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Recurrent Parotitis of Childhood

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21. Viral Meningitis (Diagnosis)

and meningoencephalitis cases in parts of the world where vaccines are not readily accessible. Males 16-21 years of age are at highest risk for developing this infection, with a 3:1 male/female ratio. Clusters of cases occur in schools and colleges in the winter months. Concomitant parotitis is a helpful clinical tool, but it may be absent in as many as half of cases with CNS involvement. A cohort study of 12,000 unvaccinated children from northern Finland revealed that mumps meningoencephalitis accounted for 40.9 (...) , benign, recurrent meningitis that resolves spontaneously. Mollaret cells (activated monocytes with an atypical appearance of enlarged, bilobed nuclei and amorphous cytoplasm) are found in the CSF usually on the first day of symptoms. Herpesvirus-6, EBV, and the human immunodeficiency virus (HIV; which is not a member of the herpes family) have also been implicated. These viruses are all known to remain latent within the nervous system. CMV infections occur mostly in immunocompromised hosts. CMV may

2014 eMedicine.com

22. Viral Encephalitis (Diagnosis)

, including viral (focal) encephalitis. Numerous other viruses are known to cause encephalitis (see Tables 2 and 3 below). The viruses most commonly associated with acute childhood encephalitis are mumps virus, measles virus, and varicella-zoster virus (VZV). Table 2. Common Viral Encephalitides: Part 1 Virus (Family) Viral Structure Transmission Mortality Specific Clinical Patterns Sequelae Season HSV (herpesvirus) ds DNA Unknown 70% if untreated Rare forms: subacute, psychiatric, opercular, recurrent (...) contagious Low Parotitis, pancreatitis, orchitis, aseptic meningitis Frequent sequelae Winter and spring Measles virus (paramyxovirus) ss RNA Direct contact (air), highly contagious 10% Characteristic rash; frequent EEG changes; myelitis Frequent: mental retardation, seizures, SSPE Winter and spring Nipah virus (paramyxovirus) ss RNA Pigs; bats 40-75% Brainstem or cerebellar signs; segmental myoclonus, dysautonomia SSPE-like syndrome? All year ds—double strand; EEG—electroencephalographic; ss—single

2014 eMedicine.com

23. Viral Arthritis (Diagnosis)

in children rarely develops into pauciarticular arthritis [ ] Mumps virus – In infected adults, this infection is associated with small or large joint synovitis that lasts for several weeks; arthritis may precede or follow parotitis by up to 4 weeks or A9, B2, B3, B4, and B6 – These infections have been associated with recurrent episodes of polyarthritis, pleuritis, myalgia, rash, pharyngitis, myocarditis, and leukocytosis - This infection can be associated with polyarthritis, fever, and myalgias Herpes (...) , arthralgia and arthritic syndromes) in association with HIV infection has been reported in the United States, Europe, and Africa. It can occur at any stage of HIV infection. The pattern of HIV-associated arthritis is similar to that of arthritis associated with other viral disorders: acute onset, short duration, recurrences, and no erosive changes. Patients infected with HIV are not at increased risk for the development of septic arthritis but they do have an increased frequency of pyomyositis. Diffuse

2014 eMedicine.com

24. Cancer and Rehabilitation (Diagnosis)

are treated with modified radical mastectomy, preceded or followed by chemotherapy. Irradiation of the chest wall is often considered when the risk of chest-wall or nodal recurrence is high, when primary tumors are large or multicentric, or when 4 or more axillary nodes contain metastatic cancer. Systemic therapy (ie, chemotherapy and/or hormonal therapy) is recommended for patients who present with metastatic disease or who have risk factors for metastases. Risk factors for metastatic cancer include age (...) , endurance, and general functional ability. Instruct the patient regarding ROM exercises, postoperative breathing, and initial mobility after surgery. Start shoulder and arm rehabilitation as soon as the surgical incision appears healed and recurrent seroma or infection is absent; remember the principles of wound healing. Early PT to the shoulder after axillary dissection does not increase the incidence of lymphedema. The development of seromas is most prevalent with extensive surgeries. Encourage

