Viral infections in children
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INFECTIOUS DISEASE
VIRAL INFECTIONS
Presented byDaniel Ansong
Department of Child Health
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Viral Infection
Objectives
To identify important viral infections in childhood
To describe the mode of infections and the major clinicalfeatures associated with the infections
To understand the pathogenesis and clinical diagnosis
To describe the life threatening events and complicationsassociated with the infections.
To understand the principles behind the treatment and
management of infections
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Measles
Etiology: RNA Virus from the parvomyxoviridae
Infectivity: Droplets spray during the prodromal period and few
days after the rash
Incubation 10-12daysInfectiousness 9th-10th day
Virus found in the nasopharyngeal secretions and spread through droplets
Epidemiology: Highly contagious infectionsNon-immune persons are at risk of infections
World-wide
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Koplik’s spots
Koplik's spots are named after Henry Koplik (1858-1927), an American pediatrician whopublished a short description of them 1896, emphasising their appearance before the
skin rash and their value in the differential diagnosis of diseases with which measles
might be mistaken.[
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Measles Conjunctivitis
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Maculopapular Rash
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Koplik’s Spots
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Clinical Features
The clinical course has three stages. An Incubation period which extends from 8-12days after initialexposure to the virus.
A prodromal period, follows consisting
Lethargy
Fever
Cough
Rhinorrhoea
Conjunctivitis
Within 2-3 days after the onset of symptoms, koplik’s spots
appears. An erythematous maculpapular rash erupts about 5 days after theonset of symptoms. The rash begins on the head and spreadsdownward, lasting about 4-5 days and then resolving from the headdownward.
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Diagnosis and Therapy
! Diagnosis is made mainly on the basis of
clinical findings
! Four fold or greater rise in
hemagglutination inhibition antibodies over
2-3 weeks confirms the diagnosis
! Therapy is supportive
! Prevention-Vaccination with a live
attenuated vaccine
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Complications
RespiratoryPneumonia
Secondary bacterial infections and Otitis media
Tracheitis
Reactivation of dormant tubercle bacilli
Neurological
Febrile convulsionsEEG abnormalities
Encephalitis
Subacute sclerosing panencephalitis (SSPE),long term complication.
Others
Diarrhoea
Hepatitis
AppendicitisCorneal uclceration
Myocarditis
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Rubella (German measles)
RNA-Virus classified as a togavirus based on biochemical andmorphological properties
Clinical Features
postnatal clinical features are absent in many cases of rubella
Incubation period:12-23 days,
In adult prodrome of malaise, fever and anorexiaThere is no prodrome in children
Days after the onset of symptoms
Posterial auricular
Cervical and
Suboccipital lymphadenopathy developsMaculopapular rash follows the appearance of the nodes.
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Characteristic of rash
Begins from the face and then becomes generalised.
Seldom lasts longer than 5 days .
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Congenital Rubella
Features of congenital rubella syndrome may be dividedinto three broad categories
Transient- Including low birth weight,hepatosplenomegaly, thrombocytopenia, hepatitis,
pneumonitis and radiolucent bone lesionPermanent- Including deafness, cataracts and congenitalheart lesions (PDA> PAS>AS> VSD)
Developmental- Including psychomotor delay, behavioraldisorders, and endocrine dysfunctions
The most characteristic features of CRS are CHD,Cataracts, microphthalmia , cornea opacities, glaucoma,and radiolucent bone lesions
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Congenital rubella
Disease at 1-2months gestation
Associated with 40-60% Multiple congenitaldefects and spontaneous abortions.
Disease at 3 months gestation Associated with a 30-35% risk of asingle defect.
Disease at 4 months gestation is
Associated with 10% risk of a single defectDisease at 5-9 months gestation occasionally isassociated with a single defect.
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Rubella Vaccine
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Roseola infantum
Cause by Human Herpes Virus 6
In 1988 it was found to be the cause of Roseolainfantum
Classical presentation
High fever lasting for few days.
