COMMUNICABLE DISEASES: HANDOUT VIRAL INFECTIONS 1.

Chicken Pox (Varicella - zoyster virus) Incubation: 10-21 days Infectious: 1-2 days before rash until all lesions are dried. Symptoms: fever, malaise, and anorexia for 24-48 hours before rash. Rash usually appears on the trunk and scalp first. Lesions begin as a macular rash and progress to a red papular rash then to vesicles with a red base. The vesicles become pustular and dry and crust. Crops of lesions usually appear in 3 successive eruptions over 3-4 days. The primary case usually has fewer lesions than secondary cases. Lesions may appear on mucous membranes in the mouth, on rectum, and genitals. Treatment: Symptomatic, prevent child from scratching. Antibiotics are given if there is a secondary infection. Respiratory and contact isolation keep child home until all lesions have dried. The organism establishes a latent infection in the sensory nerves and dorsal root ganglia, which may reactivate later as Zoster or Shingles. More common in elderly, immumnocompromised, and children who were exposed in utero or before age 2. Transmission: droplets and direct contact. Immunity: active or passive. Rarely does one have a second infection. More common in immunocompromised. Peak season: late winter to early spring 2. German Measles (Rubella) RNA virus Incubation: 14-21 days Infectious: 7 days before symptoms until 14 days after rash. Symptoms: Usually mild disease in children and adults. Often asymptomatic until rash. Slight fever, nasal discharge, malaise, sore throat, headache, and enlargement of the posterior cervical and occipital lymph nodes. The maculopapular rash is a pinkish rose color. It begins on the face, neck and scalp and extends downward to cover the entire body. It fades on the face as it spreads to the trunk. Tiny petechiae may appear on the soft palate. Treatment: Symptomatic and supportive. Prevent transmission especially to pregnant women. Neonates: Congenital rubella is devastating to the infant, especially if the infection occurs during the first trimester of pregnancy. Deafness is the most common manifestation. Other effects include growth retardation, cataracts, retinopathy and cardiac abnormalities. Effects that develop later include diabetes, thyroid disorders, mental retardation, and encephalopathy. Infants remain infectious until they are 1 year old or until repeated cultures taken after 3 months of age are negative. Transmission: Airborn or direct contact with droplets. Trans-placental transmission. Immunity: Natural or acquired. Peak Season: Winter/spring 3. Red Measles (Rubeola)

Incubation: 7-14 days Infectious: 1-2 days before onset of symptoms until 4 days after rash appears. Symptoms: Respiratory symptoms appear after about 10 days coryza, cough, and fever. Conjunctivitis and photophobia may occur. Koplik spots appear about 2 days before the rash. They are small blue-white spots with a red base on the buccal mucosa. They last about 3 days then slough off. The measles rash is red and maculopapular and blanches easily with pressure. It begins behind the ears, at the hairline, on the forehead and on the upper part of the neck and spreads downward to the feet. The rash gradually turns brownish color and lasts about 6-7 days. Treatment: Supportive, symptomatic care. Airborn precautions. Restrict to bedrest and quiet activities during febrile period. Vitamin has been shown to reduce mortality and morbidity in some children with particular risk factors. Transmission: Airborn or direct contact with droplets. Immunity: Natural or vaccine. Peak Season: Winter/Spring 4. Roseola (human herpesvirus 6) Incubation: 5-15 days Infectious: Unknown thought to be from febrile stage to rash appears. Symptoms: Most cases occur in children 6-18 months old. Sudden high fever (103 106 degrees), malaise, irritability, but may remain active and alert. Fever may last for 3-5 days. Within hours to 2 days after the fever resolves a rash appears. The rash consists of rose-pink maculopapules or macules that may be surrounded by a whitish ring and blanch with pressure. The rash usually lasts for 1-2 days. Child may also have HA, cough, coryza, abd. pain, vomiting and diarrhea. Treatment: Supportive. Child may have febrile seizures temperature measures. Transmission: Saliva Immunity: NA Peak Season: Spring/Fall 5. Mumps (Infectious parotitis) paramyxovirus Incubation: 16-18 usually, maybe up to 25 days Infectious: 7 days before swelling to 9 days after onset of swelling. Symptoms: Classic signs are parotid gland swelling following a prodrome of fever, malaise, muscular pain and HA. Swelling does not occur in all cases, but when it does occur it is accompanied by fever. Complications include: Aseptic meningitis most cases have a full recovery. Unilateral nerve deafness which may be transient or permanent is an uncommon complication. The complication that is usually of most concern to patients and families is orchitis which is painful and may result in sterility is a small percentage of cases. Treatment: Uncomplicated cases require supportive/symptomatic care. If hospitalized for complications, isolation should be carried out according to policy. Droplet precautions with the child taught to cover mouth when sneezing or coughing and hand washing is used at home. Orchitis: Bedrest, ice packs intermittently, and emotional support. Transmission: Airborn droplets, saliva, possibly urine.

