[eotour cue Infectious Diseases Peter BallContents Classical infectious diseases of childhood Horpos zoster (shingles) Herpes simplex infoctions 2 Kawasaki (mucocutaneous lymph node) syn Lyme disease Ort Herpangina disoase Infectious mononucleosis ma) Cytomegalovirus infection Virus hepatitis Staphylococcal infection Ostoomyelitis (OM) infections with Scarlet fever Ant Diphtheri Tetanus Enteric (typhoid and paratyphoid) fevers Infantile gastroenteritis Pseudomembranous Bacterial meningitis {non-meningococeal) Viral mening Tuberculosis Pertussis (whooping cough) bronchiolitis Community-acquired Lung abscess Erythema nodosum Stovens-Johnson, syndrome Antibiotic rashes Syphilis Gonococcaemia Acquired i deficiency syndrome (alos) IndexFe {Classical infectious diseases of childhood Measles virus, a single serotype paramyxovirus, nmion in preschool and junior schoolchildren, notably in the last few months he year, the disease is now rare due to widespread effective immunization. Wh measles is now usually sporadic breaks may occur if meas d to unexposed and non-immune Explosi Case to case spread follows airbome droplet nsmission from the respiratory tract of patients with active measles. There is no other rese infection. Invasion of the upper re and conjunetivae is Iymphoid tissues an appearances are cha owed by multiplication in ‘aemia, Histological terized by a manonuclear with giant cells and endothelial proliferation. L atin skin (rash) Mucous membranes (Koplik's spots), lungs, and lymphoid t The incubation period of 2 weeks is followed by the prodromal phase, ch respiratory catarrh with buccal mucosa (Fig. 1), accompani conjunctivitis, otitis media and rhinitis (Fig, 2). 24-48h later 3 dusky red n commences on the fac via the trunk (Fig. 3, Fig. lasts for 7-10 days, which the fading rash leaves skin staining (see Fig. 5, p. brown macules with fine desquamation, which can per Woeks. aa nom Fig. 3 0 & Fig.2 Mh ooypyuyo jo Seseasp snonsayur jemsser9 / |aaa enoximoyiiae rae ln Irn oH ratory fall infiteation causing a : & 2 z fer measles, Incidence 1:6000 ca ‘ sclerosing panencop! eactivatior 2 S y of latent virus within brain after 5-7 years a sing encephalitis, fatal within 6-12 month eummonia, Historically seen in adults sitized by inactv o the 1960 Fiat 8 mea or co-amoxiclav are effective for bacterial complications. There is no effective antiviral faa forsee Cah ipacan ra RGN a but does not aect eventual fatal outcome | ay Pe Notifiable in the UK; ti 1 Activ fon: attenuated vaccine gives 97% ser ion and long-term immunity. { Mild febrile reactions occur in 3% of vacein In the UK universal immunization, using mumps/rubella (MRubella Rubella virus, a single serotype togaviru Previously observed in schoolchildren with occasional epidemic fluctu Case-to-case sirbo transmission from the respiratory tract of active case the upper respiratory tract is followed by dissemination to skin, conjunetivae and mucous membranes and a resultant mild mononuclear reaction and proliferative hyperplasia in lymph rhodes. Lesions occur in the skin, lymphoid tissue, The incubation period of 2.5~3 weeks is followed by mild upper respiratory catarrh, conjunctival suffusion and, within 24-48h, a discrete maculopapular generalized rash (Figs 7-10). I ‘contrast to measles, Koplik’'s and systemic upset and irritability are minimal Lymphadenopathy is prominent, no suboccipital and post auricular groups, The rash may last 5 days But is often fleeting and fades without staining or desquamation. Rubella is diagnosed by the haemagglutination- inhibition and IgM tes deforming and typicaly affecting small joints, Incidence 10%—mainly in women = Allergic er \mences 10-1 {days after rubella, Incidence 1:60 ‘aused by thrombocytopenia and Management is symptomatic. Non-steroidal anti inflammatory agents may be required for rubella Not notifiable in the UK: hospitalized cases must be isolated, Live attenuated rubella vaccin (Condehill and R23 strains) give high level protection. In the UK immunization is accomplished using combined measies/mum fubella (MMA) vaccine