Transcript COMMUNICABLE DISEASE

COMMUNICABLE DISEASE
HEAD START
Joyce M. Smith M.D., MPH
CHILD CARE / EARLY
EDUCATION SETTING

Group Setting
◦ Increased risk of infectious disease spread
◦ Among children
 Younger than 2 years
 Rates of Infection tend to Increase for first 6
months
 Rates decrease after six months of attendance
◦ Children are 2 to 18 times more likely to
catch an infectious disease than non-group
CHILD CARE / EARLY
EDUCATION SETTING

Adult Care Givers
◦ Increased risk of acquiring and spreading
infection in the first year

Spread depends on environmental and
host variables
◦ Season, crowding, hygiene practices
◦ Immune status of host
◦ Virulence of germ or pathogen
INCREASE TRANSMISSION
(Short List)
Otitis Media – Ear infections
 Pneumonia
 Diarrhea
 Hepatitis A
 Streptococcal Infection
 Rotavirus
 Chicken pox (Varicella)

CONDITIONS FOR
TRANSMISSION
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Pathogen (Germ) – must be present
Adequate quantity present
Susceptible Host
Correct portal of entry
MODES OF TRANSMISSION
Airborne
 Droplet
 Direct Contact (Fecal Oral)
 Fomites (Common Vehicle)
 Bloodborne
 Vectorborne

RESPIRATORY CONDITIONS
COMMON COLD
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Pathogen
◦ Virus (many strains)
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Symptoms:
◦ Runny Nose, Congestion, Headache, Cough,
Muscle aches
◦ Little or no fever
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Mode of Transmission
◦ Droplets
◦ Respiratory
RESPIRATORY CONDITIONS
COMMON COLD
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Incubation Period
◦ 1 to 3 days
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Period of Contagiousness
◦ 1 day before up to 5 days after start of symptoms
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Management
◦ Supportive
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Prevention of Spread
◦ Cover Cough, Hand Hygiene
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Only excluded if fever is present
RESPIRATORY CONDITIONS
PHARYNGITIS VIRAL
Pathogen – Viruses (Multiple Strains)
 Symptoms –
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◦ Gradual onset of sore throat, runny nose,
cough + diarrhea, + fever
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Mode of Transmission:
◦ Respiratory, droplets, close contacts
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Management –
◦ Supportive, pain and fever medication as
indicated
RESPIRATORY CONDITIONS
STREPTOCOCCAL PHARYNGITIS

Pathogen –
◦ Bacteria Streptococcus “Strep Throat”
GABHS
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Symptoms –
◦ Rapid onset, painful swallowing, fever,
headache, muscle aches, enlarged tonsils,
enlarged lymph nodes
◦ Mode of Transmission
 Respiratory, Close Contacts
RESPIRATORY CONDITIONS
STREPTOCOCCAL PHARYNGITIS

Incubation Period
◦ 1 – 3 days
◦ May develop scarlet fever
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Period of Contagiousness
◦ Treated 24 to 48 hours
◦ Untreated – 10 days
 May lead to Rheumatic Fever

Management
◦ Antibiotics within 9 days
PHARYNGITIS
Nonspecific Pharyngitis, can be produced by several
pathogens. Physical exam + Lab for final diagnosis
Nelson’s Textbook of Pediatrics, 19th edition
PHARYNGITIS
More erythematous (red) with petechiae on roof of
mouth, suggestive of strep infection
PHARYNGITIS
White exudate on tonsils suggestive of Strep or
Mono infection
RESPIRATORY CONDITIONS
CROUP
Upper Respiratory Infection with partial
obstruction, causing noisy breathing
(stridor) and respiratory distress
 Causes Bark-like cough
 Mostly affects children 3 months to 5
years
 (Video of Croup)
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RESPIRATORY CONDITIONS
CROUP
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Pathogen
◦ Usually a virus
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Symptoms
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Starts as mild cold-like illness for 1-3 days
then strider and bark-like cough develop
Fever can be low grade or high 102.2 – 104
Can become hypoxic and need hospitalization
Mode of Transmission - Respiratory
RESPIRATORY CONDITIONS
CROUP
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Management
◦ Usually can be managed at home
◦ Keep calm, respiratory distress increases with
distress and crying
◦ To Emergency Room if respiratory distress
worsens
◦ Medication can be used for severe cases
RESPIRATORY CONDITIONS
EAR INFECTION (OTITIS MEDIA)
 Middle Ear Infection
 80% of children have at least one episode
of Otitis Media
 Peak incidence in the first 2 years of life
 Most cases are self-limited
 Pathogen – Virus or Bacteria
 Symptoms
◦ Fever, ear pain,
RESPIRATORY CONDITIONS
EAR INFECTION (OTITIS MEDIA)

