PEDI
ATRI
CS
L.
2
Roseol
a
i
nfant
um
Al
socal
l
ed(
exant
hemsubi
t
umorsi
xt
hdi
sease)
ETI
OLOGY:
I
ti
scausedpr
i
mar
i
l
ybyHumanher
pesvi
r
us6(
HHV-
6AandHHV-
6B)whi
chi
sl
ar
ge
doubl
e-st
r
andedDNAvi
r
us&l
esscommonl
yHHV-
7.
EPI
DEMI
OLOGY:
-I
ti
sadi
seaseof
i
nf
ancy
.
Thepeakageofpr
i
mar
yHHV-
6i
nfect
i
oni
s
6-
9mo
of
l
i
f
e.
-maj
or
i
t
yofchi
l
dr
enacqui
r
ei
nf
ect
i
onfr
om t
hesal
i
vaorr
espi
r
at
or
y
dr
opl
et
sofasympt
omat
i
ci
ndi
vi
dual
s.
-
Twomechani
smsofver
t
i
calt
r
ansmi
ssi
onofHHV-
6havebeeni
dent
i
f
i
ed,t
r
anspl
acent
al
i
nf
ect
i
onandchr
omosomali
nt
egr
at
i
on.
CLI
NI
CALMANI
FESTATI
ONS:
*Thei
ncubat
i
onper
i
od5–15days(
aver
ages10days)
*I
ti
schar
act
er
i
zedbyt
heabr
uptonsetofhi
ghf
ever
(
38-40°C)
,whi
chmaybe
accompani
edbyi
r
r
i
t
abi
l
i
t
y.
Thef
everusual
l
yr
esol
vesacut
el
yaft
er72hrcoi
nci
dentwi
t
h
t
heappear
anceofafai
ntpi
nkorr
ose-
col
or
ed,nonpr
ur
i
t
i
cr
ash(
macul
esandpapul
es)on
t
het
r
unk.Ther
ashusual
l
yl
ast
s1-3days,spr
eadi
ngf
r
omt
het
r
unkt
ot
hefaceand
ext
r
emi
t
i
es.
Febr
i
l
eSei
zur
esmayoccuri
n5–10%ofcases.I
nf
r
equentcompl
ai
nt
si
ncl
uder
hi
nor
r
hea,
sor
et
hr
oat
,enl
ar
gedsubocci
pi
t
alnodes,abdomi
nalpai
n,vomi
t
i
ng,anddi
ar
r
hea.
DI
AGNOSI
S:
1-cl
i
ni
cal
:age,hi
st
or
y&cl
i
ni
cal
fi
ndi
ngs.
2-Ser
ol
ogi
calt
est
sf
orHHV-
6:ear
l
yI
gMant
i
body&l
at
erI
gGant
i
body
det
ect
i
on.3-Vi
r
uscul
t
ur
e
4-PCR
DI
FFERENTI
ALDI
AGNOSI
S:Rubel
l
a,Measl
es,ent
er
ovi
r
us,scar
l
etfever
,&dr
ug
hyper
sensi
t
i
vi
t
y.
TREATMENT:Suppor
t
i
vewhi
chi
ncl
udeadequat
efl
ui
di
nt
ake&ant
i
pyr
et
i
c.
Pr
ognosi
s:excel
l
ent
.
Mumps
I
ti
sacut
esel
f-
l
i
mi
t
edi
nfect
i
onchar
act
er
i
zedbyfever
,bi
l
at
er
aloruni
l
at
er
alpar
ot
i
dswel
l
i
ng
&t
ender
ness.
ETI
OLOGY.
Mumpsvi
r
uswhi
chi
sasi
ngl
e-
st
r
andedRNAvi
r
us
.
EPI
DEMI
OLOGY:
-Mumpsi
nf
ect
i
onoccur
r
edmor
ei
nt
hewi
nt
erandspr
i
ngmont
hs.
-mostcommoni
nol
derchi
l
dr
en,adol
escent
s,andyoungadul
t
s.
-spr
eadf
r
omper
sont
oper
sonbyr
espi
r
at
or
ydr
opl
et
s.
-Theper
i
odofmaxi
mum i
nfect
i
ousnessi
s1–2daysbef
or
et
o5daysaft
erpar
ot
i
dswel
l
i
ng.