2014 eMedicine.com

25. Immunoglobulin A Deficiency (Treatment)

, Monselize Y, Segal N, Zan-Bar I, Hoffer V, Garty BZ. Selective IgA deficiency in children in Israel. J Clin Immunol . 2010 Sep. 30(5):761-5. . Fazekas T, Wiesbauer P, Schroth B et al. selective IgA deficiency in children with recurrent parotitis of childhood. Pediatr Infect Dis J . 2005 May. 24(5):461-2. Shkalim V, Monselise Y, Mosseri R, Finkelstein Y, Garty BZ. Recurrent parotitis in selective IgA deficiency. Pediatr Allergy Immunol . 2004 Jun. 15(3):281-3. . Tar I, Kiss C, Marodi L, Marton IJ. Oral (...) . Tympanostomy tubes may also be helpful in reducing the risk of decreased hearing and secondary defective speech development in children with chronic suppurative otitis related to antibody deficiency. Next: Surgical Care Some patients with recurrent sinusitis require surgical interventions to promote drainage. Previous Next: Consultations See the list below: Rheumatologist Otolaryngologist Allergist/immunologist Pulmonologist Gastroenterologist Previous Next: Diet Dietary modifications may be necessary

2014 eMedicine.com

26. Cancer and Rehabilitation (Treatment)

are treated with modified radical mastectomy, preceded or followed by chemotherapy. Irradiation of the chest wall is often considered when the risk of chest-wall or nodal recurrence is high, when primary tumors are large or multicentric, or when 4 or more axillary nodes contain metastatic cancer. Systemic therapy (ie, chemotherapy and/or hormonal therapy) is recommended for patients who present with metastatic disease or who have risk factors for metastases. Risk factors for metastatic cancer include age (...) , endurance, and general functional ability. Instruct the patient regarding ROM exercises, postoperative breathing, and initial mobility after surgery. Start shoulder and arm rehabilitation as soon as the surgical incision appears healed and recurrent seroma or infection is absent; remember the principles of wound healing. Early PT to the shoulder after axillary dissection does not increase the incidence of lymphedema. The development of seromas is most prevalent with extensive surgeries. Encourage

2014 eMedicine.com

27. Viral Encephalitis (Treatment)

. Severe encephalopathy with swine origin influenza A H1N1 infection in childhood: case reports. Neurology . 2010 Mar 30. 74(13):1077-8. . Davis LE, DeBiasi R, Goade DE, et al. West Nile virus neuroinvasive disease. Ann Neurol . 2006 Sep. 60(3):286-300. . Debiasi RL, Tyler KL. West Nile virus meningoencephalitis. Nat Clin Pract Neurol . 2006 May. 2(5):264-75. . Sejvar JJ, Davis LE, Szabados E, Jackson AC. Delayed-onset and recurrent limb weakness associated with West Nile virus infection. J Neurovirol (...) . . Parisi SG, Basso M, Del Vecchio C, Andreis S, Franchin E, Dal Bello F, et al. Viral infections of the central nervous system in elderly patients: a retrospective study. Int J Infect Dis . 2016 Jan 25. . Kullnat MW, Morse RP. Choreoathetosis after herpes simplex encephalitis with basal ganglia involvement on MRI. Pediatrics . 2008 Apr. 121(4):e1003-7. . Rautonen J, Koskiniemi M, Vaheri A. Prognostic factors in childhood acute encephalitis. Pediatr Infect Dis J . 1991 Jun. 10(6):441-6. . Lancman ME

2014 eMedicine.com

28. Viral Infections of the Mouth (Treatment)

. The other forms of HHV can result in death. Herpes infections occasionally trigger erythema multiforme. Age Primary herpes infections typically occur during childhood or youth, although occasional cases are observed in older individuals. Recurrent HHV-1 infections typically occur throughout life and are particularly triggered by stress, illness, immune compromise, or other factors. Herpes zoster usually affects patients older than 40 years, and has similar triggers, although triggering conditions (...) Background HHV infections are common in the oral cavity. They may be primary or recurrent infections. Eight types of HHV have been linked with oral disease. These types have different disease patterns in their hosts. HHV-1, also known as herpes simplex virus (HSV)–1, causes primary herpetic gingivostomatitis, or oral herpes. In some hosts, it becomes latent and may periodically recur as a common cold sore. HHV-2, also known as HSV-2, causes genital herpes and occasionally causes oral disease