Risk factors
◦ Age – highest rates in 6 to 20 month old
 Anatomy – smaller facial structures allow local
spread
◦ Smoke Exposure
 Preventable risk factor
◦ Pacifier use
 Small increase Risk
◦ Breast Milk
 Protective affect
COMMUNICABLE DISEASE
CONJUNTIVIS (PINK EYE)
Viral
 Bacterial
 Allergic
 Other conditions
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COMMUNICABLE DISEASE
CONJUNTIVIS (PINK EYE)

Viral and Bacterial
◦ Highly contagious
◦ Spread by touching contaminated objects
(fomites)
◦ Poor hand hygiene
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Allergic – Not contagious
◦ Usually bilateral
COMMUNICABLE DISEASE
CONJUNTIVIS (PINK EYE)
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Symptoms
◦ Redness or Pink eyes with white or yellow
discharge
◦ May have ild eye pain
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Mode of Transmission
◦ Direct Contact
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Incubation Period – 1 to 3 days
Period of Contagiousness – until redness
resolves or determined to be noncontagious
COMMUNICABLE DISEASE
CONJUNTIVIS (PINK EYE)
VIRAL – Usually watery discharge
Medicine.net.com
COMMUNICABLE DISEASE
CONJUNTIVIS (PINK EYE)
BACTERIAL HAS THICK GREENISH
YELLOW DISCHARGE
COMMUNICABLE DISEASE
CONJUNTIVIS (PINK EYE)
BACTERIAL ASSOCIATED WITH YELLOW
CRUSTED DISCHARGE
COMMUNICABLE DISEASE
CONJUNTIVIS (PINK EYE)
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MANAGEMENT
◦ Hand Hygiene- Prevent spread to other eye,
prevent spread to other people
 Prevent progression of viral or allergic to bacterial
◦ Bacterial – Antibiotic Eye Drops
◦ Viral – Self limited
◦ Allergic – Topical Antihistamines
COMMON SKIN PRESENTATIONS
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**Measles – Viral, preventable through
vaccination
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Pathogen
Symptoms
Mode of Transmission
Incubation Period
Period of Contagiousness
Management
***MEASLES
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Pathogen – Measles Virus
Symptoms
◦ 2 – 4 days of prodrome
 Fever, 103-105, Harsh Cough, Watery Reds Eyes,
 Then blotchy red rash starts 14 to 21 days post exposure on
face and spreads to the body
 Rash lasts 4 to 7 days
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Mode of Transmission
◦ Highly Contagious
◦ Direct Contact with oral and nasal secretions
◦ Contaminated clothing

