When you have completed this unit you should be able to: Diagnose and manage children with measles, chickenpox and mumps. Diagnose and manage children with herpes stomatitis. Diagnose and manage children with viral hepatitis. Diagnose and manage children with tickbite fever. Diagnose and treat children with acute conjunctivitis.
Measles Chickenpox Mumps Herpes stomatitis Viral hepatitis Tickbite fever Conjunctivitis Some infections, such as measles, mumps and viral hepatitis, are becoming uncommon in communities where vaccines against these viral illness are routinely given.
There is a close and important relationship between measles and malnutrition (i.e. undernutrition). Measles is far more severe in children who are malnourished, especially if they are also vitamin A deficient. In addition, complications are more common and more serious in malnourished children. Measles, especially with complications such as diarrhoea, often results in failure to [...]
Otitis media Laryngotracheobronchitis with a severe cough and stridor (measles croup) Pneumonia. This may be viral (measles, herpes or adenovirus) or bacterial Gastroenteritis Oral herpes or candidiasis (thrush) Keratitis (infection of the cornea) with possible corneal ulcers due to measles or herpes virus Encephalitis (rare but serious) Reactivation of tuberculosis Immunosuppression Measles depresses the immune [...]
Measles has an incubation period of about 10 days (the delay between infection and the start of the illness). At first the child develops a fever, runny nose, conjunctivitis and cough, and is generally unwell. Two days after the start of the illness, Koplik spots appear. These are numerous small white spots on a granular [...]
Measles is caused by a virus. It is an acute, very infectious (contagious) illness and is transmitted from person to person when the measles virus is breathed, coughed or sneezed into the air and then inhaled by another person who becomes infected by droplet spread. Measles often occurs in epidemics and is an important cause [...]
The child should be kept away from other children until 5 days after the rash first appears. By this time the child is no longer infectious to others. Measles is most infectious during the 4 days of illness before the rash appears. Paracetamol for fever Adequate oral fluids to prevent dehydration Vitamin A for all [...]
By immunising all children with measles vaccine. This is usually given at 9 months and again at 18 months. Measles vaccine is a highly effective and has resulted in the disappearance of measles in many communities. Measles, mumps and rubella vaccines (MMR) are often combined and given together. Clinical measles can be prevented in an [...]
They should not come into contact with other children or adults who have not had chickenpox until there are no more crops of new rash and all the rash has formed scabs. Paracetamol for fever Try to prevent secondary bacterial infection following scratching. Baby powder often helps reduce the itching. Antibiotics may be needed for [...]
The incubation period of chicken pox is long at 2 to 3 weeks. The child becomes pyrexial and feels generally unwell. Within hours the rash appears on the face, scalp, chest, back and abdomen. The rash starts as a pink macule (spot) which soon becomes a papule (palpable) and then a vesicle (with clear fluid) [...]
Chickenpox is caused by the Varicella zoster virus. Like measles, it is very infectious and transmitted from person to person by droplet spread. Chickenpox is most infectious at the time that the rash starts. Following chickenpox, the same virus may remain silent (dormant) in the body for many years before being reactivated to result in [...]
Mumps is infectious until the parotid swelling disappears. Paracetamol for fever and discomfort is usually all the treatment that is needed. Ensure adequate fluid intake. Good mouth hygiene with antiseptic mouthwashes Mumps is becoming uncommon in many communities as the very effective mumps vaccine is often given together with measles and rubella vaccine (MMR).
Mumps usually has no complications and recovery takes about 1 to 2 weeks. However, mumps may cause very painful orchitis (inflammation of the testes) in postpubertal males. Mumps may also cause a viral meningitis.
Mumps is an acute illness which presents with fever as well as swelling and tenderness of one or both parotid glands. The enlarged parotid glands lift the lower part of the ear. Chewing may be painful due to the swollen glands. Sometimes the submandibular glands (below the jaw) may be involved. Mumps is infectious and [...]
The herpes simplex virus can remain hidden (dormant) and then become reactivated to cause fever blisters on the lips. This is similar to the varicella virus in chickenpox which can live on in the body for years before becoming reactivated to cause shingles. The onset of fever blisters may be started by other viral illnesses [...]