-Li
f
el
ongi
mmuni
t
yfol
l
owcl
i
ni
cal&subcl
i
ni
cali
nfect
i
on.
-Humani
st
heonl
ynat
ur
alhost
.
PATHOLOGYANDPATHOGENESI
S
Mumpsvi
r
ust
ar
get
st
hesal
i
var
ygl
ands,cent
r
alner
voussyst
em
(
CNS)
,pancr
eas,t
est
es,and,t
oal
esserext
ent
,t
hyr
oi
d,ovar
i
es,hear
t
,
ki
dneys,l
i
ver
,andj
oi
ntsynovi
a.
CLI
NI
CALMANI
FESTATI
ONS:
-I
ncubat
i
onper
i
odi
susual
l
y16t
o18days.
-Mumpsi
nfect
i
onmayr
esul
ti
nasympt
omat
i
cornonspeci
f
i
csympt
omst
ot
ypi
cali
l
l
ness
whi
chpr
esent
swi
t
hapr
odr
omel
ast
i
ng1–2daysconsi
st
i
ngoff
ever
,headache,&vomi
t
i
ng.
-Parot
i
t
i
st
henappear
sandmaybeuni
l
at
er
alorbi
l
at
er
ali
nabout70%ofcases.
The
par
ot
i
dgl
andi
st
enderwi
t
hearpai
nont
hei
psi
l
at
er
alsi
de.I
ngest
i
onofsouroraci
di
c
foodsor
l
i
qui
dsmayenhancepai
ni
nt
hepar
ot
i
dar
ea.
Ther
ei
sr
edness&edemaar
oundopeni
ngoft
heSt
ensenduct
.
Thepar
ot
i
dswel
l
i
ngpeaksi
nappr
oxi
mat
el
y3dayst
hengr
adual
l
ysubsi
desover7days.
Feverr
esol
vesi
n3t
o5days.
-
Submandi
bul
arsal
i
var
ygl
andsmaybei
nvol
ved.Edemaovert
hest
er
numduet
ol
ymphat
i
c
obst
r
uct
i
onmayal
sooccur
.
DI
AGNOSI
S:
1-cl
i
ni
calfr
omhi
st
or
y&exami
nat
i
on.
2
-
l
eukopeni
a&r
el
at
i
vel
ymphocyt
osi
s.
3-
el
evat
edser
um amyl
asel
evel
.
4-i
sol
at
i
onoft
hevi
r
usbycul
t
ur
efr
omsal
i
va,CSF,bl
ood&ur
i
ne.
5-det
ect
i
onofvi
r
alant
i
genbydi
r
ecti
mmunofl
uor
escenceorpol
ymer
asechai
nr
eact
i
on.6-ser
ol
ogi
cal
t
est
:
-Enzymei
mmunoassay(
EI
A)t
odet
ectmumpsI
gMant
i
bodi
eswhi
chi
ndi
cat
er
ecent
i
nf
ect
i
on.
-Compl
ementfi
xat
i
ont
estt
odet
ectt
heser
oconver
si
oni
nt
heI
gGant
i
bodyl
evelbet
ween
acut
e&conval
escentser
umspeci
mens.
DI
FFERENTI
ALDI
AGNOSI
S:
1-ot
hervi
r
ali
nf
ect
i
onst
hatcausepar
ot
i
t
i
saspar
ai
nf
l
uenza,i
nfl
uenzaA,
cyt
omegal
ovi
r
us,Epst
ei
n-
Bar
rvi
r
us,ent
er
ovi
r
uses,andHI
V.
2-Pur
ul
entpar
ot
i
t
i
s:
causedby
St
aphyl
ococcusaureus(uni
l
at
er
al
,ext
r
emel
yt
ender
,and
associ
at
edwi
t
hanel
evat
edwhi
t
ebl
oodcel
lcount
,andpur
ul
entdr
ai
nagefr
omt
he
St
ensenduct
.3-Submandi
bul
arorant
er
i
orcer
vi
caladeni
t
i
s.
4-noni
nfect
i
ouscauses:obst
r
uct
i
onoft
heSt
ensenduct
,col
l
agenvascul
ardi
seases
suchassyst
emi
cl
upuser
yt
hemat
osi
s,andt
umor
.
