COMMUNICABLE DISEASE

COMMUNICABLE DISEASE HEAD STARTJoyce M. Smith M.D., MPHCHILD CARE / EARLY EDUCATION SETTINGGroup SettingIncreased risk of infectious disease spreadAmong childrenYounger than 2 years Rates of Infection tend to Increase for first 6 monthsRates decrease after six months of attendanceChildren are 2 to 18 times more likely to catch an infectious disease than non-groupCHILD CARE / EARLY EDUCATION SETTINGAdult Care GiversIncreased risk of acquiring and spreading infection in the first yearSpread depends on environmental and host variablesSeason, crowding, hygiene practicesImmune status of hostVirulence of germ or pathogenINCREASE TRANSMISSION (Short List)Otitis Media Ear infectionsPneumoniaDiarrheaHepatitis AStreptococcal InfectionRotavirusChicken pox (Varicella)CONDITIONS FOR TRANSMISSIONPathogen (Germ) must be presentAdequate quantity presentSusceptible HostCorrect portal of entry

MODES OF TRANSMISSIONAirborne DropletDirect Contact (Fecal Oral)Fomites (Common Vehicle)BloodborneVectorborne

RESPIRATORY CONDITIONSCOMMON COLDPathogenVirus (many strains)Symptoms: Runny Nose, Congestion, Headache, Cough, Muscle aches Little or no feverMode of TransmissionDropletsRespiratory

RESPIRATORY CONDITIONSCOMMON COLDIncubation Period1 to 3 daysPeriod of Contagiousness1 day before up to 5 days after start of symptomsManagement SupportivePrevention of SpreadCover Cough, Hand HygieneOnly excluded if fever is present

RESPIRATORY CONDITIONSPHARYNGITIS VIRALPathogen Viruses (Multiple Strains)Symptoms Gradual onset of sore throat, runny nose, cough + diarrhea, + feverMode of Transmission: Respiratory, droplets, close contactsManagement Supportive, pain and fever medication as indicated

RESPIRATORY CONDITIONSSTREPTOCOCCAL PHARYNGITIS Pathogen Bacteria Streptococcus Strep Throat GABHSSymptoms Rapid onset, painful swallowing, fever, headache, muscle aches, enlarged tonsils, enlarged lymph nodesMode of TransmissionRespiratory, Close Contacts

RESPIRATORY CONDITIONSSTREPTOCOCCAL PHARYNGITIS Incubation Period1 3 daysMay develop scarlet feverPeriod of ContagiousnessTreated 24 to 48 hoursUntreated 10 daysMay lead to Rheumatic FeverManagement Antibiotics within 9 days

PHARYNGITIS

Nonspecific Pharyngitis, can be produced by several pathogens. Physical exam + Lab for final diagnosis Nelsons Textbook of Pediatrics, 19th editionPHARYNGITIS

More erythematous (red) with petechiae on roof of mouth, suggestive of strep infection PHARYNGITIS

White exudate on tonsils suggestive of Strep or Mono infectionRESPIRATORY CONDITIONSCROUPUpper Respiratory Infection with partial obstruction, causing noisy breathing (stridor) and respiratory distressCauses Bark-like coughMostly affects children 3 months to 5 years(Video of Croup)RESPIRATORY CONDITIONSCROUPPathogen Usually a virusSymptomsStarts as mild cold-like illness for 1-3 days then strider and bark-like cough developFever can be low grade or high 102.2 104Can become hypoxic and need hospitalizationMode of Transmission - Respiratory

RESPIRATORY CONDITIONSCROUPManagement Usually can be managed at homeKeep calm, respiratory distress increases with distress and cryingTo Emergency Room if respiratory distress worsensMedication can be used for severe cases

RESPIRATORY CONDITIONSEAR INFECTION (OTITIS MEDIA)Middle Ear Infection80% of children have at least one episode of Otitis MediaPeak incidence in the first 2 years of lifeMost cases are self-limitedPathogen Virus or BacteriaSymptomsFever, ear pain, RESPIRATORY CONDITIONSEAR INFECTION (OTITIS MEDIA)Risk factorsAge highest rates in 6 to 20 month oldAnatomy smaller facial structures allow local spreadSmoke Exposure Preventable risk factorPacifier useSmall increase RiskBreast MilkProtective affectCOMMUNICABLE DISEASECONJUNTIVIS (PINK EYE)ViralBacterialAllergicOther conditionsCOMMUNICABLE DISEASECONJUNTIVIS (PINK EYE)Viral and Bacterial Highly contagiousSpread by touching contaminated objects (fomites)Poor hand hygieneAllergic Not contagiousUsually bilateral

COMMUNICABLE DISEASECONJUNTIVIS (PINK EYE)SymptomsRedness or Pink eyes with white or yellow dischargeMay have ild eye painMode of TransmissionDirect ContactIncubation Period 1 to 3 daysPeriod of Contagiousness until redness resolves or determined to be non-contagious