Paracetamol for pain and fever Good mouth hygiene with Glyco Thymol mouthwashes Ensure adequate hydration. A nasogastric tube may be needed if the child refuses to drink or swallow. Acyclovir in severe stomatitis, especially children with HIV infection. These children need hospitalisation. Children with severe herpes stomatitis should be referred to hospital.
Herpes stomatitis (or oral herpes) is an acute infection of the mouth cause by the herpes simplex virus The infection is common and often asymptomatic. However, some children get numerous small, shallow ulcers on the tongue, gums and mucosa inside the cheeks. As the ulcers are very painful the child salivates and often refuses to [...]
Allow the child to eat whatever is wanted. A high energy diet with a lot of carbohydrate is best tolerated. Keep the child at home if possible. Good hygiene prevents other children getting hepatitis. Hepatitis A is most infectious in the days just before the onset of jaundice. Look out for danger signs of depressed [...]
Hepatitis A: This virus is spread by the virus in stool-contaminated food or water, which is then eaten or drunk by someone else (the faeco-oral route). Good sanitation, clean water, hand-washing before meals and the hygienic preparation of food are therefore important to prevent the spread of the virus. A very effective vaccine to prevent [...]
Liver failure with acute viral hepatitis is uncommon. Liver failure presents with drowsiness and confusion or severe vomiting. These children need urgent referral to hospital. Some of these children die. Chronic hepatitis due to the hepatitis B virus may lead to cirrhosis and liver cancer in adulthood. Therefore, it is important to prevent hepatitis due [...]
Acute viral hepatitis in children is often asymptomatic or presents with loose stools and a general feeling of being unwell. Clinical hepatitis may develop with loss of appetite, nausea and vomiting and pain over the liver. The liver is enlarged and tender. Some children have jaundice with dark urine and pale stools. Acute hepatitis is [...]
There are 2 common causes of acute viral hepatitis in children: Hepatitis A virus: This has a shorter incubation period (15–50 days) and is spread by swallowing the virus in contaminated food or water. Hepatitis A is the most common type of hepatitis in children. Hepatitis B virus: This has a longer incubation period (5–150 [...]
Hepatitis is an inflammation of the liver. Although there are many causes of hepatitis, the main cause in children is viral. During the early stages of hepatitis both bilirubin and urobilin are present in the urine when tested with reagent strips. This is a useful way of confirming the diagnosis of hepatitis. With hepatitis there [...]
It is best to avoid exposure to ticks or use insecticide spray on shoes, socks and trousers when walking in the country. Immediately remove any ticks found on the skin. Doxycycline 100 mg orally twice a day for 5 days is effective. However, it should only be used for severe infections in children under 7 [...]
It is an acute illness caused by a bite from an infected tick. It presents with fever, headache and mild conjunctivitis, often followed in a few days by a maculopapular rash which can include the palms and soles. The headache is the most striking symptom. With careful inspection of the skin and scalp, a typical [...]
Some childhood illnesses have almost disappeared due to routine immunisation: Poliomyelitis (polio) Whooping cough Diphtheria Other infections are more common in adolescents and young adults: Infectious mononucleosis (Glandular fever) Rubella (German measles)
Topical antibiotic drops or ointment (e.g. chloromycetin) or povidone-iodine drops are used for a few days. If there is marked swelling of the eyelids, give intramuscular ceftriaxone daily for 3 days. 1% chloromycetin eye ointment, 1% tetracycline eye ointment or 2.5% povidone-iodine aqueous solution are used to treat bacterial conjunctivitis. Tetracycline and povidone-iodine can also [...]
It may involve one or both eyes. The conjunctivae become red and swollen. With viral conjunctivitis there is a watery discharge. With bacterial conjunctivitis the discharge may become purulent (yellow pus) and the eyelashes stick together. Allergic conjunctivitis is very itchy. Sudden onset of pain and redness of the conjunctiva in one eye suggests a [...]
Acute conjunctivitis is common and highly infectious. Usually it is caused by a virus (e.g. adenovirus) but it may be bacterial (e.g. Staphylococcus). Acute conjunctivitis may occur in outbreaks in schools. Measles, tickbite fever and tuberculosis may also cause acute conjunctivitis. Conjunctivitis due to allergy may be recurrent or chronic, and is usually associated with [...]
