Académique Documents
Professionnel Documents
Culture Documents
ROSEOLA INFANTUM
ETIOLOGY
HHV-6 and HHV-7
CD46 & CD4 T cells
primary
target cells in vivo
EPIDEMIOLOGY
Early in life
Peak: 6-15mos
2 y.o, 7-10 y.0.
PATHOLOGY
(incubation period)
CLINICAL MANIFESTATIONS
Rinorrhea
Sore throat
Slight pharyngeal inflammation
Abdl pain
Diarrhea, vomiting
Roseola rash
Nagayama spots
RUBEOLA
(ETIOLOGY):
Measles virus
Remain viable for atleast
34hr at room temp.
ROSEOLA INFANTUM
LABORATORIES
DIAGNOSIS
High fever (3 days)
blanching maculopapular
rash (trunk)
presence of actively
replicating virus
GOLD STANDARD:
Viral culture
COMPLICATIONS
Convulsions
Seizure (peak age: 12-15 months)
post-ictal paralysis
30% - prolonged seizures
29% - focal seizures
38% - repeated seizures
status epilepticus
Encephalitis
Acute disseminated demyelination
Acute cerebellitis
Hepatitis
Myocarditis
Developmental disabilities
Autistic like features
PALE (posttransplant acute limbic
encephalitis)
TREATMENT
Minimum of 3 weeks
PROGNOSIS
PREVENTION
INFECTIOUS
MONONUCLEOSI
S
ETIOLOGY
Epstein Barr Virus
double-stranded DNA virus
y-herpesvirus
EBV 1 & 2
EBV 1
more prevalent worldwide
Induces growth transformation of B cells
EBV 2 = Africa
EPIDEMIOLOGY
MOT :
oral secretions
> 6 mo after acute infection
intermittently for life
sexual intercourse
PRIMARY INFECTION during childhood
Usually asymptomatic
Mild or indistinguishable
PRIMARY INFECTION in adolescents & adults
30 to 50 %
CLASSIC TRIAD:
fatigue, pharyngitis, generalized lymphadenopathy
PATHOGENESIS
Acquisition in ORAL CAVITY
EBV infects CRYPT EPITHELIAL CELLS >>> pharyngitis
INTRACELLULAR VIRAL REPLICATION & CELL LYSIS (release of
new virions)
VIRUS SPREADS to salivary glands
VIREMIA & INFXN of B lymphocytes , lymphoreticular system
(liver & spleen)
ATYPICAL LYMPHOCYTES ( CD8 T lymphocytes)
CLINICAL MANIFESTATION
INCUBATION PERIOD
30 to 50 days (adolescents)
PRODROMAL PERIOD
1 to 2 weeks
CLINICAL MANIFESTATION
CLINICAL
MANIFESTATION
AMPICILLIN RASH
morbilliform, vasculitic rash
DIAGNOSIS: Infectious
mononucleosis
presumptive
confirmatory
serologic testing
Laboratory Tests
> 90% of cases
leukocytosis of
10,000-20,000
cells/L (2/3s are
lymphocytes)
atypical
lymphocytes: 2040% of the total
number
Laboratory Tests
Heterophile Antibody Test
transient heterophile antibodies /PaulBunnell antibodies
IgM Abs detected by the Paul-BunnellDavidsohn test for red sheep agglutination
(greater sensitivity) agglutinate in sheep rbc
(+) in 75% cases: 1st week
(+) in 90-95% cases : 2nd week
Laboratory Tests
SPECIFIC EPSTEIN-BARR VIRUS
ANTIBODIES
testing is useful to confirm
Treatment
NO specific treatment
Mainstay Management:
rest, encouraging adequate fluid and
nutrition intake
symptomatic treatment with acetaminophen
or NSAIDS (fever, throat discomfort,malaise)
Treatment
Antiviral therapy is not
recommended
acyclovir, with or without corticosteroids
decreases viral replication and
oropharyngeal shedding during
it does NOT reduce the severity or duration
of symptoms or alter the eventual outcome
Complications
subcapsular splenic hemorrhage or
splenic rupture
occurs during 2nd week, rate of <0.5%
of cases in adults
Complication
Airway compromise with progressive symptoms
occurs
<5% of cases
common indication for hospitalization
elevating the head bed, intravenous
hydration, humidified air, and systemic
corticosteroids
Respiratory distress with incipient or actual
airway occlusion
managed by
tonsilloadenoidectomy
endotracheal intubation for 12-24 hr
Complication
Headache (50% of cases)
Headache with severe neurologic
manifestations
seizures and ataxia, in 1-5% of cases
Alice-in-Wonderland syndrome
(metamorphopsia)
Perceptual distortions of sizes, shapes,
and spatial relationships
Complication
Guillain-Barr syndrome or Reye
syndrome
Hemolytic anemia
(+) Coombs test result and with cold
agglutinins specific for red cell antige,
occurs in 3% of cases
1st 2 wk of illness and lasts for <1 mo.
