2023-09-21 20:55:47
Likewise, now is a good time to refresh your knowledge of common infections that may affect your young patients as they return to the classroom. Although progress has been made in closing vaccination gaps during the pandemic, it is helpful to remain alert to illnesses affecting schools and campuses.
SItuation 1
This young, febrile child presented to daycare with palmar blisters surrounded by an erythematous halo. Most vesicles have an elliptical appearance, with the long axis of the lesions oriented along the skin lines.1 The patient also has intraoral sores. What is the probable cause of these skin lesions?
Answer : Hand, foot and mouth syndrome (HFS)
SPMB is an acute viral disease caused by a member of the genus Enterovirus, commonly coxsackievirus A16 in the United States; types 5, 10, and 71 are also associated with SPMB. More than 200,000 cases of SPMB are reported in the United States each year.2
Although SPMB usually affects children under the age of five, it can occur in adults. Signs and symptoms include a rash with blisters on the hands and soles of the feet, intraoral (herpangina) and perioral blister-like sores (arrow), fever, and sore throat. Transmission occurs through direct contact, through airborne droplets from coughs or sneezes, or through contaminated surfaces or objects. Excreted viral particles are present in the saliva, sputum, nasal mucus, fluid contained in the bubbles as well as the stools of the infected person.
Although this is a clinical diagnosis, throat or stool cultures can provide confirmation, if necessary. There is no vaccine or specific treatment. Management involves providing support, including prescribing over-the-counter analgesics/antipyretics (aspirin should be avoided in children) and mouthwashes and/or oral sprays.
Situation 2
The itchy and generalized skin manifestation that began on the face, chest and back of this child is indicative of what disease?
Answer : Varicella
Chickenpox is a highly contagious disease caused by the varicella-zoster virus (VZV). It causes fever, malaise and an itchy, fluid-filled blistering rash, which eventually crusts over. The rash appears on the chest, back and face, then spreads to the entire body.
Transmission occurs by direct contact using viral particles from skin bubbles or respiratory viral particles from infected people who cough or sneeze. Infected people who cough or sneeze. Infected people are contagious from 1 to 2 days before the rash appears and until no new lesions have appeared within 24 hours. Clinical manifestations may not appear until two weeks following exposure.3
It is also a clinical diagnosis that can be confirmed by a polymerase chain reaction (PCR) test; isolation of VZV from skin lesions. Treatment usually consists of supportive care. Since the introduction of the vaccine in 1995, hospitalizations and deaths linked to chickenpox have been rare.4
Although monkeypox (related to smallpox and cowpox [cowpox]) is rare in children, this infection can mimic the more common chickenpox, with fever, body aches and a blistering rash. Clinical differences that may help distinguish the two diseases include: early in the course of the disease, mpox may be accompanied by headache and lymphadenopathy; Furthermore, chickenpox lesions are more superficial, occur in clusters and evolve quickly. Conversely, mpox lesions are deep, well circumscribed, and may become more ulcerative in appearance.5 The rash in mpox, which lasts regarding two to four weeks, often begins on the face or organs. genitals and then spreads to other parts of the body. The time between exposure and symptoms can vary from 5 to 21 days. Reporting is essential and treatment is symptomatic.
Exposed individuals may receive the mpox vaccine or smallpox vaccine as part of post-exposure prophylaxis. Vaccination within four days of exposure offers the best chance of preventing the onset of the disease. Vaccination between 4 and 14 days following exposure can reduce the severity of the disease, but does not prevent it.6
Siuation 3
The unvaccinated child presents with a diffuse rash accompanied by cough, coryza and conjunctivitis. What is the suspected etiology of his illness?
Answer : Measles
Measles is a highly contagious respiratory disease that is spread through contact with an infected person and through the coughs and sneezes of an infected person. After exposure, the incubation period lasts 7 to 14 days. Patients then develop high prodromal fevers (with temperatures often above 40°C) with the classic triad of cough, coryza and conjunctivitis. After a few days, Koplik spots may develop on the oral mucosa up to the soft palate.
