Molluscum contagiosum overview
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Molluscum contagiosum Microchapters |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mahshid Mir, M.D. [2]
Overview
Molluscum contagiosum is a common disease that mostly affect chilcren in preschool age and school aged children as well.
Historical perspective
Molluscum contagiosum was first discovered by Bateman in 1817 in his second edition of his synopsis. In 1841 Paterson demonstrated molluscum contagiosum's infectious nature. The viral nature of the disease was demonstrated by Juliusberg in 1905. Outbreaks of molluscum contagiosum have occurred in the different settings like swimming pools, but the exact information about outbreaks is not available due to report policy.
Classification
Molluscum contagiosum may be classified according to restriction endonuclease analysis into 4 different subtypes. There are 4 types of MCV, MCV-1 to -4, with MCV-1 being the most prevalent and MCV-2 seen usually in adults and often sexually transmitted. There is not enough evidence about correlation of molluscum contagiosum subtypes and the disease features or anatomical distribution of lesions.[1]
- There is a problem with the molluscum contagiosum diagnosis as it is not possible to grow the virus in standard cell culture or in an animal model of infection.
- There are a few reports of some success in growing molluscum contagiosum with the human foreskin xenograft fragments culturing, but it is still under further investigation.[1]
Pathophysiology
Molluscum contagiosum is usually transmitted via direct contact with a lesion route to the human host. Following transmission, the molluscum contagiosum uses the human body cells to replicate. On gross pathology, a central umbilication, and punctiform vessels are characteristic findings of molluscum contagiosum. On electronic microscopic analysis, typical brick-shaped poxvirus particles inside the infected tissue are characteristic findings of molluscum contagiosum.
Differentiating tonsillitis from other diseases
Molluscum contagiosum must be differentiated from other diseases that cause infection of the skin and of the mucous membranes, including chickenpox, herpes zoster, erythema multiforme, among others. Skin lesions due to cryptococcosis, histoplasmosis, or Penicillium marneffei infection may resemble molluscum lesions. Other lesions that may be mistaken for molluscum contagiosum include flat warts, condyloma acuminatum, pyogenic granuloma , adnexal tumors, Langerhans cell histiocytosis , basal cell carcinoma , and amelanotic melanoma. Skin biopsy is useful for distinguishing molluscum contagiosum from other disorders.
Epidemiology and Demographics
he prevalence of molluscum contagiosum is estimated to be around 8000 cases per 100,000 annually. Worldwide, the incidence of molluscum contagiosum is 1200-1400 per 100,000 persons.[2] Molluscum contagiosum is a common disease that tends to affect children and immunocompromised. There is no racial predilection to molluscum contagiosum.
Risk Factors
The most important risk factors associated with molluscum contagiosum include: children, participation in contact sports[3], swimming-pool attendance [4] sexual relationship and multipartnership[3], immunodeficient states:[5], cellular immunodeficiency, such as occurs in inherited immunodeficiencies, human immunodeficiency virus (HIV) infection, following treatment with immunosuppressive drugs [6]
Screening
There is insufficient evidence to recommend routine screening for adenoiditis.Molluscum Contagiosum Diagnostic Tool for Parents (MCDTP) is a new developed diagnostic test for in home diagnosis of the molluscum contagiosum in children but it is not recommended by guidelines as a routine screening test. There is no guideline recommendation for screening of molluscum contagiosum in suspected cases.[7]
Natural history, complications and prognosis
Natural History
Acute adenoiditis will usually present with erythema and edema of the adenoids. This occurs rapidly upon infiltration of the adenoids by the pathogen.[8] Symptoms, including fever and sore throat, will usually manifest within 24 hours of infection. Adenoiditis is usually combined with tonsilitis due to close anatomical location.
Complications
Complications of adenoiditis are caused by persistence and/or spread of the responsible pathogen - usually bacterial. The complications of adenoiditis include speech abnormalities, otitis media, acute sinusitis, pneumonia, adenoid hyperplasia, peritonsillar abscesssandleep apnea
.Prognosis
The prognosis for acute adenoiditis without treatment is usually good. Adenoiditis is usually a self-limiting disease and resolves by itself within 3-4 days.[9]
Diagnosis
Diagnostic criteria
There is no criteria for the diagnosis of adenoiditis. However, seeing inflamed and hypertrophied adenoid tissue with flexible or rigid nasopharyngoscopy can be used as a criteria for adenoidectomy in patients suspected of chronic adenoiditis.
