps Rubella Smallpox
When is IgM produced?
in acute infection
When is IgG produced?
Long term immunity
What are the differential diagnoses for a child with a rash?
Parvovirus Measles Chickenpox Rubella Non-polio enterovirus infection EBV (with ampicillin) (not forgetting bacterial causes such as Staphylococcus aureus, N. meningitidis)
Which virus causes measles
Paramyxovirus Enveloped single stranded RNA virus
How is measles transmitted?
Person to person Droplet spread
When is the infectivity of measles?
From start of first symptoms (4 days before rash to 4 days after disappearance of rash)
What is the incubation period of measles?
7-18 days (average 10-12)
How contagious is measles?
90% unprotected contacts will acquire active infection
What are the clinical features of measles?
•Prodrome Fever, malaise, conjunctivitis, coryza and cough (3’c’s)
•Rash Erythematous, maculopapular, head – trunk,
•Koplik’s spots 1-2 days before rash.
•Infection in the immunocompromised
•Rash + fever + cough/coryza/conjunctivitis
What are the possible complications of measles?
•Otitis media (7-9%)
•Acute encephalitis – rare but fatal (1 in 2000)
Which rare (1/25000) complication of measles can cause death up to 30 years after contracting the disease?
Subacute sclerosing panencephalitis (SSPE)
How is measles diagnosed?
•Oral fluid sample
What is the treatment for measles?
•Antibiotics for superinfection
What is the prevention for measles?
•Vaccine – live MMR
1 year / pre-school
•Human normal immunoglobulin
What disease has caused this rash?
What virus causes chicken pox?
Varicella zoster virus
How is chicken pox spread?
Respiratory spread/personal contact (face to face/15mins)
What is the incubation period of chicken pox?
What is the duration of infectivity of chicken pox?
2 days before onset of rash until after vesicles dry up
What are the clinical features of chicken pox?
•Fever, malaise, anorexia
•Rash – centripetal
macular > papular > vesicular > pustular
What are the possible complications of chicken pox?
–Pneumonitis (risk increased for smokers)
–Central nervous system (CNS) involvement
–Foetal varicella syndrome
How is chicken pox diagnosed?
–PCR –vesicle fluid/CSF
–IgG in pregnant women in contact with VZV and no history of chickenpox
What is the treatment for chicken pox?
–Symptomatic adults and immunocompromised children
–Aciclovir oral, iv in severe disease or neonates.
–Chlorpheniramine can relieve itch (>1 yr olds)
What are the potential prevention methods for chicken pox?
–Vaccine – live, 2 doses (USA/Japan)
•Health care workers
•Susceptible contacts of immunocompromised pts
–VZ Immunoglobulin (VZIG) given if:
•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
What disease caused this rash?
What virus causes rubella?
•Togavirus, RNA virus
How is rubella transmitted?
•Droplet spread – air-borne
What is the incubation period for rubella?
When is rubella infective?
•One week before rash to 4 days after.
What are the clinical features of rubella?
•Prodrome – non-specific
•Lymphadenopathy – post-auricular, suboccipital
•Rash very non specific
transient, erythematous, behind ears and face and neck.
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.
What are the risks of rubella in pregnancy?
•Congenital rubella syndrome (CRS)
–cataracts and other eye defects
–retardation of intra-uterine growth
inflammatory lesions of brain, liver, lungs and bone marrow
How is rubella diagnosed?
•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.
What is the treatment for rubella?
•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.
What is Parvovirus B19 also known as?
–’slapped cheek’ or ‘fifth disease’
How is parvovirus B19 transmitted?
•Transmitted by respiratory secretions or from mother to child
What is the incubation period of parvovirus B19?
What are the clinical features of parvovirus B19?
Minor respiratory illness
Rash illness ‘slapped cheek’
Anaemia in the immunosuppressed
- this may be prolonged
How is parvovirus B19 diagnosed?
- Serology IgM/IgG – 90% have IgM at time of rash
- Amniotic fluid sampling
- PCR in immunocompromised.
How is parvovirus B19 treated?
- None if self limiting illness
- Blood transfusion
- No vaccine available
What are enteroviral infections?
•Coxsackie, entero, echoviral infections.
•Hand, foot and mouth disease.
•Meningitis – PCR of CSF.
What diseases might cause respiratory symptoms in a child?
•Respiratory Syncytial Virus
Rhinovirus is a member of which classification?
What are the two main viruses that cause diarrhoea in children?
What family does mumps belong to?
How is mumps spread?
- direct contact,
- droplet spread,
What is the incubation period of mumps?
•2-4 weeks (mostly 16-18 days)
What are the clinical features of mumps?
- 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
What are the rare complications of mumps?
•Rare manifestations :-
–Submandibular and/or sublingual sialadenitis
–Renal function abnormalities (mild)
•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
What disease does this child have?