Childhood Diseases

Infectious Mononucleosis
AKA Mono, “Kissing Disease”, Epstein-Barr Viral Syndrome
Cause: Epstein-Barr virus and Cytomegalovirus
Both from the herpes virus family
Incubation period: 7-14 days

Commonly transmitted by saliva and close contact
MC age group affected is 15-17 year olds
Infection may occur at any age
Younger children often don't have symptoms
Older patients may have fatigue for up to 6 weeks

Gradual onset of symptoms including:
Sore throat
Fever
Headache
Fatigue
Sore throat becomes progressively worse often accompanied by enlarged tonsils with a whitish yellow covering.

Enlarged lymph lodes
MC cervical & axillary
Cervical lymph nodes often painful
Rash
Pink, measles-like rash
more common if given amoxicillin for throat infection
Enlarged spleen & liver

Common tests for EB virus include:
A monospot test (positive for infectious mononucleosis)
Epstein-Barr virus antigen by immunoflouresence (positive for EBV)
Epstein-Barr virus antibody titers

Management
Antiviral medications do not help
Most patients recover within 2-4 weeks without medication
Fatigue usually resolves within a few weeks
may linger for 2 to 3 months
To relieve typical symptoms…
Gargle with warm salt water (sore throat)
Rest & fluids
Avoid contact sports while the spleen is enlarged

Rubella
AKA Three day measles; German measles
Viral infection
Contagious 1 week before onset of rash until 1-2 weeks after rash disappears
Spread through the air or by close contact
May be transmitted to fetus by a mother with an active infection

Rubella is usually a mild, self-limited infection
Children generally have few symptoms

Signs & Symptoms
Low-grade fever (<102 F)
Headache,malaise, runny nose,bloodshot eyes
Rash with skin redness or inflammation
Complications:
Congenital rubella syndrome
Transient arthritis
common in adolescents and adults with rubella
Otitis Media (rare)
Encephalitis (rare)

Tests:
A rubella serology
A nasal or throat swab for viral culture
Lifelong immunity to the disease follows infection
A rubella vaccine is available

Congenital Rubella Syndrome
“About 25% of infants born to mothers infected with rubella during early pregnancy will develop congenital rubella syndrome associated with a poor outcome.”

Defects related to congenital rubella are more common during early pregnancy
Complications are rare after the 20th week
Deafness (MC)
Cataracts
Cardiac defects
Mental retardation
Microcephaly
Miscarriage or stillbirth may occur

Rubeola
AKA Measles, Red Measles
Viral infection
Incubation period: 8 to 12 days before symptoms generally appear
Spread by contact with droplets from the nose, mouth, or throat of an infected person

Signs & Symptoms:
Sore throat,runny nose, cough, muscle pain, fever, bloodshot eyes
Koplik's spots
White spots inside the mouth
Photophobia

Complications:
Secondary bacterial infections
otitis media, bronchitis, or pneumonia
Encephalitis (~1/1000)
Tests:
Viral culture (rarely done)
Measles serology
Immunity occurs after active infection
A vaccine is available

Fifth Disease
AKA Parvovirus B19, erythema infectiosum, “slapped cheek”
A viral illness characterized by mild symptoms and a blotchy rash
Once the rash appears, the patient is non-contagious and may return to school or day care

First sign noticed by parents: bright red cheeks
Later a rash appears on the extremities and trunk
Fades from the center
outwards giving it a
“lacy appearance”
Rash disappears
entirely in 1-2 weeks

Complications
Generally no complications in normally healthy children
Mild and generally benign viral infection
Complete recovery can be expected
Tests
Blood tests for antibodies against Parvovirus B19 are available

Varicella
AKA Chicken Pox
Cause: varicella-zoster (herpesvirus family)
also causes herpes zoster (shingles) in adults
Very contagious; can be spread by direct contact, droplet transmission, or airborne transmission
A vaccine is available

Usually occurs in children younger than ten
Adults and older children usually get sicker than younger children
Characterized by vague symptoms (fever, headache, tummy ache, or loss of appetite) for 1-2 days before the classic pox rash appears
These symptoms generally last 2 to 4 days after the rash appears

Itchy fluid-filled blisters develop over red spots on the skin
(dew drops on a rose petal)
Often appear first on the face, trunk, or scalp and spread from there

Complications:
Secondary infection of the blisters may occur
Reyes syndrome, pneumonia, myocarditis, and transient arthritis
Cerebellar ataxia may appear during the recovery phase or later
Encephalitis (rare)
Congenital infection
Newborns are at risk for severe infection (if mother is not immune)

