Many viruses affect children, especially if they haven’t been immunized. Although adults can acquire these viruses, for the Physician Assistant Exam (PANCE), think of them as causing childhood diseases, because that is where they do the most damage.
Measles: Measles is a highly contagious viral syndrome characterized by certain clinical findings. Like all viral syndromes, initial symptoms include fever, cough, and upper respiratory tract infection symptoms. The fever usually lasts 3 to 4 days. In addition, the child has a diffuse rash that’s maculopapular in nature. Measles is transmitted via respiratory droplets.
One of the hallmarks of measles is the presence of Koplik spots, which are white lesions found in the mouth, often before measles begins.
Mumps: Mumps can be summed up by the -itises: parotitis, orchitis, and sometimes pancreatitis. The most common clinical finding is significant parotitis. As with measles, the child can also have a fever and a skin rash. Like measles, mumps is transmitted via respiratory droplets. An infected person is able to transmit the virus for at least 1 week after acquiring the disease.
Rubella: Rubella is another virus transmitted by respiratory droplets. Also known as German measles, it’s also associated with a skin rash. The rash is erythematous and papular.
Be aware that rubella can be transmitted from mother to fetus, leading to congenital rubella syndrome. It can cause multiple birth defects and can affect the heart and brain, among other body organs.
The MMR (measles, mumps, and rubella) inoculation that children get between 12 and 15 months of age confers immunity to measles, mumps, and rubella. Because of the MMR vaccine, rubella is now a very uncommon illness.
Erythema infectiosum: Erythema infectiosum, which is caused by parvovirus B19, is also called fifth disease. The classic physical finding for this condition is a characteristic skin rash on the cheeks, lending a “slapped-cheek” appearance. The rash has often been described as “lace-like.” The child also has maculopapular appearance on the arms and legs.
Roseola: Roseola, also known as sixth disease, is a viral infection that affects infants, generally from 4 to 12 months of age. Roseola is caused by human herpes virus 6 (HHV-6B). Initially, the child has flu-like symptoms. In addition, he or she may have conjunctivitis and high fevers.
After about 2 to 3 days, the child develops a characteristic skin rash that begins on the chest and spreads over the body to include the upper and lower extremities. In addition to the rash, one big characteristic is that the affected child looks relatively nontoxic despite the high fevers. Roseola is usually self-resolving after a few days.
Why is there a fifth and a sixth disease? They’re part of the historical classification of childhood rashes: 1) measles, 2) scarlet fever, 3) rubella, 4) Duke’s disease, 5) fifth disease (erythema infectiosum), and 6) sixth disease (roseola).
Which one of the following is associated with parvovirus B19?
(A) Asymmetric polyarthritis
(B) Diarrhea
(C) Hemolytic anemia
(D) Kidney failure
(E) Lung fibrosis
The correct answer is Choice (A). For PANCE purposes, parvovirus B19 can do three things: It can cause erythema infectiosum, it can cause asymmetric polyarthritis in young women, and it can cause aplastic anemia in someone diagnosed with sickle cell anemia.