Followed with generalized macular rash which appearsas the fever wanes
HHV-6 is the most common cause of febrile convulsion
Other presentationsEncephalitis; Hepatitis; Infectious mono-nucleosis-likesyndrome and Haematological malignancies.
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Human Herpes Viruses
Eight Herpes Viruses are known to affect
manHerpes simplex 1 and 2
Varicella Zoster
Cytomegalovirus
Epstein-Barr virus
Human herpes viruses 6,7 and 8
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Manifestations of HSV
Asymptomatic
Gingivostomatitis
Skin manifestations-
-Eczema herpeticum-Herpetic whitlows
Eye disease
Central nervous systemic
Neonatal infectionsInfections in the immunocompromised host
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Varicella Zoster
Varicella Zoster infection share many features withHSV-Vesicular rash and latent infectons.
Varicella spread by respiratory route
Clinical featuresIncubation period: 10-21(usually 14-16days)
Children are infectious from 48 hours before and up to 5 days afterthe onset of the lesions.
" General vesicular rash which starts on the scalp or trunk spread
over the rest of the body.
" Lesion may be macular or papular before developing into vesicles
which crust soon after their appearance.
" Systematic infections are mild or absent
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Varicella Zoster
Complications
Secondary bacterial infection of the skin
Encephalitis:3-6 days after the onset of rash is
characterized by cerebellar signs and ataxiaImmuno-compromised persons have severe progressive
disease
Management
Human Varicella Zoster Immunoglobulin (ZIG) isrecommmended for high risk individuals
Acyclovir for severe chickenpox
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Epstein-Barr Virus (EBV)
Diseases associated with it
Infectious Mono-Nucleosis
Burkitts Lymphoma
Lymphoproliferative Disease inimmunocompromised persons
Nasopharyngeal Carcinoma
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Infectious Mononucleosis
Non-Specific clinical signs present in younger children.Older children develop a overt presetation
Fever; malasie; tonsillopharyngitis
Lymphadenopathy-prominent cervical lymph nodes, withdiffused adenopathy
Petechiae on the soft palate
Splenomegaly; Hepatomegaly
Maculopapular rashJaundice
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Diagnosis of Infectious Mononucleosis
" Atypical lymphocytes
"
Positive monospot test (Test for heterophileantibodies)-2 to 9 weeks after the infections
"
The heterophile antibodies (Often negative in
young children)
" EBV antibodies test-Performed when the
monospot test is negative
Treatment
Symptomatic
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The common signs of mono include swollen, red tonsils, enlarged lymphnodes in the neck, and a fever that ranges from 38°C to 40°C. About one-third
of people who have mono have a whitish coating on their tonsils.
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Cytomegalovirus
TransmissionOral and Genital route
Maternal transmission
Blood transfusion
Organ transplant
Clinical importance
Disease in the immunocompromised individuals and
FetusMimics EBV or Toxoplasmosis but heterophile antibodies negative
Organ transplant
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Cytomegalovirus infections
Presentation in ImmunocompromsiedPneumonitis
Encephalitis
HepatitisRetinitis
Colitis and oesophagitis
Treatment
Ganciclovir an analogue of aciclovir is effective
Foscarnet an antiviral agent as second line.
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Parvovirus B19
1983 Parvovirus B19 was diagnosed as the cause oferythema infectiosum-Fifth disease or slapped cheek
syndrome
Causes
Asymptomatic infections 5-10% of children
Erythema infectiosum: Fever; fatigue; headache and
myalgia followed by a rash a week later in the face(slapped cheek) progressing to a maculo-papular rash.
