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
- The symptoms of molluscum contagiosum usually develop 2 to 7 weeks after exposure but may range from 1 week to 6 months, with a mean of 6 weeks.
- Molluscum contagiosum start with symptoms such as rash and pruritis.
- Molluscum contagiosum is a self limited disease that can be resolved even without treatment.
- Occasionally, disease may persists for three to five years. [8][9][6]
Complications
Complications that can develop as a result of Molluscum contagiosum is skin scarring (which usually may happen after spontaneous resolution), chronic conjunctivitis or keratoconjunctivitis, and rarely Gianotti-Crosti like eruptions. Inflammatory reactions to molluscum contagiosum antigen, including the previously underrecognized GCLR, has been reported.[10][11].
Prognosis
The prognosis of molluscum contagiosum is good even without treatment.
Diagnosis
Diagnostic criteria
There are no criteria for the diagnosis of molluscum contagiosum. Although the diagnosis is usually based on characteristic appearance of the lesions, diagnostic studies that can be used include histologic examination, dermoscopic examination and electron microscopy of biopsies.
History and Symptoms
The hallmark of molluscum contagiosum is 2 to 5 mm in diameter lesions that spares hand and foot. A positive history of swimming-pool attendance[4], sexual multipartnership [3], and endemic infection are suggestive of molluscum contagiosum. The most common symptoms of molluscum contagiosum include shiny surface skin lesions, maybe associated with erythema around the lesion and pruritis. Less common symptoms of molluscum contagiosum include conjunctivitis, and erythema in all the body.
Physical Examination
Patients with molluscum contagiosum usually appear good and healthy. Physical examination of patients with molluscum contagiosum is usually remarkable for skin papules that are small, shiny and firm.
Laboratory Findings
There are no diagnostic lab findings associated with molluscum contagiosum. The diagnosis of molluscum contagiosum should be made clinically. For confirmation of the diagnosis, pathological studies can be done which involve H&E staining of the infected tissue[12] and direct visualization. it is also recommended to test for other sexual transmitted diseases in adults and for immunodeficiency related diseases.
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.[13]
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.[14]
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.[15]
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 3.2 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.
- ↑ 4.0 4.1 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.
- ↑ 6.0 6.1 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.
- ↑ Brown J, Janniger CK, Schwartz RA, Silverberg NB (2006). "Childhood molluscum contagiosum". Int. J. Dermatol. 45 (2): 93–9. doi:10.1111/j.1365-4632.2006.02737.x. PMID 16445494.
- ↑ Butala N, Siegfried E, Weissler A (2013). "Molluscum BOTE sign: a predictor of imminent resolution". Pediatrics. 131 (5): e1650–3. doi:10.1542/peds.2012-2933. PMID 23545377.
- ↑ Berger EM, Orlow SJ, Patel RR, Schaffer JV (2012). "Experience with molluscum contagiosum and associated inflammatory reactions in a pediatric dermatology practice: the bump that rashes". Arch Dermatol. 148 (11): 1257–64. doi:10.1001/archdermatol.2012.2414. PMID 22911012.
- ↑ Babu TA, Arivazhahan A (2015). "Gianotti-Crosti Syndrome following immunization in an 18 months old child". Indian Dermatol Online J. 6 (6): 413–5. doi:10.4103/2229-5178.169713. PMC 4693355. PMID 26751677.
- ↑ Pearce L, Brown WH (1945). "HEREDITARY ACHONDROPLASIA IN THE RABBIT : II. PATHOLOGIC ASPECTS". J. Exp. Med. 82 (4): 261–80. PMC 2135556. PMID 19871499.
- ↑ 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.