Infectious Diseases Peter Ball recred Honorary Senior Lecturer School of Biomedical Sciences University of St. Andrews St. Andrews Scotland James A. Gray recred Formerly Consultant Infectious Disease Physician City Hospital Edinburgh Scotland SECOND EDITION CHURCHILL LIVINGSTONE EDINBURGH LONDON MADRID MELBOURNE NEW YORK SAN FRANCISCO TOKYO 1998Contents Classical infectious diseases of childhood syndrome Mumps Erythema inf Chickenpox Herpes zoster (shingles) Herpes simplex infections 2 Kawasaki (mucocutaneous lymph node) syndrome Lyme disease Orf Herpangina Hand, foot and mouth disease Infectious mononucleosis (IM) Toxoplasmosis Cytomegalovirus infection Virus hepatitis Leptospirosis Staphylococcal infection Osteomyelitis (OM) Infections with Streptococcus pyogenes Scarlet fever Anthrax Diphtheria Tetanus Enteric (typh and paratyphoid) fevers Infantile gastroenteritis Pseudomembranous colitis Meningococcal infections Bacterial meningitis (non-meningococcal) Viral meningitis Tuberculosis Pertussis (whooping cough) Acute croup and bronchiolitis Community-acquired Lung abscess Erythema nodosum Stevens-Johnson syndrome Gonococcaemia Acquired immune deficiency syndrome (AIDS) IndexAetiology Incidence Pathogenesis Clinical features _1/ Classical infectious diseases of childhood Measles Measles virus, a single serotype paramyxovirus. Previously common in preschool and junior schoolchildren, notably in the last few months of the year, the disease is now rare due to widespread effective immunization. Where present, measles is now usually sporadic or sub-epidemic. Explosive outbreaks may occur if measles is introduced to unexposed and non-immune communities. Case to case spread follows airborne droplet transmission from the respiratory tract of patients with active measles. There is no other reservoir of infection. Invasion of the upper respiratory tract and conjunctivae is followed by multiplication in lymphoid tissues and viraemia. Histological appearances are characterized by a mononuclear reaction with giant cells and endothelial proliferation. Lesions are present in skin (rash), mucous membranes (Koplik’s spots), lungs, gut and lymphoid tissue The incubation period of 2 weeks is followed by the prodromal phase, characterized by upper respiratory catarrh with Koplik’s spots on the buccal mucosa (Fig. 1}, accompanied by conjunctivitis, otitis media and rhinitis (Fig. 2) 24-48h later a dusky red maculopapular rash commences on the face and spreads peripherally via the trunk (Fig. 3, Fig. 4, p. 4). Uncomplicated measles lasts for 7-10 days, following which the fading rash leaves skin staining (see Fig. 5, p. 4), brown macules with fine desquamation, which can persist for up to 3 weeks. gy POOUpILYO Jo Saseasip snoDajuN JeDISseI / | ie 8 Fig. 1 Koplik's spots on buccal mucosa Fig. 2 Morbilliform rash, conjunetivitis and rhinitis. Fig. 3 Details of measles rash 2