Communicable Diseases

Communicable Diseases Rubella, Rubeola, Roseola, Fifth’s Disease, Chicken Pox, Scarlet Fever, Mononucleosis

Review terminology r/t communicable diseases: • Incubation period • Prodromal symptoms • Period of communicability • Types of Isolation: contact, respiratory

Immunizations can prevent many of these diseases—primary prevention strategy • Careful handwashing to prevent transmission in essential for healthcare practitioners and for families • Infection Control: pp. 1019-1020 & Box 27-3 (9th ed.); pp. 193-195 & Box 6-1 (10th ed.) • Early identification of symptoms so that treatment can be initiated is also paramount to a good outcome. Prevention

If a child is admitted to the hospital with an UNDIAGNOSED EXANTHEMA, strict isolation is instituted until a diagnosis is confirmed. • These are a few communicable diseases that require isolation: • diphtheria • chickenpox • Measles, mumps, rubella • tuberculosis • adenovirus • Haemophilusinfluenzaetype B • influenza • meningitis • Mycoplasma pneumonia, pseudomonas aeroginosa pneumonia • pertussis • RSV • streptococcal pharyngitis, scarlet fever • Clostridium difficile, e.coli, shigella • pneumonia / pneumonic plague / • (AAP, Committee on Infectious Diseases, 2003) • Reportable Communicable Dz list for Cook County

Any immunocompromised children—those receiving steroid or immunosuppressive therapy, are always at risk for viremia, especially from viruses like herpes zoster. • Children with sickle cell anemia may develop aplastic anemia from erythemainfectiosum (EI)[Fifth’s Dz]. The human parvovirus (HPV) infects and lyses RBC precursors. • Diphtheria and Scarlet Fever are bacterial and prevention of complications requires compliance with antibiotic therapy. Prevent complications

High-risk children exposed to chickenpox should receive VZIG (varicella zoster immune globulin). • Acyclovir (Zovirax) may be used to treat varicella infections in high risk children with the disease. • Vitamin A supplementation in high doses has recently been shown to decrease morbidity and mortality rates in measles. Careful instruction to parents on safe storage of Vitamin A is essential. Prevent complications

Alleviate itching that is one of the most common discomforts of rashes • Cool/tepid baths without soap, may use oatmeal • Calamine/Caladryl lotions must be applied sparingly to prevent toxic levels being absorbed. They contain diphenhydramine. • Wear lightweight, loose clothing, keep cool • Keep nails short, wear mittens on young children • Suggest po. Diphenhydramine (Benadryl) • Offer antipyretics (acetominophen or ibuprofen) for fever and general malaise • Lozenges, saline rinses for sore throats • Suggest quiet activities Provide comfort

Provide accurate information re: period of communicability and period of recovery. • Provide support and encouragement. • Review importance of compliance with therapy. • No Salicylate products with all viral diseases because of link to Reye Syndrome (p.1462-3 10th ed.)—metabolic encephalopathy: fever, profoundly impaired consciousness, and liver dysfunction. Support family and child

Review Table 16-1 Communicable Diseases of Childhood pp. 608-614 (Hockenberry et al, 9th ed.) • Table 6-2 in 10th ed. Pp. 212-218 • Know association of high fever and febrile seizures with Roseola and importance of careful antipyretic management. • Know common sx of Rubeola (measles) including koplik’s spots, photophobia. • Know period of communicability of Varicella/chickenpox and appropriate counsel to parents re: when child can return to school • Know etiology of Scarlet Fever, common sx, management, and when to return to school • Know risks to fetus if Rubella is contracted in the mother’s first trimester of pregnancy • Know appearance of rash for Fifth Disease (HPV)

Which is which?? Fifth Disease Roseola Chicken pox Scarlet Fever

Etiology: Epstein Barr Virus • Natural Hx: • Typically self-limiting & uncomplicated • -7Incubation period: 30-60 days • Preclinical stage: 3-5 days • Acute illness: 7-20 days • Convalescence: 2-6 weeks • Viral excretion may occur many months after infection • Often asymptomatic and difficult to diagnose Mononucleosis (pp.1175-7 10th ed.)

Transmission: through saliva (usually intimate contact, thus the nickname, ‘Kissing Disease’) • Pathophysiology • EBV infects B-lymphocytes lymphoproliferation • Lab results: atypical lymphocytes called Downey cells •  WBC’s especially lymphs and •  liver enzymes • EBV antibody titer  • + Monospot test Mononucleosis (cont’d)

Signs and Symptoms • General malaise • Sore throat, gelatinous film over palate and uvula, red macules on palate • Tonsillar enlargement, white exudate on tonsils, red pharynx • Fever • Macular rash (trunk) • Abdominal pain • Cervical lymphadenopathy • Splenomegaly • Hepatomegaly Mononucleosis (Cont’d)

Population most affected:12-26 yr olds • Nursing concerns • Potential for secondary infection • Potential for injury • School absenteeism • Possible complications: • Aseptic meningitis • Encephalitis • Guillian Barré Syndrome • Splenic rupture Mononucleosis (cont’d)

Primary prevention • General health promotion measures • Secondary prevention • Prompt medical attention for sore throats to r/o strep throat • Screening to r/o secondary bacterial infection • Tertiary prevention • Palliative: • Fever (rest,  calories,  fluids, Acetominophen • Saline gargles • Soft foods • No contact sports • Referral for home-bound teacher, if pt has to stay home for lack of energy and malaise • Can go to school if feels up to it

That should do it! Wash your hands and stop the spread of these communicable diseases!

Communicable Diseases