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Infectious
Diseases
Peter BallContents
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)
IndexFe {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 (MRubella
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 / 4Mumps
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 / 1Erythema 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)