(*** Reportable; One case reported in Illinois in
2013)
MEASLES
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Incubation Period
◦ 8 to 12 days – range 7 to 18 days
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Period of Contagiousness
◦ Slightly before prodrome until 4 days after
rash develops
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Complications may include
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Pneumonia
Meningitis
Otitis Media
Death
MEASLES
Intensely erythematous
pathches of the face with
spreading inferiorly onto
the trunk
Hurwitz Clinical Pediatric Dermatology Third Edition
RUBELLA – GERMAN MEASLES
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Pathogen – German Measles Virus
Symptoms – 3-Day Measles
◦ Mild disease, mild fever, swollen glands
◦ Rash last 2 to 3 days
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Mode of Transmission
◦ Contact with respiratory droplets
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Incubation Period
◦ 14 to 21 days
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Period of Contagiousness
Management - Immunization
RUBELLA GERMAN MEASLES
Nonspecific
“rose pink”
macules and
papules on the
trunk of an
adolescent male
Hurwitz Clinical Pediatric Dermatology Third Edition
***VARICELLA (CHICKEN POX)
Pathogen - VZV Varicella-Zoster Virus
 Incubation Period
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◦ 10 to 21 days
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Symptoms
◦ Sudden onset, mild fever itchy rash starts as
maculopapular and progresses to vesicles,
then crust, more develop – different stages of
healing,
◦ Ave about 300 lesions. Much worse in older
children and adults
***VARICELLA (CHICKEN POX)
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Mode of Transmission
◦ Direct Contact with respiratory droplets and
contaminated items, touching skin vesicles
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Period of Contagiousness
◦ 24 to 48 hours before the rash until lesions are
crusted
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Management / Complications
◦ ***Reportable to the city
◦ Notification of parents,VZIG within 96 hours of
exposure
◦ Immunizations
***VARICELLA (CHICKEN POX)
UNIMMUNIZED CHILD
***VARICELLA (CHICKEN POX)
BREAK THROUGH LESIONS OF IMMUNIZED CHILD
FIFTH DISEASE
(Erythema Infectiosum)
Pathogen – Parvovirus B19
 Incubation Period – 4 to 28 days
 Symptoms – Usually benign, mild fever
slapped cheek rash, progress to lacy
appearance
 Mode of Transmission – Respiratory nasal
droppings
 Period of Contagiousness – right before
rash
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FIFTH DISEASE
(Erythema Infectiosum)
Erythema of the cheeks giving a “slapped cheeks” appearance
FIFTH DISEASE
(Erythema Infectiosum)
Reticulate erythema
lacy rash on upper
arm
HAND-FOOT AND MOUTH
DISEASE
Pathogen –Coxsackie Virus A 16
 Incubation Period
 Symptoms – Mild Illness with low grade
fever, on ulcers on Mouth and blisters
Hands and Feet
 Mode of Transmission
 Period of Contagiousness – Before
lesions appear and for several weeks after
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HAND-FOOT AND MOUTH
DISEASE
Deep-seated vesicles with erythema involving the palmar surface
of the hand
HAND-FOOT AND MOUTH
DISEASE
A painful ulcer on the lateral aspect of the tongue
HAND-FOOT AND MOUTH
DISEASE
Red to purple vesicles involving the knee
HAND-FOOT AND MOUTH
DISEASE
WARTS (VERRUCA)
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Pathogen – HPV
◦ Human Papilloma Virus (Multiple strains more
than 200)
◦ Usually benign in children and adolescents
◦ Incidence is highest in children and adolescents
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Incubation Period –
◦ Develop lesions one month after inoculation
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Symptoms –
◦ Slow developing growth, sometimes painful
◦ Usually less than 3 in mm in size
WARTS (VERRUCA)
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Mode of Transmission –
◦ Direct contact, autoinoculation and fomites
Period of Contagiousness, no limits, can
be covered to avoid direct contact
 Management / Complications
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65% disappear within 2 years
Liquid Nitorgen
Salicyclic Acid – Compound W
podophyllin
WARTS (VERRUCA)
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Multiple Forms
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Flat
Filiform
Plantar
Common
Periungual
COMMON WARTS (VERRUCA)
A dome-shaped
lesion on the nose
and filliform wart
down below
COMMON WART (VERRUCA)
Common Wart on the Tongue
PLANTAR WARTS (VERRUCA)
SUBUNGAL WARTS
Verrucous papules under the thumb and index finger
with extension under the nail plate
MOLLUSCUM CONTAGIOSUM
Pathogen – Poxvirus
 Incubation Period