Complication
Aplastic Anemia
3-4 wk after the onset
recovery in 4-8 days
some cases do require bone marrow
transplantation
Prognosis
for complete recovery is EXCELLENT
major symptoms
last 2-4 wk followed by gradual recovery
within 2 mo of onset of symptoms
Prevention
impractical to prevent
virus is ubiquitous
majority of the population is EBVpositive
CYTOMEGALOVIRUS
INFECTION
ETIOLOGY:
-largest of the herpes virus
CYTOMEGALOVIRUS INFECTION
EPIDEMIOLOGY
Acquired in different settings:
1. Community exposure
2. Nosocomial transmission
3. Intrauterine infection
Transmission: Saliva, Breastmilk, urine,
cervical and vaginal secretions, urine, semen,
stools, blood and tissue or organ transplant
-requires very close or intimate contact
Community exposure
BF is the most common route of CMV
infection in early childhood
Ingestion of BM from Seropositive
mothers- 60-70% of infants infected
Infection common in the 1st 6mos
Adolescents- Inc. infxn dt sexual
contact
Nosocomial Transmission
Exposure to blood product, allograft
transplantation
Pathology
RUBELLA
German measles or 3 day measles
INFANTS AND CHILDREN
ADULTS
ETIOLOGY
Family Togaviridae and is the only species
of the genus Rubivirus.
Single stranded RNA virus
SENSITIVE to heat, UV light, and
extremes of pH
STABLE at cold temperatures
Humans
EPIDEMIOLOGY
PREVACCINE ERA
INTRODUCTION OF THE VACCINE
AFTER SEVERAL YEARS
2 dose recommendation for rubella
vaccine
PATHOLOGY
Lymphoreticular inflammation and
mononuclear perivascular and
meningeal infiltration.
PATHOGENESIS
CLINICAL MANIFESTATIONS
Incubation period: 14 21 days
Symptoms of:
Low grade fever
Sore throat
Red eyes with or without pain
Headache
Malaise
Anorexia
In older girls and women, polyarthritis may occur with
arthralgia, swelling, tenderness, and effusion bu
Lymphadenopathy
Suboccipital, postauricular and anterior cervical lymph nodes are
most prominent
RASH
3 days
Examination of the
oropharynx
tiny, rose-colored lesions
(Forschheimer spots) or
petechial hemorrhages on
the soft palate.
LABORATORY FINDINGS/DIAGNOSIS
DIFFERENTIAL DIAGNOSES
Measles
Adenovirus infections
Parvovirus infections (erythema
infectiosum)
Eipstein-Barr virus
Enterovirus
Mycoplasma pneumoniae
COMPLICATIONS
Postinfectious thrombocytopenia
COMPLICATIONS
Arthritis
Adults (women)
Begins within 1 week of onset
COMPLICATIONS
Encephalitis
Postinfectious encephalitis
COMPLICATIONS
Encephalitis
Progressive rubella panencephalitis (PRP)
Infectious pathogenesis
Death occurs 2-5 yrs after onset
TREATMENT
No specific treatment available
Supportive Care
Antipyretics, analgesics
Children with CRS is more complex
PROGNOSIS
Excellent prognosis
Reinfection with wild virus
PREVENTION
Isolation from susceptible individuals
for 7 days after onset of rash
Standard plus droplet precautions
Children with CRS may excrete virus
up to 1 yr of age
VACCINATION
1st at 12 15 months
2nd at 4 6 yrs of age
Postexposure prophylaxis = within 3
days of exposure
Should not be given to severely
immunocompromised px
Should not be given during
pregnancy
Measles/Rubeola
Etiology
Measles Virus
Genus: Morbillivirus
Family:
Paramyxoviridae
Prodromal period:
shed in
Nasopharyngeal
secretions
Blood
Urine
: Neutralizing
antibodies
: Limit
proliferatio
n during
infection
Epidemiology
Endemic throughout the world
90% of children acquire this before 15 years old
before immunizations
Cases have decreased with vaccinations
MODE OF
TRANSMISSION
Portal of entry
Respiratory tract
Conjunctivae
Pathogenesis
incubation
Prodromal
Exanthemat
ous
Onset of rashes
1) Antibody production begins, 2) viral replication 3) subsiding
of symptoms
Infects CD4 T cells
Desquamation of rashes
Recovery
Clinical Manifestations
Pathognomonic Sign: Koplik Spots and
Warthin-Finkeldey Cell
1.