COMMUNICABLE DISEASECONJUNTIVIS (PINK EYE)

VIRAL Usually watery dischargeMedicine.net.comCOMMUNICABLE DISEASECONJUNTIVIS (PINK EYE)

BACTERIAL HAS THICK GREENISH YELLOW DISCHARGECOMMUNICABLE DISEASECONJUNTIVIS (PINK EYE)

BACTERIAL ASSOCIATED WITH YELLOW CRUSTED DISCHARGECOMMUNICABLE DISEASECONJUNTIVIS (PINK EYE)MANAGEMENTHand Hygiene- Prevent spread to other eye, prevent spread to other peoplePrevent progression of viral or allergic to bacterial

Bacterial Antibiotic Eye DropsViral Self limited Allergic Topical Antihistamines

COMMON SKIN PRESENTATIONS**Measles Viral, preventable through vaccinationPathogenSymptomsMode of TransmissionIncubation PeriodPeriod of ContagiousnessManagement

***MEASLESPathogen Measles VirusSymptoms2 4 days of prodrome Fever, 103-105, Harsh Cough, Watery Reds Eyes, Then blotchy red rash starts 14 to 21 days post exposure on face and spreads to the bodyRash lasts 4 to 7 daysMode of TransmissionHighly ContagiousDirect Contact with oral and nasal secretionsContaminated clothing(*** Reportable; One case reported in Illinois in 2013)MEASLESIncubation Period 8 to 12 days range 7 to 18 daysPeriod of ContagiousnessSlightly before prodrome until 4 days after rash developsComplications may includePneumoniaMeningitisOtitis MediaDeath

MEASLES

Hurwitz Clinical Pediatric Dermatology Third EditionIntensely erythematous pathches of the face with spreading inferiorly onto the trunkRUBELLA GERMAN MEASLESPathogen German Measles VirusSymptoms 3-Day Measles Mild disease, mild fever, swollen glandsRash last 2 to 3 daysMode of TransmissionContact with respiratory dropletsIncubation Period14 to 21 daysPeriod of ContagiousnessManagement - Immunization

RUBELLA GERMAN MEASLES

Hurwitz Clinical Pediatric Dermatology Third Edition

Nonspecific rose pink macules and papules on the trunk of an adolescent male***VARICELLA (CHICKEN POX)Pathogen - VZV Varicella-Zoster VirusIncubation Period 10 to 21 daysSymptomsSudden onset, mild fever itchy rash starts as maculopapular and progresses to vesicles, then crust, more develop different stages of healing, Ave about 300 lesions. Much worse in older children and adults

***VARICELLA (CHICKEN POX)Mode of TransmissionDirect Contact with respiratory droplets and contaminated items, touching skin vesiclesPeriod of Contagiousness24 to 48 hours before the rash until lesions are crustedManagement / Complications***Reportable to the cityNotification of parents, VZIG within 96 hours of exposureImmunizations

***VARICELLA (CHICKEN POX)

UNIMMUNIZED CHILD***VARICELLA (CHICKEN POX)

BREAK THROUGH LESIONS OF IMMUNIZED CHILDFIFTH DISEASE (Erythema Infectiosum)Pathogen Parvovirus B19Incubation Period 4 to 28 daysSymptoms Usually benign, mild fever slapped cheek rash, progress to lacy appearance Mode of Transmission Respiratory nasal droppingsPeriod of Contagiousness right before rash

FIFTH DISEASE (Erythema Infectiosum)

Erythema of the cheeks giving a slapped cheeks appearanceFIFTH DISEASE (Erythema Infectiosum)

Reticulate erythema lacy rash on upper armHAND-FOOT AND MOUTH DISEASEPathogen Coxsackie Virus A 16Incubation PeriodSymptoms Mild Illness with low grade fever, on ulcers on Mouth and blisters Hands and FeetMode of Transmission Period of Contagiousness Before lesions appear and for several weeks after

HAND-FOOT AND MOUTH DISEASE

Deep-seated vesicles with erythema involving the palmar surface of the hand HAND-FOOT AND MOUTH DISEASE

A painful ulcer on the lateral aspect of the tongueHAND-FOOT AND MOUTH DISEASE

Red to purple vesicles involving the kneeHAND-FOOT AND MOUTH DISEASE

WARTS (VERRUCA)Pathogen HPV Human Papilloma Virus (Multiple strains more than 200)Usually benign in children and adolescentsIncidence is highest in children and adolescentsIncubation Period Develop lesions one month after inoculationSymptoms Slow developing growth, sometimes painfulUsually less than 3 in mm in size

WARTS (VERRUCA)Mode of Transmission Direct contact, autoinoculation and fomitesPeriod of Contagiousness, no limits, can be covered to avoid direct contactManagement / Complications65% disappear within 2 yearsLiquid NitorgenSalicyclic Acid Compound Wpodophyllin

WARTS (VERRUCA)Multiple FormsFlatFiliformPlantarCommonPeriungualCOMMON WARTS (VERRUCA)