◦ Greater than 2 weeks
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Symptoms
◦ Occurs mainly on children and immune
compromised adults. Discreet pearly to flesh
colored dome shape papules with umbilicated
center
◦ Anywhere on the body. Ave last 6 to 9 months
◦ May persist for years
MOLLUSCUM CONTAGIOSUM
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Mode of Transmission
◦ Direct Contact
◦ Fomites
◦ Autoinoculation
Period of Contagiousness – May be
present for years
 Management
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◦ Self limited
◦ Curettage (scraping) is the treatment of
choice
MOLLUSCUM CONTAGIOSUM
Solid dome shaped pearly papule
MOLLUSCUM CONTAGIOSUM
FUNGAL DISEASE OF SKIN
TINEA
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Tinea
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Capitus (Ring Worm of the Scalp)
Corporis (Ring Worm of the body)
Pedis (Athletes Foot)
Versicolor
Intertrigo – In skin folds
FUNGAL DISEASE OF SKIN
TINEA CAPITUS
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Pathogen – Fungus – Dermatophytes affect skin
Incubation Period
Symptoms
◦ Hair loss, “Black dot” hair breaks off near the scalp; Diffuse
flakiness with little or no hair loss; Sever inflammatorty
reactions produces kerions
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Mode of Transmission
◦ Direct contact with fomites
 Combs, brushes, chairs, hats
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Period of Contagiousness –
◦ Ongoing without treatment
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Management
◦ Oral antifungal medication for 6 to 8 weeks
FUNGAL DISEASE OF SKIN
TINEA CAPITUS
BLACK-DOT RING WORM
FUNGAL DISEASE OF SKIN
TINEA CAPITUS - KERION
FUNGAL DISEASE OF SKIN
TINEA CORPORIS (Body)
Pathogen – Fungal Dermatophyte
 Incubation Period
 Symptoms
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◦ Round reddish, scaly areas that progress to
centrally clean can be millimeters or
centimeters in size
FUNGAL DISEASE OF SKIN
TINEA CORPORIS (Body)
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Mode of Transmission
◦ Direct Contact
◦ Infected Pet
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Period of Contagiousness
◦ As long as lesions are present
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Management
◦ Topical antifungal medication – OTC
◦ Small lesions can be covered to decrease
spreading
FUNGAL DISEASE OF SKIN
TINEA VERSICOLOR
Hypopigmented minimally
scaly macules and patches
on trunk
FUNGAL DISEASE OF SKIN
TINEA VERSICOLOR
Tinea Versicolor in
dark skinned
person
BACTERIAL SKIN DISORDERS

Scarlet Fever
◦ Abcesses
◦ Impetigo
BACTERIAL SKIN DISORDERS
SCARLET FEVER
Scarlet fever in a dark-skinned person. The rash resembles
“gooseflesh.” Note the beginning of desquamation
BACTERIAL SKIN DISORDERS
Post-scarlet fever desquamation. Extensive peeling of the hands
following treatment
BACTERIAL SKIN DISORDERS
ABCESS (CARBUNCLE)
Large, tender eythematous swelling on lateral trunk of
teenager.. Note small adjacent furnacle
BACTERIAL SKIN DISORDERS
IMPETIGO (BULLOUS)
Multiple tender eythematous patches with a peripheral collarette
representing the remnants of the blister roof
BACTERIAL SKIN DISORDERS
IMPETIGO
These multiple
lesion have
spread as a
result of
autoinoculation
INFESTATIONS LICE
Head Lice
 Scabies

INFESTATIONS HEAD LICE
Pathogen- Insect (Pediculosis)
 Incubation Period
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◦ Eggs hatch in seven to ten days
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Symptoms
◦ Scratching of head
◦ Identification of nits (eggs) attached to hair and lice present
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Mode of Transmission
◦ Direct contact with an infested person, clothing or article
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Period of Contagiousness
◦ As long as eggs are not treated
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Management
◦ Application of 1% Permethrin Creme leave on 10 mintues then
wash out
◦ Consider second treatment 1 – 2 weeks later
INFESTATIONS HEAD LICE
Nits and Lice Visible on hair
INFESTATIONS SCABIES

Pathogen
◦ Body Lice – Arthropods
◦ Mite
◦ Obligate human parasite
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Incubation Period
◦ Two to six weeks – first time
◦ One to four days – future infestations
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Symptoms
◦ Itching, scratching, papulosquamous lesions
INFESTATIONS SCABIES
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Mode of Transmission
◦ Direct contact with infested individuals
◦ Possibly fomites
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Period of Contagiousness
◦ Until 24 hours after treatment
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Management
◦ Application of Permethrin
◦ Wash off in 8 hours
INFESTATIONS SCABIES
INFESTATIONS
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SCABIES
INFESTATIONS SCABIES
Scabies lesions with burrows of egg deposits under the skin
INFESTATIONS SCABIES
COMMUNICABLE DISEASES
QUESTIONS?
References
Hurwitz: Clinical Pediatric Dermatology,
third edition
 Nelsons Textbook of Pediatrics, 19th
edition
 Communicable Disease Guide, Illinois
Department of Public Health 2002
 Web M.D.