Chickenpox is usually diagnosed from the classic rash and the child's medical history
Tests:
Blood tests and tests of the pox blisters themselves can confirm the diagnosis if there is any question

Treatment
Antiviral medicines
skin conditions (eczema or recent sunburn)
lung conditions (asthma)
recently taken steroids
take aspirin on an ongoing basis

In most cases, it is enough to keep children comfortable while their own bodies fight the illness…
Treatment:
Trim the fingernails
reduce secondary infections and scarring
Oatmeal and/or baking soda baths
Topical lotions
Oral antihistamine

Roseola
Caused by a human herpesvirus 6
Incubation period: 5 to 15 days
Spread either through fecal-oral contact or via airborne droplets
Common in children 3 months to 4 years old
MC in those between 6 months and 1 year

Classic presentation
Fever (up to 105 F) ~3 days (may last 7)
Fever falls between the 2nd and 4th day
As the fever falls, the rash appears
First on the trunk and then spreads to the limbs, neck, and face
Rash lasts from a few hours to two days

Symptoms:
Abrupt onset of high fever
Irritability
Rash erupts on the 4th or 5th day of the illness (fever has usually resolved or is dropping by the time the rash appears)
Signs:
A history of roseola in the community
A physical exam of rash
Swollen occipital lymph nodes

The vast majority of children with roseola fully recover
Complications:
Febrile Seizure
Encephalitis (rare)
Aseptic meningitis (rare)

Treatment :
No specific treatment
usually resolves without complications
Medical Management:
Acetaminophen and sponge baths (fever)
If convulsions occur ~>medical evaluation

Hand-Foot-and-Mouth Disease
AKA Coxsackievirus infection
MC in young children
can be seen in adolescents and occasionally adults
Outbreaks occur most often in the summer and fall

Symptoms
Fever
Sore throat
Loss of appetite
Headache
Ulcers in the throat, mouth & tongue
Vesicular rash on hands, feet, & diaper area

Infection usually begins in the throat
Hands, feet, and diaper area are affected by a vesicular rash (very small blisters)
Typically on the palm side of the hands & the sole side of the feet
Tender or painful if pressed

Expectations:
Usually a mild illness
Generally complete recovery occurs in 5-7 days
Complications:
Dehydration may occur
mouth lesions cause pain with swallowing
Possible febrile seizures

Scarlet Fever
AKA Scarlatina
Cause: group A streptococcal throat infection
Incubation period: generally 1-2 days

Symptoms:
Sore throat
Fever, chills
Abdominal pain, vomiting
Headache
Muscle aches
Generalized discomfort (malaise)
Swollen, red “strawberry tongue”
Rash on neck and chest
Pastia's lines
bright red color in the creases of the underarm and groin

Typically begins with fever & sore throat
Strep. produces a toxin that causes a rash
Appears 1-2 days after the onset of illness
Usually appears on the neck & chest, then spreads over the body
Described as "sandpapery" in quality
Can last for over a week
As the rash fades, peeling (desquamation) may occur (finger tips, toes, and groin area)

Diagnosis:
Physical examination
texture of the rash is more important than the appearance in confirming the diagnosis
Tests:
Throat culture positive for Group A Strep
Rapid antigen detection (throat swab)

Scarlet fever was once a very serious childhood disease, but now is easily treatable…
Expectations:
With proper antibiotic treatment, symptoms should resolve quickly
Rash can last for up to 2-3 weeks before it is fully resolved
Treatment:
Antibiotic therapy
Crucial to preventing rheumatic fever

Complications are rare with proper treatment
Complications include:
Acute rheumatic fever
Ear infection
Adenitis or abscess
Pneumonia
Sinusitis
Meningitis
Bone or joint problems (osteomyelitis or arthritis)
Liver damage (hepatitis)
Kidney damage (glomerulonephritis)

Mumps
AKA Epidemic parotitis
Viral infection
Incubation period: 12 to 24 days
Spread from person-to-person by respiratory droplets or articles contaminated with infected saliva
MC in children between the ages of 2 and 12
can occur in other age groups

Acute, contagious, viral disease
Causes painful enlargement of the salivary or parotid glands
Other organs may be involved including the testes, the CNS, and the pancreas
After the illness, life-long immunity to mumps occurs
A vaccine is available