Laboratory confirmation includes detection of measles-specific immunoglobulin (Ig) M antibodies and measles RNA by real-time PCR. Treatment involves supportive care and oral vitamin A.7 Although widespread use of the measles vaccine has resulted in a greater than 99% reduction in historical cases in the United States, measles remains the a leading cause of death among young children worldwide, due to the progressive encephalitis and pneumonia it causes. In 2022, 121 new cases of measles were reported in the United States.8
Situation 4
A young girl presents with facial swelling and pain when chewing. She has a fever of 38.4°C (101.1°F) and is not vaccinated once morest mumps. What is the treatment for mumps? How do you advise parents?
Answer : Symptomatic management. There is no specific treatment for mumps.
Mumps is a contagious but relatively mild viral illness that is uncommon in the United States due to routine vaccination once morest measles, mumps, and rubella. Although most infected patients are relatively asymptomatic, signs and symptoms may include the following: a few days of fever, myalgia, fatigue, anorexia, and headache, followed by parotitis (arrows).
Serious complications are rare. However, before widespread vaccination, mumps was the leading cause of deafness in children. Viral meningitis can occur in regarding 1 in 7 cases; encephalitis is rare.9
The diagnosis of mumps is generally clinical; Treatment consists of supportive care. Enteroviruses cause most cases of parotitis, but mumps should always be considered in the differential diagnosis.
Situation 5
The child presents with a rash on both cheeks following several days of fever and rhinitis. What diagnosis should be suspected?
Answer : Fifth disease (epidemic megalerythema)
Caused by parvovirus B19, fifth disease usually presents as a mild rash following symptoms that may include fever, rhinitis and headache.
Patients may develop a “slapped cheek” facial rash, which is the most recognized feature of this disease. Subsequently, a generalized, sometimes itchy rash may develop.
Parvovirus B19 is spread through respiratory secretions. Patients usually become ill within 14 days of infection, although 20% of infected people may be asymptomatic. Typically, clinical diagnosis, IgM assay, dot-blot hybridization, PCR testing, and loop-mediated isothermal amplification can be used for confirmation.11
Infection in pregnant women has caused fetal hydrops and fetal death. Pregnant mothers and teachers should therefore be informed of the risk of exposure to infected children.
Parvovirus B19 can also cause aplastic crisis in patients with sickle cell disease and other hemoglobinopathies, as well as chronic anemia in immunocompromised patients.10,11
Situation 6
This child’s mother calls the day before school starts to report the new onset of fever, chills and body aches. She claims that her son was in perfect health the day before. What might you suspect?
Answer : Flu
The last two years have certainly added complexity to this discussion. Although the common cold, flu, and COVID-19 can have similar symptoms, the absence of nasal congestion may suggest the flu. However, symptoms alone do not always differentiate between illnesses.
Commonly transmitted by respiratory droplets, influenza can also be spread through contact with people infected through respiratory droplets. Signs and symptoms usually appear within two to three days of infection and include fever, cough, pharyngitis, myalgia, headache, and one or more malaise. Vomiting and diarrhea may also occur. The diagnosis is clinical, although rapid tests are available.
Patients generally recover within a few days; those with chronic illness or at the extremes of age are at risk for serious complications. Treatment mainly consists of supportive care; Antiviral medications may be given early in more severe or complicated cases or to at-risk patients. The way to prevent the disease is annual flu vaccination (for people older than six months).12
The above CT images of the chest show multiple ground-glass opacities (small arrows) and irregular lesions (arrowhead) in a four-year-old boy with a five-day history of fever and cough.13
After the first week of school, your child gets sick with a new bout of fever, cough, and congestion. The child is vaccinated and your family has followed current COVID-19 mitigation practices. What can you expect from your child’s healthcare provider?
Answer : COVID-19 testing.
Common symptoms of COVID-19 in children are cough and fever, although symptoms may differ depending on the type of variant. Other symptoms may include fatigue, headache, myalgia, nasal congestion or rhinorrhea, loss of taste or smell, pharyngitis, dyspnea, abdominal pain, diarrhea, and nausea or vomiting. Infected children may be asymptomatic.13,14
Multisystem Inflammatory Syndrome in Children (MIS-C) is a rare complication associated with COVID-19. Patients with MIS-C require extensive medical testing and typically present with persistent fever, severe illness with multisystem organ involvement, and elevated laboratory levels of inflammatory markers.15
The U.S. Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics have recommended COVID-19 vaccination for all children aged 6 months and older, and boosters for all children 5 years and older, if eligible. 14,15,16
This article was originally published on Medscape.
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