Chickenpox (Varicella)

• Childhood communicable disease incidence has decreased due to immunizations, antibiotics, and antitoxins. Nurses should know infectious agents to recognize diseases and implement preventive measures

Chickenpox (Varicella)

• Agent: Varicella-zoster virus (VZV).
• Source: Respiratory tract secretions, skin lesions (scabs not infectious).
• Transmission: Direct contact, airborne droplets, contaminated objects.
• Incubation: 2-3 weeks (typically 14-16 days).
• Communicability: 1 day before lesions appear until 6 days after vesicles when crusts form.
• Symptoms:
  • Prodromal: Slight fever, malaise, anorexia for 24 hours
  • Rash: Pruritic macules that become papules, then vesicles with an erythematous base; all stages present at once
  • Distribution: Centripetal, spreading to face and extremities, sparse on distal limbs
  • Constitutional: Elevated temperature, lymphadenopathy, irritability from pruritus
• Treatment:
  • Specific: Acyclovir, varicella-zoster immune globulin (IVIG) for high-risk children
  • Supportive: Antihistamines for itching, skin care to prevent infection
• Complications:
  • Secondary bacterial infections, encephalitis, varicella pneumonia, hemorrhagic varicella, thrombocytopenia.
• Prevention: Childhood immunization.
• Nursing:
  • Standard, Airborne, and Contact Precautions if hospitalized until lesions are crusted
  • Isolate until no new lesions appear
  • Skin care: Baths, clean clothes, calamine lotion, short nails, mittens
  • Keep child cool
  • Avoid aspirin due to Reye syndrome risk

Diphtheria

• Agent: Corynebacterium diphtheriae.
• Source: Mucous membrane discharges, skin lesions.
• Transmission: Direct contact with infected persons, carriers, or contaminated articles.
• Incubation: 2-5 days.
• Communicability: Until 3 negative cultures, usually 2-4 weeks.
• Symptoms:
  • Nasal: Cold-like, serosanguineous discharge without systemic symptoms
  • Tonsillar-pharyngeal: Malaise, anorexia, sore throat, low-grade fever, elevated pulse, white/gray membrane, lymphadenitis ("bull’s neck"), toxemia
  • Laryngeal: Fever, hoarseness, cough, potential airway obstruction, dyspnea, cyanosis
• Treatment:
  • Equine antitoxin (test for sensitivity first), antibiotics (penicillin G or erythromycin).
  • Complete bed rest
  • Tracheostomy
• Complications: Toxic cardiomyopathy, toxic neuropathy.
• Prevention: Childhood immunization.
• Nursing:
  • Standard and Droplet Precautions until 2 negative cultures
  • Contact Precautions for cutaneous diphtheria
  • Timely antibiotics
  • Sensitivity testing
  • Complete bed rest
  • Suctioning
  • Observe respirations
  • Humidified oxygen

Erythema Infectiosum (Fifth Disease)

• Agent: Human parvovirus B19.
• Source: Infected persons (school-age children).
• Transmission: Respiratory secretions, blood/blood products.
• Incubation: 4-14 days (up to 21 days).
• Communicability: Before symptom onset in aplastic crisis
• Symptoms:
  • Stage I: "Slapped face" appearance (facial erythema) that disappears in 1-4 days; Stage II: Maculopapular red spots on extremities, lasting ≥1 week; Stage III: Rash reappears with irritation
  • Aplastic crisis: Fever, myalgia, lethargy, nausea, vomiting, abdominal pain.
• Treatment:
  • Symptomatic: Antipyretics, analgesics, anti-inflammatory drugs.
  • Blood transfusion for aplastic anemia
• Complications:
  • Arthritis, arthralgia
  • Fetal complications if mother infected during pregnancy
  • Aplastic crisis in hemolytic disease or immunodeficiency
  • Myocarditis
• Nursing:
  • Isolation not needed, Droplet and Standard Precautions for hospitalized immunosuppressed or aplastic crisis patients
  • Low fetal risk counseling, fetal ultrasound to detect fetal hydrops