2014 eMedicine.com

29. Viral Encephalitis (Overview)

(focal) encephalitis. Numerous other viruses are known to cause encephalitis (see Tables 2 and 3 below). The viruses most commonly associated with acute childhood encephalitis are mumps virus, measles virus, and varicella-zoster virus (VZV). Table 2. Common Viral Encephalitides: Part 1 Virus (Family) Viral Structure Transmission Mortality Specific Clinical Patterns Sequelae Season HSV (herpesvirus) ds DNA Unknown 70% if untreated Rare forms: subacute, psychiatric, opercular, recurrent meningitis HSV (...) contagious Low Parotitis, pancreatitis, orchitis, aseptic meningitis Frequent sequelae Winter and spring Measles virus (paramyxovirus) ss RNA Direct contact (air), highly contagious 10% Characteristic rash; frequent EEG changes; myelitis Frequent: mental retardation, seizures, SSPE Winter and spring Nipah virus (paramyxovirus) ss RNA Pigs; bats 40-75% Brainstem or cerebellar signs; segmental myoclonus, dysautonomia SSPE-like syndrome? All year ds—double strand; EEG—electroencephalographic; ss—single

2014 eMedicine.com

30. Immunoglobulin A Deficiency (Overview)

described 63 Israeli children with SIgAD followed for 10 years, with malignancies diagnosed in 3 children (4.8%). [ ] Patients with IgAD who have a compensatory increase in IgM in their upper respiratory tract secretions and GI fluids tend to be less symptomatic. Note that patients with total IgAD are usually more symptomatic than patients partial IgAD. A previously unrecognized clear association of SIgAD with recurrent parotitis of childhood (PTC) was demonstrated by Fazekas et al in an Austrian (...) with recurrent parotitis of childhood. Pediatr Infect Dis J . 2005 May. 24(5):461-2. Shkalim V, Monselise Y, Mosseri R, Finkelstein Y, Garty BZ. Recurrent parotitis in selective IgA deficiency. Pediatr Allergy Immunol . 2004 Jun. 15(3):281-3. . Tar I, Kiss C, Marodi L, Marton IJ. Oral and dental conditions of children with selective IgA deficiency. Pediatr Allergy Immunol . 2008 Feb. 19(1):33-6. . Nikfarjam J, Pourpak Z, Shahrabi M, Nikfarjam L, Kouhkan A, Moazeni M, et al. Oral manifestations in selective

2014 eMedicine.com

31. Viral Infections of the Mouth (Overview)

. The other forms of HHV can result in death. Herpes infections occasionally trigger erythema multiforme. Age Primary herpes infections typically occur during childhood or youth, although occasional cases are observed in older individuals. Recurrent HHV-1 infections typically occur throughout life and are particularly triggered by stress, illness, immune compromise, or other factors. Herpes zoster usually affects patients older than 40 years, and has similar triggers, although triggering conditions (...) Background HHV infections are common in the oral cavity. They may be primary or recurrent infections. Eight types of HHV have been linked with oral disease. These types have different disease patterns in their hosts. HHV-1, also known as herpes simplex virus (HSV)–1, causes primary herpetic gingivostomatitis, or oral herpes. In some hosts, it becomes latent and may periodically recur as a common cold sore. HHV-2, also known as HSV-2, causes genital herpes and occasionally causes oral disease

2014 eMedicine.com

32. Viral Meningitis (Overview)

and meningoencephalitis cases in parts of the world where vaccines are not readily accessible. Males 16-21 years of age are at highest risk for developing this infection, with a 3:1 male/female ratio. Clusters of cases occur in schools and colleges in the winter months. Concomitant parotitis is a helpful clinical tool, but it may be absent in as many as half of cases with CNS involvement. A cohort study of 12,000 unvaccinated children from northern Finland revealed that mumps meningoencephalitis accounted for 40.9 (...) , benign, recurrent meningitis that resolves spontaneously. Mollaret cells (activated monocytes with an atypical appearance of enlarged, bilobed nuclei and amorphous cytoplasm) are found in the CSF usually on the first day of symptoms. Herpesvirus-6, EBV, and the human immunodeficiency virus (HIV; which is not a member of the herpes family) have also been implicated. These viruses are all known to remain latent within the nervous system. CMV infections occur mostly in immunocompromised hosts. CMV may

