Question

Read from chapter 31 to 35  

II. Read Table 33.3- Communicable Diseases of Childhood and write a summary about Chickenpox ( Varicella), Measles ( Rubeola), Mumps and Pertussis ( Include etiology, clinical manifestations, complications and management)

Answer 1

Chickenpox - Chickenpox is an infection caused by the varicella-zoster virus. It causes an itchy rash with small, fluid-filled blisters.

Etiology : Varicella-zoster virus (VZV) causes the chickenpox infection. Most cases occur through contact with an infected person. The virus is contagious to those around for one to two days before your blisters appear. VZV remains contagious until all blisters have crusted over. The virus can spread through:

• saliva
• coughing
• sneezing
• contact with fluid from the blisters

Clinical manifestation : The itchy blister rash caused by chickenpox infection appears 10 to 21 days after exposure to the virus and usually lasts about five to 10 days. Other signs and symptoms, which may appear one to two days before the rash, include:

• Fever
• Loss of appetite
• Headache
• Tiredness and a general feeling of being unwell (malaise)

Complication : Varicella-zoster virus (VZV) causes the chickenpox infection. Most cases occur through contact with an infected person. The virus is contagious to those around you for one to two days before your blisters appear. VZV remains contagious until all blisters have crusted over. The virus can spread through:

• saliva
• coughing
• sneezing
• contact with fluid from the blisters

Management : If aciclovir by mouth is started within 24 hours of rash onset, it decreases symptoms by one day but has no effect on complication rates.Use of aciclovir therefore is not currently recommended for individuals with normal immune function. Children younger than 12 years old and older than one month are not meant to receive antiviral drugs unless they have another medical condition which puts them at risk of developing complications.

Treatment of chickenpox in children is aimed at symptoms while the immune system deals with the virus. With children younger than 12 years, cutting nails and keeping them clean is an important part of treatment as they are more likely to scratch their blisters more deeply than adults.Aspirin is highly contraindicated in children younger than 16 years, as it has been related to Reye syndrome.

Measles : Measles is a childhood infection caused by a virus. Once quite common, measles can now almost always be prevented with a vaccine.Also called rubeola, measles can be serious and even fatal for small children. While death rates have been falling worldwide as more children receive the measles vaccine, the disease still kills more than 100,000 people a year, most under the age of 5.

Etiology : Measles is caused by the measles virus, a single-stranded, negative-sense, enveloped RNA virus of the genus Morbillivirus within the family Paramyxoviridae. The virus is highly contagious and is spread by coughing and sneezing via close personal contact or direct contact with secretions. Measles is the most contagious transmissible virus known. It remains infective for up to two hours in that airspace or nearby surfaces. Measles is so contagious that if one person has it, 90% of nearby non-immune people will also become infected. Humans are the only natural hosts of the virus, and no other animal reservoirs are known to exist.

Clinical Manifestation : Measles signs and symptoms appear around 10 to 14 days after exposure to the virus. Signs and symptoms of measles typically include:

• Fever
• Dry cough
• Runny nose
• Sore throat
• Inflamed eyes (conjunctivitis)
• Tiny white spots with bluish-white centers on a red background found inside the mouth on the inner lining of the cheek — also called Koplik's spots
• A skin rash made up of large, flat blotches that often flow into one another.

Complication : Complications of measles may include:

• Ear infection
• Bronchitis, laryngitis or croup
• Pneumonia
• Encephalitis

Management : There is no specific antiviral treatment if measles develops. Instead the medications are generally aimed at treating superinfections, maintaining good hydration with adequate fluids, and pain relief. Some groups, like young children and the severely malnourished, are also given vitamin A, which act as an immunomodulator that boosts the antibody responses to measles and decreases the risk of serious complications.

Medications

Treatment is supportive, with ibuprofen or paracetamol (acetaminophen) to reduce fever and pain and, if required, a fast-acting medication to dilate the airways for cough. As for aspirin, some research has suggested a correlation between children who take aspirin and the development of Reye syndrome.

The use of vitamin A during treatment is recommended to decrease the risk of blindness; however, it does not prevent or cure the disease. A systematic review of trials into its use found no reduction in overall mortality, but two doses (200 000 IU) of vitamin A was shown to reduce mortality for measles in children younger than two years of age. It is unclear if zinc supplementation in children with measles affects outcomes as it has not been sufficiently studied.

Mumps : Mumps is a viral infection that primarily affects saliva-producing (salivary) glands that are located near your ears. Mumps can cause swelling in one or both of these glands.

