THE CHILD WITH AN INFECTIOUS DISEASE
Viral Exanthems
Rubeola
(Measles)
Causative agent
Manifestations
Complications
Management
RNA Virus
3-5 days before the
appearance of the rash
to 4-6 days after
appearance of the rash
RNA Virus 14- 21
Days Ranges from 7
days before onset of
symptoms to 14
days after
appearance of the
rash
Secondary infections
such as otitis media,
bronchopneumonia, and
laryngotracheobronchitis,
and myocarditis and
pericarditis, can cause
premature birth and
miscarriage in pregnant
women.
Most common are
arthritis and arthralgia
occur more often in adult
women than in children
or adolescents. Mild
thrombocytopenia may
also occur a rare
complication is
Encephalitis
Symptomatic, require
airborne isolation
precaustions. (MMR)
and varicella vaccine.
Rubella (German
Measles, 3-day
Measles)
Prodrome period with
fever that rises
gradually and the
three “Cs” Coryza,
Cough, and
Conjunctivitis last 2-4
days Koplik spots 1-4
days before rash last
6-7 days
A rash begins on
face, neck, and scalp
and spreads
downward to entire
body; fades on face as
it spreads to trunk.
Pinkish,
maculopapular rash,
reddish, pinpoint
petechial may occur
on soft palate
Erythema
Infectiosum (Fifth
disease, Parvovirus
B19)
Parvovirus B19 4-17
days but can be up
to 28 days shedding
of virus occurs
between days 5 and
12 of the infection
Because the disease is
mild, complications are
not usually reported.
Patients with sickle cell
disease or beta
thalassemia are at risk
for anemia and aplastic
crisis.
Roseola Infantum
(Exanthema subitum
3-day fever)
Human Herpesvirus
6 (HHV-6)
Incubation period 5
– 15 days. Contact
transmission (saliva,
cerebrospinal fluid)
Airborne particles,
respiratory droplets,
blood, and transplacental
transmission fiery red,
edematous rash on the
cheeks “slapped cheek”
appearance rash that
comes and goes.
Nonspecific symptoms
such as headache, runny
nose, malaise, and mild
fever. Erythematous,
maculopapular rash
appears on
Sudden onset high fever
103 F to 106 F, malaise,
and irritability, mild
cough, runny nose,
abdominal pain,
headache, vomiting, and
diarrhea. Rash consist
of rose-pink
maculopapular or
macules that blanch with
pressure on the neck and
trunk may be
surrounded by a whitish
ring.
Febrile seizures
Supportive and
symptomatic the disease
is self-limiting with
resolution within 5
days. Exclusion of
affected children from
other child is 7 days
after the rash begins.
Considered contagious
until age 1 year or
nasopharyngeal and
urine cultures for the
rubella virus are
repeatedly negative.
Adm. Rubella vaccine
in combination with
measles and mumps
vaccine. (MMR)
Treatment is
symptomatic and
supportive.
Treatment is
symptomatic
Viral Exanthema
Causative agent
Mumps
Paramyxovirus,
single-stranded
RNA
Prodromal
manifestations
include fever,
myalgia, headache,
and malaise. Classic
clinical sign of
parotid glandular
swelling and fever.
Manifestations
Complications
Management
Most common
complication is aseptic
meningitis, with the virus
identified in the CSF,
Signs of CNS
involvement include
nuchal rigidity, lethargy,
and vomiting. A less
common CNS
complication is
meningoenchalomyelitis
manifested by fever,
headache, nausea,
vomiting, nuchal rigidity,
and changes in
sensorium The potential
complication of most
concern to parents is
orchitis (inflammation of
a testis). Seen in
adolescent boys and
almost never before
puberty, Can cause
sensorineural hearing
impairment.
Rare exanthems and
hepatitis. Most serious
complications involve
the pulmonary,
neurologic, and
hematopoietic systems.
The risk of splenic
rupture, Swelling of the
pharynx and tonsils can
be severe enough to
compromise respirations.
Avoidance of acidic
foods such as orange
juice is helpful.
Droplet precaution
are indicated until 9
days after the onset of
the parotid swelling.
Absolute avoidance
of any form of
aspirin. Orchitis
requires bed rest,
intermittent
application of ice
packs, pain
management,
emotional support,
and diversional
activities.
Epstein-Bar Virus
(Infectious
Mononucleosis)
Epstein-Barr virus
(EBV, a herpes-like
virus) doublestranded DNA
Most common in
older children and
young adults with the
highest prevalence in
15-19 year-olds.
Fever exudative
pharyngitis,
lymphadenopathy
(cervical, axillary and
inguinal),
hepatosplenomegaly.
Some develop a
maculopapular rash,
after treatment with
an amino penicillin
antibiotic. Children
may report malaise,
headache, fatigue,
nausea, and
abdominal pain.
Bacterial Infections
Causative agent
Scarlet Fever
Group A Betahemolytic
streptococci
Manifestations
Complications
Management
Abrupt fever,
vomiting, headache,
abdominal pain,
pharyngitis, and chills
characterize the
onset. Within 24
hours, a fine red
popular rash appears
in the axillae, groin,
and neck, which feels
like sandpaper to the
touch. By the fourth
Result from extension of
the streptococcal
infection. Sinusitis,
otitis media, mastoiditis,
peritonsillar abscess,
bronchopneumonia,
meningitis,
osteomyelitis, rheumatic
fever, and
glomerulonephritis
Rapid streptococcal
screening in an office
setting. The preferred
treatment for any
streptococcal infection
is penicillin. Children
allergic to penicillin can
be given erythromycin a
cephalosporin.
Supportive, Use of
steroids to treat acute
tonsillar swelling and
other symptoms of
infectious
mononucleosis is
effective in managing
inflammation.
Pertussis
(Whooping Cough)
Bordetella
pertussis (a gramnegative bacillus)
day the papillae
slough off, leaving a
red, swollen tongue
the tonsils are
edematous and may
be covered with a
gray-white exudate,
petechial
hemorrhages cover
the soft palate.
The three stages of
pertussis are
catarrhal,
paroxysmal, and
convalescent, lasting
a total of 6 to 12
weeks The classic
stages are not
commonly seen in
infants younger than
3 months.
The most frequent
complication of Pertussis
is pneumonia.
Prevention through
vaccine in combinations
with tetanus and
diphtheria (DTaP)