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VIRAL INFECTIONS

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Viruses cause most pediatric infections. Mixed viral or viral-bacterial infections of the respiratory and intestinal tracts are very common, as is prolonged asymptomatic shedding of some viruses in childhood, especially in young children. Thus, the detection of a virus is not always proof that it is the cause of a given illness. Viruses are often a predisposing factor for bacterial respiratory infections (eg, otitis, sinusitis, and pneumonia).

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Many respiratory and herpesviruses can now be detected within 24–48 hours by combining culture and monoclonal antibody techniques ("rapid culture technique") or through antigen or nucleic acid detection techniques. These techniques are more rapid than isolation of viruses in tissue culture and in most cases are equally sensitive or more so. Polymerase chain reaction (PCR) amplification of viral genes has led to recognition of previously undetected infections. New diagnostic tests have changed some basic concepts about viral diseases and made diagnosis of viral infections both more certain and more complex. Only laboratories with excellent quality-control procedures should be used, and the results of new tests must be interpreted cautiously. The availability of specific antiviral agents increases the value of early diagnosis for some serious viral infections. Table 40–1 lists viruses associated with common clinical signs, and Table 40–2 lists diagnostic tests. The viral diagnostic laboratory should be contacted for details regarding specimen collection, handling, and shipping. Table 40–3 lists common causes of red rashes in children that should be considered in the differential diagnosis of certain viral illnesses.

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Table 40–1.Some viral causes of clinical syndromes.

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