TSS is an acute multisystem disease characterized by high fever, hypotension, vomiting, diarrhea, myalgias, nonfocal neurologic abnormalities, conjunctival hyperemia, strawberry tongue, and an erythematous rash with subsequent desquamation on the hands and feet

ETIOLOGY.

TSS is caused by TSST-1-producing strains of S. aureus, which may colonize the vagina or cause focal sites of staphylococcal infection.

CLINICAL MANIFESTATIONS.

The diagnosis of TSS is based on clinical manifestations.

The onset is abrupt, with high fever, vomiting, and diarrhea, and is accompanied by sore throat, headache, and myalgias. A diffuse erythematous macular rash (sunburn-like or scarlatiniform) appears within 24 hr and may be associated with hyperemia of pharyngeal, conjunctival, and vaginal mucous membranes. A strawberry tongue is common.

Symptoms often include alterations in the level of consciousness, oliguria, and hypotension, Continue reading »

Mumps is an acute self-limited infection, characterized by fever, bilateral or unilateral parotid swelling and tenderness, and the frequent occurrence of meningoencephalitis and orchitis.

ETIOLOGY.

Mumps virus is in the family Paramyxoviridae and the genus Rubulavirus. Mumps virus exists as a single immunotype, and humans are the only natural host.

CLINICAL MANIFESTATIONS

Mumps virus targets the salivary glands, central nervous system (CNS), pancreas, testes, and, to a lesser extent, thyroid, ovaries, heart, kidneys, liver, and joint synovia

The incubation period for mumps ranges from 12 to 25 days, but is usually 16 to 18 days

Mumps virus infection may result in clinical presentation ranging from asymptomatic or nonspecific symptoms to typical illness associated with parotitis with or without complications involving several body systems.

The typical case presents with a prodrome lasting 1–2 days consisting of fever, headache, vomiting, and achiness. Parotitis then appears and may be unilateral initially but becomes bilateral in about 70% of cases

The parotid gland is tender, and parotitis may be preceded or accompanied by ear pain on the ipsilateral side. Ingestion of sour or acidic foods or liquids may enhance pain in the parotid area. As swelling progresses, the angle of the jaw is obscured and the ear lobe may be lifted upward and outward

The parotid swelling peaks in approximately 3 days then gradually subsides over 7 days. Fever resolves in 3 to 5 days along with the other systemic symptoms. A morbilliform rash is rarely seen. Submandibular salivary glands may also be involved or may be enlarged without parotid swelling.

DIAGNOSIS.

When mumps was highly prevalent, the diagnosis could be made based on history of exposure to mumps infection, an appropriate incubation period, and development of typical clinical findings. Confirmation of the presence of parotiditis could be made with demonstration of an elevated amylase level.

Virus can be isolated from upper respiratory tract secretions, CSF, or urine during the acute illness. Serologic testing is usually a more convenient and available mode of diagnosis.

TREATMENT.

No specific antiviral therapy is available for mumps. Management should be aimed at reducing the pain associated with meningitis or orchitis and maintenance of adequate hydration. Antipyretics may be given for fever.

Diarrhea is a leading cause of childhood mortality in the world, accounting for 5–10 million deaths per year. In early childhood, the single most important cause of severe dehydrating diarrhea is rotavirus infection.

Epidemiology:
Rotaviruses, which are in the Reoviridae family, cause disease in virtually all mammals and birds. The virus is a wheel-like, triple-shelled icosahedron containing 11 segments of double-stranded RNA. The diameter of the particles by electron microscopy is approximately 80 nm. Rotaviruses are classified by serogroup (A, B, C, D, E, F, and G) and subgroup (I or II).
Occasional human outbreaks of group C rotavirus are reported. The other serogroups infect only nonhumans.
Rotavirus infection is most common in winter months in temperate climates. In the United States, the annual winter peak spreads from west to east
Disease tends to be most severe in patients 3–24 mo of age, although 25% of the cases of severe disease occur after 2 yr of age, with serologic evidence of infection developing in virtually all children by 4–5 yr of age. Infants younger than 3 mo are relatively protected by transplacental antibody and possibly breast-feeding. Infections in neonates and in adults in close contact with infected children are generally asymptomatic

Clinical Features:
Rotavirus infection typically begins after an incubation period of <48 hr (range 1–7 days) with mild to
moderate fever as well as vomiting followed by the onset of frequent, watery stools. All 3 symptoms are present in about 50–60% of cases. Vomiting and fever typically abate during the 2nd day of illness, but diarrhea often continues for 5–7 days. The stool is without gross blood or white cells. Dehydration may develop and progress rapidly, particularly in infants. The most severe disease typically occurs among children 4–36 mo of age.

Treatment:

Avoiding and treating dehydration are the main goals in treatment of viral enteritis. A secondary goal is maintenance of the nutritional status of the patient.
There is no routine role for antiviral drug treatment of viral gastroenteritis
Therapy with probiotic organisms such as Lactobacillus species has been shown to be helpful only in mild cases and not in dehydrating disease.