Aplastic crisis
Fetal disease- Fetal hydrops and death
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Congenital infections
Clinical Features Rubella CMV Toxoplasmosis
Growth Retardation
+++ +++ + Anaemia + ++ ++
Petechiae, purpura ++ +++ +
Jaundice + +++ ++
Hepatosplenomegaly +++ +++ ++
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Congenital Infections
Clinical features Rubella CMV Toxoplasmaosis
Congenital heartdisease
+++ ----- ___
Pneumonitis + ++ +
Glaucoma ++ ___ ____
Retinopathy + + +++Cataract ++ ___ +
Encephalitis + ++ +
Microcephaly + ++ +
Intracranialcalcifications
___ + ++
Hydrocephalus ____ + ++
Sensorineural
Deafness
+++ ++ ___
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HIV Infections in Children
Human Immunodeficiency Virus
# Human T-lymphotropic retroviurs
# High affinity binding to CD4 molecule on T helper cellsand monocyte-macrophages
#
Cytopathic effect on CD4+ Cell
# Increased HIV expression in activated cells
# Viral genes and gene products
Group specific antigen/core p18 p24 p55Polymerase p31 p51 p66
Envelope gp41 gp120 gp160
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HIV Infections in Children
Diagnosis of HIV infections
A.
Viral Detection1. Circulating viral antigens (p24)
2. Viral culture
3. Gene detection by PCR
B. Antibodies1. ELISA
2. Western blot3. IgA antibodies
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HIV Infections in Children
Risk for vertical TransmissionMaternal/Birth :
# HIV/AID
# Low maternal CD4 count
#
High levels of maternal viral load
# Vitamin A deficiency
# Instrumental delivery
# PROM
#
Bleeding episodes
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HIV Infections in Children
Risk and Epidemiology
TransmissionVertical Transmission
Transmission through breast milk
Blood and blood productsHeterosexual
Sexual abuse
Blood products (factors Vlll, plasma etc)
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HIV Infections in Children
Neonate1. Prematurity
2. Breast feeding; Missed feed>>> Exclusive>…Bottle
feeding
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HIV Infections in Children
Clinical Characteristics
A.
Main features:
1. Short incubation peroid in =50% of infants
2. Recurrent bacterial infections
3. Failure to thrive (Height and Weight)4. Neurodevelopmental delays (IQ, Motor)
B. Clincial prognositc factors
1. Pneumocystis carinii pneumonia (PCP)
2. Encephalopathy
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HIV Infections in Children
Clinical Characteristics
Clinical progression
441
289
130
90
50
CD4cells
Pulmonary Tuberculosis
Extra-pulmonary Tuberculosis
Pneumocystis carinii pneumonia
Cerebral toxoplasmosis
Mortality
Time
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Management of Paediatrics HIV
"
Anti-retroviral Therapy
" Support Therapy
"
VCT AND VCCT.
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Viral Upper respiratory infections
Acute Infectious Laryngitis
Acute laryngotracheitis
Acute spasmodic laryngitis
Laryngotracheobronchitis
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Acute infectious laryngitis
Etiology-Viral and Bacterial
Clinical Feature- Mild illness; no respiratory
distress except in young children
Diagnosis- Clinical features; Larynx revealshyperemic and edematous muscosa
Management- Supportive measure; resting and
inhaling moistened air.
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Aetiology and severity
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Croup
General term use to describe several acute
conditions both infectious and non-infectious)
Involving the LARYNX; Trachea and bronchi
Characteristically: Barking cough combined withone or more of the following: Hoarseness,
inspiratory stridor and signs of respiratory
distress due to laryngeal obstruction
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Acute laryngotracheitis
Commonly termed as “Croup” Etiology: Parainfluenza virus
Clinical features: Gradual onset; worse at night
and persit for several days—Signs of uppers respiratory tract infectionfollowed with barking cough; inspiratory stridor;Fever; Hoarseness an aphonia
Diagnosis-Clinical; or Anterioposterial view of theneck show a classic narrowing of the trachea(Wine bottle sign)
Steeple sign on x ray
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Steeple sign on x-ray
The steeple sign is the result of a narrowed column of subglottic air seen on aposterior-anterior view and an over-distended hypopharynx on the lateral view
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Indicators of severity of illness
Level of conscious
Normal 0
Altered mental status 5
Grading
0-3 mild>3 Moderate to severe croup
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Differential Diagnosis
Foreign Body in the upper airwary
Peritonsillar Abscess
Epiglottitis
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Read about
Bronchiolitis
Kawasaki’s disease
Grading of HIV infections
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