Etiology : The mumps are caused by a virus called the paramyxovirus. It's spread from one child to another through direct contact with discharge from the nose and throat. Infected droplets in the air from a sneeze or close conversation can be inhaled and may cause infection. Child is contagious from one to seven days before the symptoms occur, and remains contagious for five to nine days after

Clinical Manifestation :

• Pain in the swollen salivary glands on one or both sides of your face
• Pain while chewing or swallowing
• Fever
• Headache
• Muscle aches
• Weakness and fatigue
• Loss of appetite

Complication : Mumps can lead to sever complications, including:

• Meningitis
  • swelling of tissue around the brain and the spinal cord
  • symptoms may include:
    • headaches
    • neck stiffness
    • nausea and vomiting
    • changes in behavior
    • eyes sensitive to light
• Pancreatitis
  • inflammation of the pancreas.
  • this is a rare, but serious complication.
  • symptoms may include:
    • sudden onset of severe pain high in the stomach
    • fevers
    • chills
    • vomiting
    • weakness

• Orchitis
  • inflammation of the testes
  • symptoms may include:
    • fever
    • chills
    • headaches
    • nausea and vomiting
    • stomach pains
    • painful swelling of one or both testes
• Oophoritis
  • inflammation of the ovaries in females
  • symptoms may include:
    • fever
    • stomach pain and tenderness
    • nausea and vomiting
    • pain on one side of the pelvic area or both

Management : The treatment of mumps is supportive. Symptoms may be relieved by the application of intermittent ice or heat to the affected neck/testicular area and by acetaminophen for pain relief. Warm saltwater gargles, soft foods, and extra fluids may also help relieve symptoms. Acetylsalicylic acid (aspirin) is not used to treat children due to the risk of Reye syndrome.

No effective postexposure recommendation is made to prevent secondary transmission, nor is the postexposure use of vaccine or immunoglobulin effective. Also, no available evidence regarding the Chinese herbal medicine.

Mumps is considered most contagious in the 5 days after the onset of symptoms, and isolation is recommended during this period. In someone who has been admitted to the hospital, standard and droplet precautions are needed. People who work in healthcare cannot work for 5 days.

Pertussis :  Whooping cough (pertussis) is a highly contagious respiratory tract infection. In many people, it's marked by a severe hacking cough followed by a high-pitched intake of breath that sounds like "whoop."Before the vaccine was developed, whooping cough was considered a childhood disease. Now whooping cough primarily affects children too young to have completed the full course of vaccinations and teenagers and adults whose immunity has faded.

Deaths associated with whooping cough are rare but most commonly occur in infants. That's why it's so important for pregnant women — and other people who will have close contact with an infant — to be vaccinated against whooping cough.

Etiology :  Whooping cough is caused by a type of bacteria called Bordetella pertussis. When an infected person coughs or sneezes, tiny germ-laden droplets are sprayed into the air and breathed into the lungs of anyone who happens to be nearby.

Clinical manifestation : Once become infected with whooping cough, it takes about seven to 10 days for signs and symptoms to appear, though it can sometimes take longer. They're usually mild at first and resemble those of a common cold:

• Runny nose
• Nasal congestion
• Red, watery eyes
• Fever
• Cough

After a week or two, signs and symptoms worsen. Thick mucus accumulates inside your airways, causing uncontrollable coughing. Severe and prolonged coughing attacks may:

• Provoke vomiting
• Result in a red or blue face
• Cause extreme fatigue
• End with a high-pitched "whoop" sound during the next breath of air

Complication : In infants especially those under 6 months of age complications from whooping cough are more severe and may include:

• Pneumonia
• Slowed or stopped breathing
• Dehydration or weight loss due to feeding difficulties
• Seizures
• Brain damage

Because infants and toddlers are at greatest risk of complications from whooping cough, they're more likely to need treatment in a hospital. Complications can be life-threatening for infants younger than 6 months old.

Management : The antibiotics erythromycin, clarithromycin, or azithromycin are typically the recommended treatment. Newer macrolides are frequently recommended due to lower rates of side effects. Trimethoprim-sulfamethoxazole (TMP/SMX) may be used in those with allergies to first-line agents or in infants who have a risk of pyloric stenosis from macrolides.

A reasonable guideline is to treat people age >1 year within 3 weeks of cough onset and infants age <1 year and pregnant women within 6 weeks of cough onset. If the person is diagnosed late, antibiotics will not alter the course of the illness, and even without antibiotics, they should no longer be spreading pertussis. When used early, antibiotics decrease the duration of infectiousness, and thus prevent spread. Short-term antibiotics (azithromycin for 3–5 days) are as effective as long-term treatment (erythromycin 10–14 days) in eliminating B. pertussis with fewer and less severe side effects.