2014 eMedicine.com

33. Viral Arthritis (Overview)

in children rarely develops into pauciarticular arthritis [ ] Mumps virus – In infected adults, this infection is associated with small or large joint synovitis that lasts for several weeks; arthritis may precede or follow parotitis by up to 4 weeks or A9, B2, B3, B4, and B6 – These infections have been associated with recurrent episodes of polyarthritis, pleuritis, myalgia, rash, pharyngitis, myocarditis, and leukocytosis - This infection can be associated with polyarthritis, fever, and myalgias Herpes (...) , arthralgia and arthritic syndromes) in association with HIV infection has been reported in the United States, Europe, and Africa. It can occur at any stage of HIV infection. The pattern of HIV-associated arthritis is similar to that of arthritis associated with other viral disorders: acute onset, short duration, recurrences, and no erosive changes. Patients infected with HIV are not at increased risk for the development of septic arthritis but they do have an increased frequency of pyomyositis. Diffuse

2014 eMedicine.com

34. Cancer and Rehabilitation (Follow-up)

are treated with modified radical mastectomy, preceded or followed by chemotherapy. Irradiation of the chest wall is often considered when the risk of chest-wall or nodal recurrence is high, when primary tumors are large or multicentric, or when 4 or more axillary nodes contain metastatic cancer. Systemic therapy (ie, chemotherapy and/or hormonal therapy) is recommended for patients who present with metastatic disease or who have risk factors for metastases. Risk factors for metastatic cancer include age (...) , endurance, and general functional ability. Instruct the patient regarding ROM exercises, postoperative breathing, and initial mobility after surgery. Start shoulder and arm rehabilitation as soon as the surgical incision appears healed and recurrent seroma or infection is absent; remember the principles of wound healing. Early PT to the shoulder after axillary dissection does not increase the incidence of lymphedema. The development of seromas is most prevalent with extensive surgeries. Encourage

2014 eMedicine.com

35. Immunoglobulin A Deficiency (Follow-up)

, Zhou Z, Mankarious S, Courter S. Long-term use of IgA-depleted intravenous immunoglobulin in immunodeficient subjects with anti-IgA antibodies. J Clin Immunol . 1993 Jul. 13(4):272-8. . Shkalim V, Monselize Y, Segal N, Zan-Bar I, Hoffer V, Garty BZ. Selective IgA deficiency in children in Israel. J Clin Immunol . 2010 Sep. 30(5):761-5. . Fazekas T, Wiesbauer P, Schroth B et al. selective IgA deficiency in children with recurrent parotitis of childhood. Pediatr Infect Dis J . 2005 May. 24(5):461-2 (...) . Shkalim V, Monselise Y, Mosseri R, Finkelstein Y, Garty BZ. Recurrent parotitis in selective IgA deficiency. Pediatr Allergy Immunol . 2004 Jun. 15(3):281-3. . Tar I, Kiss C, Marodi L, Marton IJ. Oral and dental conditions of children with selective IgA deficiency. Pediatr Allergy Immunol . 2008 Feb. 19(1):33-6. . Nikfarjam J, Pourpak Z, Shahrabi M, Nikfarjam L, Kouhkan A, Moazeni M, et al. Oral manifestations in selective IgA deficiency. Int J Dent Hyg . 2004 Feb. 2(1):19-25. . Jorgensen GH

2014 eMedicine.com

36. Viral Infections of the Mouth (Follow-up)

. The other forms of HHV can result in death. Herpes infections occasionally trigger erythema multiforme. Age Primary herpes infections typically occur during childhood or youth, although occasional cases are observed in older individuals. Recurrent HHV-1 infections typically occur throughout life and are particularly triggered by stress, illness, immune compromise, or other factors. Herpes zoster usually affects patients older than 40 years, and has similar triggers, although triggering conditions (...) Background HHV infections are common in the oral cavity. They may be primary or recurrent infections. Eight types of HHV have been linked with oral disease. These types have different disease patterns in their hosts. HHV-1, also known as herpes simplex virus (HSV)–1, causes primary herpetic gingivostomatitis, or oral herpes. In some hosts, it becomes latent and may periodically recur as a common cold sore. HHV-2, also known as HSV-2, causes genital herpes and occasionally causes oral disease