History and Symptoms
A positive history of fever and nasal obstruction and snoring are suggestive of adenoiditis. The most common symptoms of adenoiditis include nasal discharge which may be purulent, mouth breathing, nasal pain and sore throat.[10][11][12]
Physical Examination
Patients with adenoiditis are usually well-appearing. Physical examination of patients with adenoiditis is usually remarkable for fever, and purulent nasal discharge.[13][14][15]
Laboratory Findings
Laboratory findings consistent with the diagnosis of adenoiditis include neutrophilia, positive culture for organism from throat exam sampling, and positive blood culture for the organism in severe cases.[16]
Imaging Findings
On lateral neck x-ray, adenoiditis is characterized by enlargement of adenoids and narrowing of airways. Adenoiditis diagnosis can be confirmed if during flexible or rigid nasopharyngoscopy inflamed adenoid tissue is seen. Flexible or rigid nasopharyngoscopy can provide a direct visualization of nasopharynx and Waldeyer ring so that the inflamed adenoid tissue can be seen too.[17]
Treatment
Medical Therapy
The mainstay of therapy for adenoiditis is symptomatic therapy. Pharmacologic medical therapy is recommended among patients with recurrent and chronic adenoiditis. The best antibiotic therapy regimen include amoxicillin - clavulanic acid or a cephalosporin.
Surgery
Surgery is not the first-line treatment option for patients with adenoiditis. Adenoidectomy is usually reserved for patients with chronic persistent adenoiditis who developed adenoid hypertrophy. Adenoidectomy has shown to be effective independent of the size of the adenoids.[18]
Prevention
Primary Prevention
Primary prevention strategies to prevent adenoiditis include hygienic practices.
Secondary Prevention
Secondary prevention involves usage of antibiotics to prevent recurrence of adenoiditis. It can be helpful in certain circumstances like history of rheumatic fever, to prevent pharyngitis cause by group A beta-hemolytic streptococci.[19]
References
- ↑ Fife KH, Whitfeld M, Faust H, Goheen MP, Bryan J, Brown DR (1996). "Growth of molluscum contagiosum virus in a human foreskin xenograft model". Virology. 226 (1): 95–101. doi:10.1006/viro.1996.0631. PMID 8941326.
- ↑ Olsen JR, Gallacher J, Piguet V, Francis NA (2014). "Epidemiology of molluscum contagiosum in children: a systematic review". Fam Pract. 31 (2): 130–6. doi:10.1093/fampra/cmt075. PMID 24297468.
- ↑ 3.0 3.1 Dohil MA, Lin P, Lee J, Lucky AW, Paller AS, Eichenfield LF (2006). "The epidemiology of molluscum contagiosum in children". J. Am. Acad. Dermatol. 54 (1): 47–54. doi:10.1016/j.jaad.2005.08.035. PMID 16384754.
- ↑ Monteagudo B, Cabanillas M, Acevedo A, de Las Heras C, Pérez-Pérez L, Suárez-Amor O, Ginarte M (2010). "[Molluscum contagiosum: descriptive study]". An Pediatr (Barc) (in Spanish; Castilian). 72 (2): 139–42. doi:10.1016/j.anpedi.2009.09.008. PMID 19880360.
- ↑ Zhang Q, Davis JC, Lamborn IT, Freeman AF, Jing H, Favreau AJ, Matthews HF, Davis J, Turner ML, Uzel G, Holland SM, Su HC (2009). "Combined immunodeficiency associated with DOCK8 mutations". N. Engl. J. Med. 361 (21): 2046–55. doi:10.1056/NEJMoa0905506. PMC 2965730. PMID 19776401.
- ↑ Lee R, Schwartz RA (2010). "Pediatric molluscum contagiosum: reflections on the last challenging poxvirus infection, Part 1". Cutis. 86 (5): 230–6. PMID 21214122.