COMPLI
CATI
ONS:
1-CNScompl
i
cat
i
ons:
a-
Meni
ngi
t
i
sandMeni
ngoencephal
i
t
i
s.
b-Tr
ansver
semyel
i
t
i
s,aqueduct
alst
enosi
s,f
aci
alpal
sy&sensor
yneur
alhear
i
ngl
oss.
2-Or
chi
t
i
s&oophr
i
t
i
s:or
chi
t
i
si
sr
ar
ei
npr
epuber
t
alage,butcommoni
nadol
escent&
youngadul
t
.30%ofcasesar
ebi
l
at
er
al
,maycausi
ngat
r
ophyoft
het
est
es,butst
er
i
l
i
t
y
i
sr
ar
e.
3-Pancr
eat
i
t
i
s.Somest
udi
essuggest
edt
hatmumpsmaybeassoci
at
edwi
t
ht
he
subsequentdevel
opmentofdi
abet
esmel
l
i
t
us.
4-myocar
di
t
i
s
5-Ar
t
hr
i
t
i
s
6-
Thyr
oi
di
t
i
s
7-conj
unct
i
vi
t
i
s&opt
i
cneur
i
t
i
s
8-
pneumoni
a
9-
Nephr
i
t
i
s
10-
Thr
ombocyt
openi
a
TREATMENT:
Nospeci
f
i
cant
i
vi
r
alt
her
apyi
savai
l
abl
ef
ormumps.
Suppor
t
i
vecar
e:1-
ant
i
pyr
et
i
cf
orfever
.
2-bedr
est&anal
gesi
aforpai
nassoci
at
edwi
t
h
or
chi
t
i
s.3-adequat
ehydr
at
i
on.
PREVENTI
ON:
*I
sol
at
i
onper
i
odof5daysaf
t
eronsetofpar
ot
i
t
i
sf
orpat
i
ent
swi
t
hmumpsi
nbot
h
communi
t
yandheal
t
hcar
eset
t
i
ngs.
*MMRvacci
ne,2-
doser
egi
men.
Di
pht
heri
a
ETI
OLOGY:
Corynebacteri
um di
phtheri
aewhi
chi
saer
obi
c,gr
am-
posi
t
i
vebaci
l
l
iof3bi
ot
ypes
(
mi
t
i
s,
gr
avi
s,
i
nt
er
medi
us)
.
EPI
DEMI
OLOGY.
*i
ti
sexcl
usi
vei
nhabi
t
antofhumanmucousmembr
ane&ski
n.
*spr
eadbyai
r
bor
ner
espi
r
at
or
ydr
opl
et
s,di
r
ectcont
actwi
t
hr
espi
r
at
or
ysecr
et
i
onsof
sympt
omat
i
ci
ndi
vi
dual
s,orexudat
efr
omi
nf
ect
edski
nl
esi
ons.
PATHOGENESI
S:
*Bot
ht
oxi
geni
candnont
oxi
geni
c
C.di
phtheri
aecauseski
nandmucosali
nfect
i
on.
*Themaj
orvi
r
ul
enceoft
heor
gani
smi
sabi
l
i
t
yt
opr
oduceexot
oxi
n,whi
chi
nhi
bi
t
s
pr
ot
ei
nsynt
hesi
sandcausesl
ocalt
i
ssuenecr
osi
s&pseudomembr
anefor
mat
i
on.
*Toxi
nabsor
pt
i
onl
eadt
osyst
emi
cmani
fest
at
i
onsl
i
kecar
di
omyopat
hy,and
demyel
i
nat
i
onofner
veswhi
choccur
s2–10wkaft
ermucocut
aneousi
nf
ect
i
on.
CLI
NI
CALMANI
FESTATI
ONS:
-
Respi
r
at
oryTr
actDi
pht
heri
a:t
hepr
i
mar
yf
ocusofi
nfect
i
onwast
het
onsi
l
sorphar
ynx,
wi
t
ht
henoseandl
ar
ynxt
henextcommon.Af
t
eri
ncubat
i
onper
i
odof2–4days,l
ocal
si
gnsandsympt
omsofi
nfl
ammat
i
ondevel
op.
*I
nf
ect
i
onoft
heant
er
i
ornar
es,whi
chi
smor
ecommonamongi
nf
ant
s,causespur
ul
ent
,
er
osi
ver
hi
ni
t
i
swi
t
hmembr
anefor
mat
i
on.Shal
l
owul
cer
at
i
onoft
heext
er
nalnar
esand
upperl
i
pi
schar
act
er
i
st
i
c.