Immunity: Natural and Vaccine. Peak Season: Late Winter and Spring 6. Fifth Disease (Erythema Infectiousm) parvovirus B19 Incubation: 4-14 days, up to 20. Infectious: Unknown, thought to be from prodrome to rash appears. Symptoms: Mild systemic symptoms such as HA, runny nose, malaise and mild fever. Child may appear well, but have slapped - cheek appearance. Environmental temperature may aggravate rash. 1-4 days after the face rash, a red, maculopapular, lacy rash appears on the trunk and extremities. Treatment: Supportive. Avoid exposure of pregnant women. Transmission: Respiratory droplets, blood, blood products, trans-placental transmission that may result in fetal death (<2.5%), but has not been associated with fetal anomalies. Immunity: Natural Peak Season: Winter and Spring 7. Poliomylitis three different polioviruses Incubation: 3-6 days for abortive, 7-21 days for paralytic Infectious: Shortly after onset of symptoms. Virus is shed in pharynx for one week and in the stool for several weeks to months. Symptoms: Abortive polio symptoms are so mild they may go unnoticed fever, malaise, HA, sore throat, nausea, abdominal pain. The second stage is non-paralytic and the symptoms are the same, but more intense. There is also, soreness and stiffness of the neck, trunk, and limbs. If the disease does not progress to paralytic polio, the temperature will fall and recovery may begin in 3-10 days. The third stageflaccid paralysis is the most obvious sign. The muscles deteriorate and atrophy. The lower extremities and large muscle groups are affected. Bulbar Polio is the most life threatening because it affects respiratory and vasomotor centers. Treatment: Transmission: Fecal-oral, oral-oral. Immunity: IPV Vaccine Peak Season: Summer/Fall BACTERIAL INFECTIONS 1. Diphtheria Corynebacterium diphtheriae Incubation: 2-5 days Infectious: Usually less than 2 weeks, up to several months if untreated. Symptoms: Foul smelling mucopurulent nasal discharge. Low-grade fever, Thin gray membrane on the tonsils and pharynx, neck edema bull neck. Treatment: IV diphtheria antitoxin and antibiotics. Bedrest, monitor respirations, and droplet precautions. Transmission: Contact with carrier or droplets Immunity: Natural disease, vaccine, passive immunity from maternal antibodies Peak Season: Fall/Winter

