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Childhood viral illnesses

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Erythema infectiosum (Fifth disease) Mumps. Varicella-Zoster ... Erythema infectiosum. Distinct facial rash: 'slapped cheek' sparing the area around the mouth ... – PowerPoint PPT presentation

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Title: Childhood viral illnesses


1
Childhood viral illnesses
  • Dr. Kevin Forward
  • Departments of Pathology, Microbiology and
    Immunology and Medicine
  • 473-4109
  • kevin.forward_at_cdha.nshealth.ca

2
Common Childhood Viral Infections
  • Measles (rubeola, red measles)
  • Rubella (German measles)
  • Erythema infectiosum (Fifth disease)
  • Mumps
  • Varicella-Zoster (Chickenpox)
  • Coxsackievirus and Echovirus associated
    infections (hand-foot-and-mouth disease)

3
Measles
  • Related to mumps and, RSV, an enveloped ssRNA
    virus
  • Worldwide occurrence, epidemics were common in
    North America pre-vaccination but are now rare
  • However in the third world 1 million kids die
    yearly
  • One of the most infectious of all viruses
  • Vaccination instituted in 1963
  • Slight increase in incidence in 1980s with need
    to institute 2nd dose vaccine

4
Measles
  • Transmission direct droplet contact incidence
    greater in winter months
  • Incubation 2 weeks
  • Rash evolves from face to trunk to extremities
    (including palms and soles)
  • Fever and the three Cs cough, coryza and
    conjunctivitis
  • Koplik spots (little sugary spots on the mucosa
    next to the molar teeth)
  • Diagnosis
  • antibody detection (IgM)

5
Measles (continued)
  • Complications are common in the very young and
    older kids and young adults
  • Malnutrition esp vitamin A deficiency is a major
    cause of mortality
  • Complications include
  • Otitis media
  • Pneumonia
  • Encephalitis
  • Death

6
Rubella
  • Also known as German measles
  • Transmission respiratory droplets
  • Incubation period is 2-3 weeks
  • Infections may be sub-clinical esp in young kids
  • Mild to no prodromal phase
  • Rash (face to body notoriously difficult to make
    a clinical diagnosis)
  • Adenopathy (swollen lymph nodes)
  • Adults may also get mild arthritis

7
Rubella
  • Congenital rubella is the most severe
    complication
  • Most infections and complications occur in the
    first 16 weeks of pregnancy (90 transmission
    rate to fetus)
  • Infants are born with numerous defects
  • Cardiac abnormalities
  • Cataracts
  • Deafness
  • Brain, liver and organ damage

8
Rubella
9
Erythema infectiosum
  • Also known as Fifth disease
  • Caused by Parvovirus B19 infection
  • Small single-stranded icosahedral DNA virus
  • Worldwide infection
  • Seroprevalence increases with age (15-60 by age
    5-9)
  • Transmission
  • Respiratory droplets
  • Vertical (mom to fetus)

10
Erythema infectiosum
  • Distinct facial rash slapped cheek sparing the
    area around the mouth
  • Lacy pink rash of the extremities
  • Resolves within one week but can return with
    exposure to heat
  • May cause fetal abnormalities if pregnant women
    are infected
  • Diagnosis Antibody detection (IgM)

11
Fifth Disease
12
Fifth disease
13
Mumps
  • Occurs worldwide
  • Uncommon because of vaccine use and esp after the
    introduction of a second dose of MMR
  • Transmission Droplet spread
  • Incubation 2-3 weeks

14
Mumps
  • No rash parotid gland swelling associated with
    ear ache is seen in 95
  • Other salivary glands and lymph nodes in head and
    neck 10
  • Menningitis in 15, encephalitis is rare
  • Occasionally orchitis (common in young men but
    rarely leads to sterility), oopheritis
  • Diagnosis Antibody testing or finding the virus
    in saliva or urine (culture or PCR).

15
  • Mumps Outbreak United States 2006

Provisional Number of Cases by State as of June
20, 2006
16
Onset information missing for 55 cases 3
asymptomatic
17
ChickenpoxVaricella-zoster virus
  • Infection is primarily by the airborne route
  • Very infectious (90 of non-immune household
    contacts will become infected).
  • Almost all children will be infected by the age
    of 15
  • Unlike other human herpes viruses almost all
    infections are symptomatic.
  • Infections in immune compromised and neonates can
    produce encephalitis, pneumonia or disseminated
    infection.

18
Chickenpox (varicella)
  • Chicken pox is usually characterized by fever and
    a generalized vesicular eruption.
  • The virus replicates in the throat and
    subsequently spreads during secondary viremia to
    the skin, reticuloendothelial tissue and rarely
    to lungs and brain.
  • The incubation time is usually 11-13 days.
  • Typical progression is Maculegtpapulegtvesicl
    egtpustulegtulcergtcrust
  • Dew drop on a rose petal

19
Complications of chickenpox
  • Pneumonia (Approximately 15 of adults with
    chickenpox)
  • Varicella in the immuno-compromised host
  • Varicella causes severe infections in newborns
    whose mothers are non-immune, and in patients
    with abnormal CMI
  • Central nervous system involvement (This is quite
    rare1 in 200)
  • Bacterial super-infection (usually due to S.
    aureus and to S. pyogenes).

20
Shingles (varicella zoster)
  • The incidence increases with age, 10-20 of
    adults will eventually get shingles
  • Patients altered cell mediated immunity are most
    susceptible. (ie altered cell mediated immunity)
  • The virus becomes latent in dorsal root and
    cranial nerve ganglia, reactivating later in life
  • Shingles are characterized by inflammation of
    sensory nerve and their ganglia and a localized
    vesicular rash along the distribution of that
    nerve.
  • Intense post-herpetic neuralgia is the principal
    complication

21
Diagnosis of varicella zoster infections
  • Clinical syndrome recognition.
  • Electron microscopy (all Herpesviridae look
    alike).
  • Virus isolation (the varicella zoster virus grows
    slowly and cultures are frequently negative).
  • Viral serology usually not necessary however,
    this may be useful to determine the immune status
    of an exposed individual.

22
Prevention of varicella-zoster infections
  • Vaccine
  • Now universal in Nova Scotia (Jan 2003)
  • A live vaccine that may produce mild chickenpox
  • Shingles may follow
  • VZ immune globulin (VZIG)Post exposure
    prophylaxis
  • Congenital or acquired immunodeficiency
    (congenital, malignancy or drug-induced).
  • Newborn of a mother developing chickenpox from
    five days to two days after delivery.

23
Treatment of varicella-zoster infections
  • Usually only local measures are necessary.
  • Patients with pneumonia may need oxygen therapy
    and other forms of respiratory support.
  • Acyclovir or a cousin may be used in the
    immune-compromised host and in patients with
    varicella pneumonia or with central nervous
    system infections.
  • These drugs may also be useful in the treatment
    of patients with zoster.

24
Coxsackieviruses and Echoviruses
  • Enteroviruses, members of the Picornavirus family
  • Infections occur June-October
  • Transmission fecal-oral
  • 50-80 of infections are asymptomatic
  • Can cause skin rash and can look mimic other
    virus infections
  • Common cause of meningitis, myocarditis
  • Hand-foot-and-month disease (vesicular type)
  • Usually secondary to Coxsackie A16
  • Children lt10
  • Sore throat, vesicles, fever, cutaneous lesions
    including hand and feet

25
Coxsackieviruses and Echoviruses
  • Diagnosis
  • virus isolation
  • Antibody detection not useful (there are too
    many serotypes for this to be useful or available
    widely)
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