A dome-shaped lesion on the nose and filliform wart down belowCOMMON WART (VERRUCA)

Common Wart on the TonguePLANTAR WARTS (VERRUCA)

SUBUNGAL WARTS

Verrucous papules under the thumb and index finger with extension under the nail plateMOLLUSCUM CONTAGIOSUMPathogen PoxvirusIncubation PeriodGreater than 2 weeksSymptomsOccurs mainly on children and immune compromised adults. Discreet pearly to flesh colored dome shape papules with umbilicated centerAnywhere on the body. Ave last 6 to 9 monthsMay persist for years

MOLLUSCUM CONTAGIOSUMMode of TransmissionDirect ContactFomitesAutoinoculationPeriod of Contagiousness May be present for yearsManagementSelf limitedCurettage (scraping) is the treatment of choice

MOLLUSCUM CONTAGIOSUM

Solid dome shaped pearly papuleMOLLUSCUM CONTAGIOSUM

FUNGAL DISEASE OF SKINTINEATinea Capitus (Ring Worm of the Scalp)Corporis (Ring Worm of the body)Pedis (Athletes Foot)VersicolorIntertrigo In skin foldsFUNGAL DISEASE OF SKINTINEA CAPITUSPathogen Fungus Dermatophytes affect skinIncubation PeriodSymptomsHair loss, Black dot hair breaks off near the scalp; Diffuse flakiness with little or no hair loss; Sever inflammatorty reactions produces kerionsMode of TransmissionDirect contact with fomitesCombs, brushes, chairs, hatsPeriod of Contagiousness Ongoing without treatmentManagementOral antifungal medication for 6 to 8 weeks

FUNGAL DISEASE OF SKINTINEA CAPITUS

BLACK-DOT RING WORMFUNGAL DISEASE OF SKINTINEA CAPITUS - KERION

FUNGAL DISEASE OF SKINTINEA CORPORIS (Body)Pathogen Fungal DermatophyteIncubation PeriodSymptomsRound reddish, scaly areas that progress to centrally clean can be millimeters or centimeters in sizeFUNGAL DISEASE OF SKINTINEA CORPORIS (Body)Mode of TransmissionDirect ContactInfected PetPeriod of ContagiousnessAs long as lesions are presentManagement Topical antifungal medication OTCSmall lesions can be covered to decrease spreading

FUNGAL DISEASE OF SKINTINEA VERSICOLOR

Hypopigmented minimally scaly macules and patches on trunkFUNGAL DISEASE OF SKINTINEA VERSICOLOR

Tinea Versicolor in dark skinned personBACTERIAL SKIN DISORDERSScarlet FeverAbcessesImpetigo

BACTERIAL SKIN DISORDERSSCARLET FEVER

Scarlet fever in a dark-skinned person. The rash resembles gooseflesh. Note the beginning of desquamation BACTERIAL SKIN DISORDERS

Post-scarlet fever desquamation. Extensive peeling of the hands following treatmentBACTERIAL SKIN DISORDERSABCESS (CARBUNCLE)

Large, tender eythematous swelling on lateral trunk of teenager.. Note small adjacent furnacleBACTERIAL SKIN DISORDERSIMPETIGO (BULLOUS)

Multiple tender eythematous patches with a peripheral collarette representing the remnants of the blister roofBACTERIAL SKIN DISORDERSIMPETIGO

These multiple lesion have spread as a result of autoinoculationINFESTATIONS LICEHead LiceScabies

INFESTATIONS HEAD LICEPathogen- Insect (Pediculosis)Incubation Period Eggs hatch in seven to ten daysSymptomsScratching of headIdentification of nits (eggs) attached to hair and lice presentMode of TransmissionDirect contact with an infested person, clothing or articlePeriod of ContagiousnessAs long as eggs are not treatedManagementApplication of 1% Permethrin Creme leave on 10 mintues then wash out Consider second treatment 1 2 weeks laterINFESTATIONS HEAD LICE

Nits and Lice Visible on hairINFESTATIONS SCABIESPathogenBody Lice ArthropodsMiteObligate human parasiteIncubation PeriodTwo to six weeks first timeOne to four days future infestationsSymptomsItching, scratching, papulosquamous lesions INFESTATIONS SCABIESMode of TransmissionDirect contact with infested individualsPossibly fomitesPeriod of ContagiousnessUntil 24 hours after treatmentManagementApplication of PermethrinWash off in 8 hours

INFESTATIONS SCABIES

INFESTATIONSSCABIES

INFESTATIONS SCABIES

Scabies lesions with burrows of egg deposits under the skinINFESTATIONS SCABIES

COMMUNICABLE DISEASESQUESTIONS?

ReferencesHurwitz: Clinical Pediatric Dermatology, third editionNelsons Textbook of Pediatrics, 19th editionCommunicable Disease Guide, Illinois Department of Public Health 2002Web M.D.

80