*Tonsi
l
l
arandphar
yngealdi
pht
her
i
a:sor
et
hr
oati
st
heuni
ver
salear
l
ysympt
om.onl
yhal
fof
pat
i
ent
shavef
ever
,andfewerhavedysphagi
a,hoar
seness,mal
ai
se,orheadache.
Under
l
yi
ngsoftt
i
ssueedemaandenl
ar
gedl
ymphnodescancauseabul
l
-
neckappearance.
*Lar
yngealdi
pht
her
i
a:Hoar
seness,st
r
i
dor
,dyspnea,andcr
oupycoughoccur
s.Theyar
eat
r
i
skf
orsuf
focat
i
onbecauseofl
ocalsoftt
i
ssueedemaandai
r
wayobst
r
uct
i
onbyt
he
ddi
pht
her
i
t
i
cmembr
anewhi
chmayr
equi
r
eest
abl
i
shmentofanar
t
i
fi
ci
alai
r
wayand
r
esect
i
onoft
hepseudomembr
ane.
-Cut
aneousDi
pht
heri
a:Cl
assi
cl
esi
oni
sani
ndol
ent
,nonpr
ogr
essi
vei
nf
ect
i
on
char
act
er
i
zedbyasuper
f
i
ci
al
,ect
hymi
c,nonheal
i
ngul
cerwi
t
hagr
ay-
br
ownmembr
ane.I
t
shoul
dbedi
ff
er
ent
i
at
edf
r
om st
r
ept
ococcalorst
aphyl
ococcali
mpet
i
go.
I
nfect
i
onatOt
herSi
t
es(
mucocut
aneousi
nf
ect
i
ons):
Ear(
ot
i
t
i
sext
er
na)
,t
heeye(
pur
ul
entandul
cer
at
i
veconj
unct
i
vi
t
i
s)
,andt
he
geni
t
alt
r
act(
pur
ul
entandul
cer
at
i
vevul
vovagi
ni
t
i
s)
.
COMPLI
CATI
ONS:
1-
Respi
r
at
or
yt
r
actobst
r
uct
i
onbypseudomembr
anes.
2-
Toxi
cCar
di
omyopat
hy
3-
Toxi
cNeur
opat
hy
DI
AGNOSI
S:
*Speci
mensf
orcul
t
ur
eobt
ai
nedf
r
omt
henoseandt
hr
oatandanymucocut
aneousl
esi
on.
TREATMENT:
1-
Ant
i
t
oxi
n:I
ti
st
hemai
nst
ayoft
her
apyandshoul
dbeadmi
ni
st
er
edempi
r
i
cal
l
yasa
si
ngl
edoseof20,
000–100,
000Ubasedont
hedegr
eeoft
oxi
ci
t
y.
I
tneut
r
al
i
zesonl
yfr
eet
oxi
n.I
ti
snotr
ecommendedforasympt
omat
i
ccar
r
i
er
s.
2-
Ant
i
mi
cr
obi
alt
her
apy:
Er
yt
hr
omyci
n(
40–50mg/kg/daydi
vi
dedever
y6hrPO,orCr
yst
al
l
i
nepeni
ci
l
l
i
nG
(
100,
000–150,
000U/kg/daydi
vi
dedever
y6hrI
VorI
M)
,ordai
l
yProcai
nepeni
ci
l
l
i
n
(
300,
000uni
t
s/dayI
Mf
ort
hose<10kgi
nwei
ght
;600,
000uni
t
s/dayI
Mfort
hose>10kgi
n
wei
ght
)for14days.
El
i
mi
nat
i
onoft
heor
gani
sm shoul
dbedocument
edbyatl
east2successi
venegat
i
ve
cul
t
ur
esfr
om t
henoseandt
hr
oat(
orski
n)obt
ai
ned24hrapar
taft
ercompl
et
i
onoft
her
apy.
3-
Suppor
t
i
vet
reat
ment
:i
sol
at
i
on&bedr
estdur
i
ngt
heacut
ephase&usual
l
yf
or2weeks.
PREVENTI
ON:
Di
pht
her
i
at
oxoi
d(
DTPVacci
ne)
.