Viral infections in children

8/18/2019 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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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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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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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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Neonate1. Prematurity

2. Breast feeding; Missed feed>>> Exclusive>…Bottle

feeding


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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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Clinical Characteristics

Clinical progression

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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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Viral infections in children