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Angad , JaL. Viral Exanthems. RUBEOLA. (MEASLES). Measles. Etiology RNA virus of the genus Morbillivirus in the family Paramyxoviridae Epidemiology Prior to use of vaccine, peak incidence was among 5-10 y/o Transmission 90% of susceptible contacts acquire the disease - PowerPoint PPT Presentation
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Angad, JaL
(MEASLES)
Etiology RNA virus of the genus Morbillivirus in the
family ParamyxoviridaeEpidemiology
Prior to use of vaccine, peak incidence was among 5-10 y/o
Transmission 90% of susceptible contacts acquire the
disease Maximal dissemination occurs by droplet
spray during the prodromal period
Incubation Period: Last 10-12 daysProdromal stage: Last 3-5 days
characterized by low-mod grade fever, dry cough , coryza, photophobia & conjunctivitis. Kopliks spots appear by 2nd -3rd day
Rash - as exanthem progresses systemic symptoms subside
Self-limited infection in most patients Complications common in malnourished
children, the unimmunized & those w/ congenital immunodeficiency,and leukemia
Acute complications: otitis media, pneumonia (Hecht giant cell pneumonia), diarrhea, measles encephalitis, thrombocytopenia.
Chronic complication: subacute sclerosing panencephalitis.
Based on Clinical pictureLaboratory confirmation is rarely needed
Measles IgM – detectable for 1 month after the illness but sensitivity is limited
Prevention – MMR Acute Infection – treatment is
entirely supportive (antipyretics, bed rest, adequate fluid intake)
Secondary Bacterial Infection – administration of appropriate antibiotics
(GERMAN MEASLES / 3 DAYS MEASLES)
Common benign childhood infection manifested by a characteristic exanthem and lymphadenopathy
Etiology: RNA virus , genus Rubivirus, family Togaviridae
Epidemiology Humans are the only natural host of Rubella
virus Spread by oral droplet or transplacentally to
the fetus Peak incidence is 5-14 y/o
Pathogenesis: Not well understood
Incubation Period: 14 to 21 days.Prodromal phase
Mild catarrhal symptoms In adolescents and young adults: anorexia,
malaise, conjunctivitis, headache, low-grade fever, mild URT symptoms.
Retroauricular, post cervical & postoccipital lymphadenopathy
An enanthem appears just before the onset of the rash (FORCHHEIMER SPOTS)
• Skin Lesions• Petechiae on soft palate
• Enlarged lymph nodes
Maybe apparent from clinical symptoms and PE
Usually confirmed by serology or viral culture
Latex agglutination, enzyme immunoassay & fluorescent immunoassay
In most persons, rubella is mild Pregnant women infected during the 1st
trimester can pass the infection transplacentally
Congenital rubella syndrome Congenital heart defects Cataracts Microphthalmia Deafness Microcephaly Hydrocephaly
Prevention – MMR Pregnant women should not be given live rubella virus vaccine and should avoid becoming pregnant for 3 mo after they have been vaccinated
Acute Infection – symptomatic
FIFTH DISEASE
EI is a childhood exanthem occurring with primary parvovirus B19 infection
Characterized by edematous erythematous plaques on the cheeks (“slapped cheeks”) and an erythematous lacy eruption on the trunk and extremities
Transmission: Spreads via droplet aerosol
Incubation Period: 7 to 28 daysChildren: Fever, malaise, headache,
coryza. Headache, sore throat, fever, myalgias, nausea, diarrhea, conjunctivitis, cough may coincide with rash.
Adults: Constitutional symptoms more severe, with fever, adenopathy, arthritis/arthralgias involving small joints of hand, knees, wrists, ankles, feet. Numbness and tingling of fingers.
Diffuse erythema and edema of the cheeks with “slapped cheek” facies in a child
Usually based on clinical presentation of the typical rash
Serologic test for B19PCR, nucleic acid hybridization
“Slapped cheeks” lesions fade over 1 to 4 days. Eruption lasts for 5-9 days but can recur
Arthralgia is self-limited In patients w/ chronic hemolytic
anemias transient aplastic may occur Fetal B19 infection may be
complicated by nonimmune fetal hydrops secondary to infection of erythroid precursors
No specific antiviral therapy
IVIG have been used to treat episodes of anemia and bone marrow failure
EXANTHEM SUBITUM
Exanthema subitum (sudden rash) is associated with primary HHV-6 and HHV-7 infection, characterized by the sudden appearance of rash as high-fever lysis in a healthy-appearing infant
Primary infection is acquired via oropharyngeal secretions
Pathogenesis of ES rash is not known
Incubation period: 7 -17 daysHigh fever with morning remission
until the 4th day when it falls to normal coincident with the appearance of rash
Infant remarkably well despite high fever
In Asian countries, ulcers at the uvulo-palatoglossal junction (NAGAYAMA SPOTS) are common.
Multiple, blanchable macules and papules on the back of a febrile child, which appeared as the temperature fell
Based on age, history and PE findings
Serology, virus culture, Antigen detection and PCR
Self-limited with rare sequelae
High fever maybe associated w/ seizures
HHV-6 & HHV-7 persist throughout the life of the patient
Treatment is supportive (antipyretics, bed rest, adequate fluid intake)
RUBEOLA RUBELLA ROSEOLA
ERYTHEMA INFECTIOS
UM
Etiology Paramyxoviridae Togaviridae Virus (prob) Virus (prob)
Incubation Period
10 – 12 14 - 21 7 - 17 7 - 28
Epid All ages 6 -18 months All ages Rarely > 3 y/o
Rash Maculopapular Maculopapular Maculopapular Maculopapular
Distribution Begins face, spread rapidly
Begins trunk → arms & neck face- legs – 3d
Last for 24 hr ….
Prodrome 3 – 5 d low-mod fever, hackhing cough, coryza, conjunctivitis, kopliks after 2-3 days
Mild catarrhal , retroauricular, post cervical, post occipital lymphadenopathy
None None
RUBEOLA
RUBELLA ROSEOLA
ERYTHEMA INFECTIOSUM
Fever pattern
↑ T abruptly as rash appears ↓ T when rash reaches legs & feet
Sudden onset ↑ T ↓ T on 3rd-4th d as rashes appear
Absent or low grade
Infectivity
Isolate- 7th d post exposure unti l 5 d after rash appeared
9th – 10th d post exposure (peak)
3rd day of fever and 1st day of rash
Rash Lateral neck, ears, hairline → back, abdomen, thigh → feet on 2nd
Absence of PE findings to explain fever , trunk and extremities
Rash 3 stages1.Slapped cheek2.Maculopapular on 3rd as face fades3.Lacy or reticulated appearance rash – fades central clearing pruritic lasts 2-39 days
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