2. Pertussis (Whooping Cough) Bordetella pertussis Incubation: 6-20 days Infectious: 1-2 weeks, up to 4 weeks. Symptoms: Catarrhal stage: 1-2 weeks; URI sx, mild cough, low grade fever. Paroxysmal: 2-4 weeks or longer; Severe episodes of coughing with one expiration followed by a large inspiration with a whoop sound. Cyanosis is common and vomiting may follow coughing episodes. Convalescent: 1-2 weeks. Episodes of coughing, vomiting will decrease in frequency and severity. Cough may lasts for several months. Treatment: Hospitalization and supportive care may be necessary for the infant; older children can usually be cared for at home. Respiratory and oxygenation status is closely monitored on infants. Supplemental oxygen may be ordered with additional oxygen given during coughing episodes. Suction should be available for use as needed. Droplet precautions. Rest is important. Close attention should be paid to nutrition and hydration. Erythromcin if given early in the course of the disease will decrease communicablity. It is also given to all non-immune close contacts which includes children over 13 whose DPT immunity is declining. Corticosteroids and albuterol may be used to reduce coughing. Transmission: Direct contact or droplets from coughing. Immunity: natural or vaccine. Infants do not receive maternal immunity and are very susceptible to pertussis. Peak Season: Any season 3. Scarlet Fever (Scarletina) Group A beta-hemolytic streptococci Incubation: 1-7 days (3 average) Infectious: until about 48 hours of antibiotics Symptoms: HA, fever, rapid pulse, rash that starts on the groin, axilla, and neck and spreads to cover the entire body. Skin on face dries and flakes after one week and spreads over the body. White coated tongue for first 4 days; then strawberry tongue. Petechial hemorrhages cover the soft palate. Treatment: Penicillin; Erythromycin if allergic. Supportive care. Droplet precautions until antibiotics for 24 hours. Transmission: Airborn, direct contact Immunity: None Peak Season: late Fall/Winter/Spring RICKETTSIAL INFECTIONS 1. Rocky Mountain Spotted Fever (Rickettsia rickettsii) Incubation: 2-14 days, average of 7 Infectious: NA Symptoms: A maculopapular rash begins on palms and soles and spreads to rest of body. Periorbital edema progressing to generalized edema. Gangrene in distal parts due to thrombosis. Treatment: Tetracycline, Chloramphenicol effective if treatment is started early. If vascular damage has already occurred, antibiotics may not alter course of the disease.

Transmission: Bite of infected tick Immunity: NA Peak Season: April through September 2. Lyme Disease (Borrelia burgdorferi) spirochete Incubation: 3-32 days Infectious: NA Symptoms: Three stages: First stage the lesions are prominent bulls eye rash with central clearing; may enlarge quickly to up to 68 cm. May itch or burn. Second stage: Cardiac and neurological sx. Third stage: Arthritis is main sx. Treatment: Tetracycline over 9 years of age; Amoxicillin under 9 years. Transmission: Bite of infected tick Immunity: Vaccine for high-risk persons over the age of 15. Peak Season: May to November SEXUALLY TRANSMITTED DISEASES 1. Gonorrhea Neisseria gonorrhoeae Incubation: 2-7 days Symptoms: Ophthamia neonatorum 1-4 days after birth, eye infection may be seen in children. Purulent vulvovaginitis in girls; urethritis in boys. Treatment: Third generations cephlosporin ceftriaxone. Transmission: Perinatal, sexual contact, child abuse 2. Chlamydia Chlamydia trachomatis, Chlamydia psittaci, Chlamydia pneumonia. Incubation: 7-21 days Symptoms: Neonates: conjunctivitis injection of conjunctiva, purulent drainage, eyelid edema. Pneumonia with cough and congestion that may lead to chronic respiratory problems. Girls: Purulent vaginal discharge. Boys: Urethritis. Treatment: Erythromycin for 10-14 days. Tetracycline may be used in children over 8 years. Transmission: Perinatal, sexual contact, child abuse. 3. Syphillis - Treponema pallidum Incubation: 10-90 days, average 21 Symptoms: Neonates: rhinitis, maculopapular rash and hepatosplenomegaly occurs within the first 3 months of life. Involves the bones, teeth (notched), eyes, and eight cranial nerve. Late signs: Sudden hearing loss at age 8-10 years. Acquired syphillis: Primary: painless chancre that lasts 3-6 weeks. Secondary: Rash generalized, but includes palms of hands and soles of feet. Latent stage: Chronic inflammation of bones, teeth and CNS. Treatment: Penicillin. Doxycycline or Tetracycline if allergic to penicillin. Transmission: Transplacental, sexual contact, child abuse.

4. Human Papillomavirus (HPV) Incubation: 4 weeks to months Symptoms: Anogential warts, can be transmitted to other moist areas of the body areas. Treatment: Surgery, cryotherapy, electrocautery, and laser therapy or chemical ablation. Transmission: Perinatal, sexual contact. A break in the skin is necessary for infection to occur. 5. Trichomoniasis Incubation: Trichomonas vaginalis Symptoms: May be asymptomatic in girls (25-50% have sx) dysuria and foulsmelling discharge when sx. occur. Boys: urethritis. Treatment: Flagyl single dose for adolescents and adults. Three divided doses for prepubertal girls. Transmission: Perinatal contact, sexual contact.