Symptoms:
Face pain
Swelling of the parotid glands
Fever
Headache
Sore throat
Swelling of the temples or jaw
Additional symptoms in males: testicle pain & scrotal swelling

Diagnosis:
Physical examination confirms the presence of the swollen glands
No testing is usually required

Treatment
No specific treatment
Probable outcome is good even if other organs are involved
Recommendations:
Warm salt water gargles, soft foods, and extra fluids
Intermittent ice or heat to the affected area
Acetaminophen for pain relief

Diphtheria
Cause: toxin-producing Corynebacterium diphtheriae
Incubation period: 2 to 5 days
Transmission:
Contact with respiratory droplets from infected persons or asymptomatic carriers
May also be transmitted by contaminated objects or foods

Diphtheria may be mild and unrecognized or it may become progressive
The bacteria primarily infect the nose and throat
Produces a characteristic membrane that is gray to black, tough, and fibrous
Membrane can cause airway obstruction

Symptoms :
Sore throat
mild to severe; painful swallowing; hoarseness
Drooling (airway obstruction)
Fever and chills
Bloody, watery drainage from nose
Croup-like (barking) cough
Stridor, difficulty breathing, or rapid breathing
Apnea; Cyanosis
Note: There may be no symptoms.

Complications
Diphtheria toxin can damage the heart, nervous system, kidneys, or other organs resulting in disorders such as:
Myocarditis ~> heart failure
Neurologic palsies or peripheral neuritis ~> uncoordinated movements (develops in 3-7 weeks)
Severe nerve damage ~> paralysis
Kidney damage or nephritis

Diagnosis
Characteristic gray pseudomembrane
Enlarged lymph glands, swelling of the neck or larynx
Tests
Gram stain of membrane or throat culture to identify Corynebacterium diphtheriae
If diphtheria is suspected, treatment should be started immediately, even before the results of bacterial tests are available.

Treatment :
Diphtheria antitoxin
intramuscular or IV injection as soon as the diagnosis is suspected
Infection is then treated with antibiotics
penicillin or erythromycin
A vaccine is available

Pertussis
AKA: Whooping cough
Highly contagious bacterial disease
Spread through respiratory droplets

Symptoms
Runny nose
Slight fever (102°F or lower)
Diarrhea
Severe, repeated coughs
May lead to vomitting
May make breathing difficult
May cause a short loss of consciousness
Choking spells in infants

In children, the coughing often ends with a "whoop"
Produced when the patient tries to take a breath
Rare in patients under 6 months and in adults
The infection usually lasts 6 weeks
Cold symptoms (~2 weeks)
Progressively worse cough (~4 weeks)
Complete resolution (may take months)

Diagnosis
Usually based on symptoms
When symptoms are not obvious, pertussis may be difficult to diagnose…
Differentials
In very young infants, symptoms may be caused by pneumomnia instead

Complications
Nose bleeds
Ear infections
Pneumonia
Slowed or stopped breathing (apnea)
Convulsions
Seizure disorder (permanent)
Brain damage from lack of oxygen
Bleeding in the brain (cerebral hemorrhage)
Mental retardation
Death

Expectations:
In older children, outlook is generally very good
Infants have the highest risk of death and need careful monitoring
Management
Cough mixtures, expectorants, and suppressants are usually not helpful and should NOT be used

Treatment:
Infants <18 months require constant supervision
Breathing may stop during coughing spells
Infants with severe cases should be hospitalized
An oxygen tent with high humidity may be used
If started early enough antibiotics can spead up resolution
IV fluids (severe coughing spells prevent the patient from drinking enough fluids)
A vaccine is available

Tetanus
AKA: Lockjaw
Cause: toxin of the bacteria C. tetani
Spores of the bacterium live in the soil and are found around the world (can remain infectious >40 years)
Incubation period: 5 days to 15 weeks, 7 days average
A vaccine is available
Spores in the dirt, NOT rusty nails

Infection begins when the spores are introduced into an injury or wound.
Symptoms:
Spasms and tightening of the jaw muscle
"lockjaw"
Stiffness and spasms of various muscle groups
neck, chest, abdominal, and back muscles
“opisthotonos”
Tetanic seizures
painful, powerful bursts of muscle contraction
Irritability
Fever

Additional symptoms that may be seen:
Excessive sweating
Swallowing difficulty
Hand or foot spasms
Drooling
Uncontrolled urination and/or defecation

Complications:
Airway obstruction
Respiratory arrest
Heart failure
Pneumonia
Fractures
Brain damage due to lack of oxygen during spasms