gi pooypiys jo seseesyp snonoayu easeig / |Congenital rubella syndrome (CRS) Rubella vieus (p. § Afects up to 40% of rubella during first trimeste IMR in ‘of bath occurred in the UK Follows transplacent itus. Highest risk between 6-8 weeks’ gestatior but possible risk up to 16-18 wooks. Widespread fetal involvement includes persistent infection of liver, heart, CNS, lungs, pancreas and long bane: [Neonatal jauncice and purpura are often present Dysorganogenesis results in major ophthalmic cardiac, auditory and neu 10% of affected pregnancies, Severe CRS may includ persistent ductus a And ventricular septal defect (rare) (Fig. 11 -ophthalmia, cataract (Fig. 12) and retinitis: 15 weeks) are offered the In the UK immunization is accomp| combined measlesimumps/rubell given between 12-18 mont puerperium. The live attenuat Cendehill strain) v must never be ai available for this purpose Pooypiys Jo sseesp snonodqu esse / 4Mumps Mumps virus, a single serotype paramyxovirus All ages may be affected; more common in ildren over 1 year. Subelinica infection is common, World-wide distribution before vaccine, Previously 4-year cycles, clustering in spring and winter Moderately infectious: spreads by airborne droplet transmission from active cases, This is followed by Viraemia and glandular involvement. Salivary slands: inters ma and lymphocyte nvasion. Testes: oedema, perivascular lymphocyte nvasian, focal haemorrhage, destruction of germinal epithelium and tubular plugging, The CNS, pancreas, ovaries, breasts, thyroid and joints are less frequently involved The incubation period 2 general 14-10 days is followed by ed with convulsions in small children. Tender parotid nandibular gland swelling (Figs 13 & 14, bilateral in 70%, surrounded by aed few days, Menin 21 irritation is common. Mu virus is easily cultured from seliva or CSF. Paired sera show an antibody titre tse. * Orchitis: incidence 20% of post-pubertal males Fig. 15). Bilateral orchtis may result in sub- fertilty # Lymphocytic meningitis: a frequent cause of vira meningitis during epidemics. nfectious encephalitis, pancreatitis, 8 and thyrovdits: all rar infrequent, transient and affecting the larger joints. Symptomatic, NSAIDs may relieve the pain of Notifiable in the UK. A sai faccine (Jery! Lynn strain) is available fo hildhood immunization. The Urabe strain vaccine ‘was associated with benign aseptic meningitis in 1 in 510000 recipients and is no longer aveilabl In the UK immunization is accomplished using slesimumpsirubella (MM wen between 12-18 manths of age ooupiyo jo seseesp snonzopusjeosse.9 / 1Erythema infectiosum (slapped cheek disease) 88819 | vovirus B19 (HPV B19 soy |The human pi inci World-wide distribution, most commen in child aged 4-15 years. hogenesis | Spread occurs via respiratory droplet emission from active cases. Up to 30% of household contacts are affected. HPV B19 multiplies in rapidly p snonzej dividing call, 1 ts arthritis result from a h ably immune-complex mediated. Aplasti Crises and haemolytic anaemias may folly. erythroid dysplasia. A third of intrauterine HPV B19 nia follows in 5-7 days. Rash and virus interaction + Erythema infectiosur: the incubation period ‘5-10 days) is followed by non-tender erythor of the cheeks (Fig. 16) and thereafter by the Characteristic lace-tke rash over the limbs and older ch These features persist for 7-10 «Arthritis; most common in adult contacts, usually producing symmetrical arthralgia lasting several Fig. 16 Erythams intactosum slappod check ‘= Aplastic crises: HPV 819 is the most common ‘cause of aplastic crises in patients with sickle c ‘anaemia and algo causes aplasia in patients w ‘ther forms of chronic haemolytic anaemia. ppationts: chronic infection may cause severe persistent anaemia or transient nosis logy for specific laM and IgG antibodies is able but culture for HPV B19 is not normally ntand | Treatment is symptomatic: arthritis responds to jan | NSAIDs, Experimental vaccines may be developed for human use, Parvovirus vaccines are in widespread use in animals Fig. 1 Typical lace te stn rash (dt)