2.
3.
4.
5.
6.
High fever
Enanthem
Cough
Coryza
Conjunctivitis
Prominent exanthem
Clinical Manifestations
Prodromal
Stage
Lasts 3-5days
Conjunctivitis with
photophobia
Clinical Manifestations
Final Stage
Increase in
prodromal symptoms
then rashes appear
Rashes appear and
symptoms subside
Rash fade over 7
days
COUGH: lasts longest
Generalized
lymphadenopathy
forehea
d
Behind
ears
Upper
neck
Torso
and
extremit
ies
Palms
and
soles
VELOSO
FIFTH DISEASE/
ERYTHEMA
INFECTIOSUM
ALEGARBES
EPIDEMIOLOGY
PARVOVIRUS B19
Rash and transient aplastic crisis
(school-aged children)
Seasonal peaks: late winter and spring
MOT : respiratory route, blood and
blood products
Transmission rate: 15-30%
HUMAN BOCAVIRUS
Found in respiratory secretions
Prevalent: <2 years old
Associated with wheezing respiratory
illness
Found as a coinfection:
respiratory syncytial virus
human metapneumovirus
rhinovirus
PATHOGENESIS
PRIMARY TARGET = ERYTHROID CELL LINE
(erythroid precursors near pronormoblast stage)
Viral infection >> CELL LYSIS
Progressive depletion of erythroid precursors &
arrest of erythropoiesis
Endothelial cells, Placental cells, Fetal
myocardial cells
Biphasic Illness
7 to 11 days after inoculation
Viremia
Decreased reticulocyte counts
Nasopharyngeal viral shedding
Fever
Malaise
Rhinorrhea
Clinical Manifestation:
Parvovirus B19
Erythema Infectiosum (Fifth Disease)
most common
benign, self-limited exanthematous
illness of childhood
incubation period: 4-28 days (average:
16-17 days)
prodromal phase:
mild
low-grade fever in 15-30% of cases,
headache, symptoms of mild URTI
Athropathy
Arthritis and arthralgia
adults and older adolescents
joint symptoms
diffuse polyarthralgia with morning stiffness
to frank arthritis
selflimited
resolve within 2-4 wk
Immunocompromised
Persons
Chronic anemia
accompanied by neutropenia,
thrombocytopenia, or complete marrow
suppression
cancer chemotherapy or
immunosuppressive therapy
Chronic infections
Fetal Infection
<5% risk for fetal loss after infection
Primary maternal infection: associated
with
nonimmune fetal hydrops
intrauterine fetal demise
Myocarditis
dx: serologic findings,
B19 DNA in cardiac
tissue
Other Cutaneous
Manifestations
papularpurpuric
gloves-and-socks
syndrome (PPGSS)
fever,
pruritus,painful
edema, erythema
localized to the
distal extremities
self-limited
resolves within a few
weeks
Diagnosis
Based on the clinical presentation of the typical rash
Serologic tests:
B19- specific IgM
Anti-B19 IgG- past infxn
Anti- B19IgM- recent/acute infxn
Seroconversion of anti-B19 IgG AB
Serologic test- not reliable fo IC pxs
PCR/ Nucleic acid hybridization
Immune electron microscopy
Complications
Usually recover fully but with
protracted symptoms
1. Severe pneumonitis with high fatality
rate
if hypoxemia develops