2014 eMedicine.com

37. Viral Encephalitis (Follow-up)

. Severe encephalopathy with swine origin influenza A H1N1 infection in childhood: case reports. Neurology . 2010 Mar 30. 74(13):1077-8. . Davis LE, DeBiasi R, Goade DE, et al. West Nile virus neuroinvasive disease. Ann Neurol . 2006 Sep. 60(3):286-300. . Debiasi RL, Tyler KL. West Nile virus meningoencephalitis. Nat Clin Pract Neurol . 2006 May. 2(5):264-75. . Sejvar JJ, Davis LE, Szabados E, Jackson AC. Delayed-onset and recurrent limb weakness associated with West Nile virus infection. J Neurovirol (...) . . Parisi SG, Basso M, Del Vecchio C, Andreis S, Franchin E, Dal Bello F, et al. Viral infections of the central nervous system in elderly patients: a retrospective study. Int J Infect Dis . 2016 Jan 25. . Kullnat MW, Morse RP. Choreoathetosis after herpes simplex encephalitis with basal ganglia involvement on MRI. Pediatrics . 2008 Apr. 121(4):e1003-7. . Rautonen J, Koskiniemi M, Vaheri A. Prognostic factors in childhood acute encephalitis. Pediatr Infect Dis J . 1991 Jun. 10(6):441-6. . Lancman ME

2014 eMedicine.com

38. Human Immunodeficiency Virus Infection (Diagnosis)

in the United States but still exist in developing countries. Sexual abuse of children and high-risk behaviors in adolescents also contribute to youth HIV infection. A variety of signs and symptoms should alert the clinician to the possibility of HIV infection in a child. The presentations include recurrent bacterial infections, unrelenting fever, unrelenting diarrhea, unrelenting thrush, recurrent pneumonia, chronic parotitis, generalized lymphadenopathy, delay in development with failure to thrive (...) percentage fell by 19%. [ ] Combining age effects and baseline CD4 percentage resulted in more than 90% recovery when HAART was initiated in children with mild immunosuppression at any age or advanced immunosuppression at an age younger than 3 years. Most of the immunologic benefits of HAART remained significant at 4 years. Signs and symptoms History Signs and symptoms of pediatric HIV infection include the following: Unusually frequent and severe occurrences of common childhood bacterial infections

2014 eMedicine Pediatrics

39. Sjogren Syndrome (Overview)

not have early sicca syndrome symptomatology but often have recurrent parotitis, which commonly is diagnosed as recurrent parotitis of childhood, another uncommon pediatric disorder with a bimodal age incidence of 2-5 and 10 years of age. Because of the insidious nature of these symptoms, patients often do not seek medical attention until more severe symptoms appear years later. The time from disease onset until diagnosis is often 9 years in adults and perhaps as long as 3 years in pediatric patients (...) -32. . Pessler F, Emery H, Dai L, Wu YM, Monash B, Cron RQ, et al. The spectrum of renal tubular acidosis in paediatric Sjögren syndrome. Rheumatology (Oxford) . 2006 Jan. 45(1):85-91. . Baszis K, Toib D, Cooper M, French A, White A. Recurrent parotitis as a presentation of primary pediatric Sjögren syndrome. Pediatrics . 2012 Jan. 129(1):e179-82. . Vitali C, Bombardieri S, Jonsson R, et al. Classification criteria for Sjögren's syndrome: a revised version of the European criteria proposed

2014 eMedicine Pediatrics

40. Sjogren Syndrome (Diagnosis)

not have early sicca syndrome symptomatology but often have recurrent parotitis, which commonly is diagnosed as recurrent parotitis of childhood, another uncommon pediatric disorder with a bimodal age incidence of 2-5 and 10 years of age. Because of the insidious nature of these symptoms, patients often do not seek medical attention until more severe symptoms appear years later. The time from disease onset until diagnosis is often 9 years in adults and perhaps as long as 3 years in pediatric patients (...) -32. . Pessler F, Emery H, Dai L, Wu YM, Monash B, Cron RQ, et al. The spectrum of renal tubular acidosis in paediatric Sjögren syndrome. Rheumatology (Oxford) . 2006 Jan. 45(1):85-91. . Baszis K, Toib D, Cooper M, French A, White A. Recurrent parotitis as a presentation of primary pediatric Sjögren syndrome. Pediatrics . 2012 Jan. 129(1):e179-82. . Vitali C, Bombardieri S, Jonsson R, et al. Classification criteria for Sjögren's syndrome: a revised version of the European criteria proposed

2014 eMedicine Pediatrics

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