- ↑ Olsen JR, Gallacher J, Piguet V, Francis NA (2014). "Development and validation of the Molluscum Contagiosum Diagnostic Tool for Parents: diagnostic accuracy study in primary care". Br J Gen Pract. 64 (625): e471–6. doi:10.3399/bjgp14X680941. PMC 4111339. PMID 25071059.
- ↑ "Tonsillitis - NHS Choices".
- ↑ "Tonsillitis - NHS Choices".
- ↑ Kosikowska U, Korona-Głowniak I, Niedzielski A, Malm A (2015). "Nasopharyngeal and Adenoid Colonization by Haemophilus influenzae and Haemophilus parainfluenzae in Children Undergoing Adenoidectomy and the Ability of Bacterial Isolates to Biofilm Production". Medicine (Baltimore). 94 (18): e799. doi:10.1097/MD.0000000000000799. PMC 4602522. PMID 25950686.
- ↑ Kajan ZD, Sigaroudi AK, Mohebbi M (2016). "Prevalence and patterns of palatine and adenoid tonsilloliths in cone-beam computed tomography images of an Iranian population". Dent Res J (Isfahan). 13 (4): 315–21. PMC 4993058. PMID 27605988.
- ↑ Galli J, Calò L, Ardito F, Imperiali M, Bassotti E, Fadda G, Paludetti G (2007). "Biofilm formation by Haemophilus influenzae isolated from adeno-tonsil tissue samples, and its role in recurrent adenotonsillitis". Acta Otorhinolaryngol Ital. 27 (3): 134–8. PMC 2640046. PMID 17883191.
- ↑ Kosikowska U, Korona-Głowniak I, Niedzielski A, Malm A (2015). "Nasopharyngeal and Adenoid Colonization by Haemophilus influenzae and Haemophilus parainfluenzae in Children Undergoing Adenoidectomy and the Ability of Bacterial Isolates to Biofilm Production". Medicine (Baltimore). 94 (18): e799. doi:10.1097/MD.0000000000000799. PMC 4602522. PMID 25950686.
- ↑ Kajan ZD, Sigaroudi AK, Mohebbi M (2016). "Prevalence and patterns of palatine and adenoid tonsilloliths in cone-beam computed tomography images of an Iranian population". Dent Res J (Isfahan). 13 (4): 315–21. PMC 4993058. PMID 27605988.
- ↑ Galli J, Calò L, Ardito F, Imperiali M, Bassotti E, Fadda G, Paludetti G (2007). "Biofilm formation by Haemophilus influenzae isolated from adeno-tonsil tissue samples, and its role in recurrent adenotonsillitis". Acta Otorhinolaryngol Ital. 27 (3): 134–8. PMC 2640046. PMID 17883191.
- ↑ Galli J, Calò L, Ardito F, Imperiali M, Bassotti E, Fadda G, Paludetti G (2007). "Biofilm formation by Haemophilus influenzae isolated from adeno-tonsil tissue samples, and its role in recurrent adenotonsillitis". Acta Otorhinolaryngol Ital. 27 (3): 134–8. PMC 2640046. PMID 17883191.
- ↑ Ramji M, Biron VL, Jeffery CC, Côté DW, El-Hakim H (2014). "Validation of pharyngeal findings on sleep nasopharyngoscopy in children with snoring/sleep disordered breathing". J Otolaryngol Head Neck Surg. 43: 13. doi:10.1186/1916-0216-43-13. PMC 4092353. PMID 24919758.
- ↑ El-Badrawy A, Abdel-Aziz M (2009). "Transoral endoscopic adenoidectomy". Int J Otolaryngol. 2009: 949315. doi:10.1155/2009/949315. PMC 2809357. PMID 20111586.
- ↑ Dagnelie CF, Bartelink ML, van der Graaf Y, Goessens W, de Melker RA (1998). "Towards a better diagnosis of throat infections (with group A beta-haemolytic streptococcus) in general practice". Br J Gen Pract. 48 (427): 959–62. PMC 1409991. PMID 9624764.