Exanthem Subitum (Roseola Infantum)

• Agent: Human herpesvirus type 6 (HHV-6; rarely HHV-7).
• Source: Possibly saliva of healthy adults.
• Transmission: Via nasal, buccal, or conjunctival mucosa; year-round.
• Age: Limited to children <3 years
• Symptoms:
  • High fever (39.5°C/103°F) for 3-7 days
  • Precipitous fever drop with rash appearance and bulging fontanel
  • Rash; Rose-pink macules/maculopapules on trunk, spreading to neck, face, extremities, nonpruritic, fades on pressure, lasts 1-2 days.
  • Cervical and postauricular lymphadenopathy, inflamed pharynx, cough, coryza
• Treatment:
  • Antipyretics for fever
• Complications: Febrile seizures, encephalitis, hepatitis (rare).
• Nursing:
  • Standard Precautions
  • Teach parents antipyretic measures and dosages
  • Discuss seizure precautions.

Mumps

• Agent: Paramyxovirus
• Source: Saliva of infected persons
• Transmission: Direct contact or droplet spread
• Incubation: 14-21 days
• Communicability: Before and after swelling begins
• Symptoms:
  • Prodromal: Fever, headache, malaise, anorexia for 24 hours, "earache" with chewing
  • Parotitis: Parotid gland enlargement, pain, tenderness, other exocrine glands may swell.
• Treatment:
  • Prevention: Childhood immunization
  • Symptomatic: Analgesics, antipyretics, IV fluids for dehydration from meningoencephalitis
• Complications: Sensorineural deafness, encephalitis, myocarditis, arthritis, hepatitis, epididymo-orchitis, oophoritis, pancreatitis, sterility (rare), meningitis
• Nursing:
  • Isolation during communicability; Droplet and Contact Precautions if hospitalized
  • Rest
  • Analgesics (elixir form)
  • Fluids and soft, bland foods; avoid chewing
  • Hot/cold compresses to neck.
  • Orchitis: Hot/cold packs, scrotal elevation

Measles (Rubeola)

• Agent: Virus
• Source: Respiratory tract secretions, blood, urine
• Transmission: Direct contact with droplets
• Incubation: 10-20 days
• Communicability: 4 days before-5 days after rash mainly during prodromal stage
• Symptoms:
  • Prodromal: Fever, malaise, coryza, cough, conjunctivitis, Koplik spots on buccal mucosa.
  • Rash: Erythematous maculopapular eruption on face, spreading downward
  • Constitutional: Anorexia, abdominal pain, malaise, lymphadenopathy
• Treatment:
  • Prevention: Childhood immunization.
  • Supportive: Bed rest, antipyretics
  • Antibiotics to prevent secondary bacterial infection
  • Vitamin A
• Complications: Otitis media, pneumonia, obstructive laryngitis/laryngotracheitis, encephalitis
• Nursing:
  • Isolation until fifth day of rash; Airborne Precautions if hospitalized
  • Rest
  • Fever: Antipyretics, avoid chilling
  • Eye care: Dim lights, clean eyelids
  • Coryza, cough: Cool-mist vaporizer, petrolatum around nares, fluids, soft foods
  • Skin care: Clean skin, tepid baths

Pertussis (Whooping Cough)

• Agent: Bordetella pertussis
• Source: Respiratory tract discharge
• Transmission: Direct contact or droplet spread
• Incubation: 6-20 days (usually 7-10 days)
• Communicability: Greatest during catarrhal stage
• Symptoms:
  • Catarrhal: Upper respiratory symptoms, dry hacking cough
  • Paroxysmal: Rapid coughs followed by "whoop", flushed or cyanotic, bulging eyes, protruding tongue.
  • Vomiting frequently follows attack
• Infants