Presentation on theme: "Viruses Causing Maculopapular Rash"— Presentation transcript:
1 Viruses Causing Maculopapular Rash By: Dr. Mona BadrAssistant Professor & Consultant Virologist
2 Viruses Causing Maculopapular Rash Definition of Maculopapular Rash:A small cicumscribed, solid, discoloured spot, slightly elevated lesion on the skinSome important viruses causing maculopapular rash mainly in children:Measles virus Paramyxvirus familyRubella virus Togavirus familyParvovirus B19 Parvoviridae familyHerpes virus type-6 Herpesvirus family
3 Viruses Causing Maculopapular Rash (Continued) Measles:Measles is a highly contagious, serious disease affecting young children mainly and occasionally adults.A- Virology Aspects:Family paramyxoviridaess-RNA, negative polarity ,enveloped virus.Virion contain enzyme transcriptaseParamyxovirus are able to induce cell-cell fusion multinucleated giant cell (syncytia)Measles virus -One serotype only- Infect human only
4 Viruses Causing Maculopapular Rash (Continued) B- Pathogenesis and Immunity:Measles virus transmitted from respiratory secretion by direct contact OR droplet and air borne transmission mainly in winter and spring.Virus infects first epithelial cells of respiratory tract, then virus spreads in lymphatic system blood then measles viruses wildly disseminated to the skin and other internal organs.Cell-mediated immunity is essential for the control of measles infection will be fatal in immunocompromised.Long-life immunity to measles virus develop after recovery from rash.
5 Viruses Causing Maculopapular Rash (Continued) C- Clinical Symptoms:Incubation period 7-13 daysProdromal symptoms: Fever, cough, runny nose, conjunctivitis, (1-2 days).Koplik’s spot: Small, white papules appear mostly in buccal mucosa, of 70-80% of patients for 2 daysRash: typical maculopapular rash first on the face, trunk and extremities.The patient become very sick and temperature become very high (39-40oC) when this rash appear.Recovery can be complete, but complication also can occur.Diagnosed by detection of Measles IgM Ab in the serum.
6 Viruses Causing Maculopapular Rash (Continued) D- Complication:Common complicationCroup, bronchitis, otitis media and 2nd bacterial pneumoniaRare Complication:Encephalitis occur in 1 per 1000 of infected children.Occur 7-10 days after the onset of measles,its serious its fatal.Giant cell pneumonia (Intestinal pneumonia)Occur in immunocompromised children, due to direct invasion of the virus to the lung.
10 Viruses Causing Maculopapular Rash (Continued) D- Complication:Very rare Complication:Subacut-slerosing-pan-encephalitis (SSPE)Is very rare complication (5/million)Develops several month or years after recovery average after 7 years.It occur when measles virus persist in brain tissue and act as slow virus and replicate in brain cells.Patients develops change in personality, behavior, memory blindness and convulsion will lead to coma then death.SSPE is confirmed by characteristic EEG patterns and demonstration of measles Ab in CSF with increased CSF measles Ab ratio to serum measles Ab.No effective treatment .
11 Viruses Causing Maculopapular Rash (MEASLES) E- Treatment and PreventionNo specific treatmentPreventionActiveLive attenuated vaccine (MMR)Contain live attenuated measles, mumps and rubella virusesGiven by I.M. or subcutaneously in one dose.Excellent immunityShould not be given to pregnant or immunocompromised patient.PassiveExposed people who are immunocompromised should be given passive immunization with immune serum globulin must be given within 6 days of exposure.
12 Viruses Causing Maculopapular Rash (Continued) RubellaRubella is a mild exanthematous moderately contagious disease. When the disease is acquired by the mother during first 4 months of pregnancy. The virus may infect the fetus and cause TERATOGENIC EFFECT.Virology Aspects:Family TogavirusEnveloped, nucleocapsid virusSingle stranded RNA, positive polarityAgglutinate avian erythrocytes
13 Viruses Causing Maculopapular Rash (Continued) Epidemiology:Humans are the only host for rubellaVirus is spread in respiratory secretion and is generally acquired during childhood.The incidence of infection peaks in the springBefore the development and use of the rubella vaccine, cases of rubella in school children would be reported evey spring.
14 Post –natal (CHILDHOOD) Viruses Causing Maculopapular Rash (Continued)3- Clinical Syndromes:Rubella is a mild disease of childrenBut if contracted in early pregnancy (first 4 months) the virus can cause severe congenital abnormalities in the fetus (Teratogenic)So we have 2 differentClinical SyndromePost –natal (CHILDHOOD)Rubella InfectionCongenitalRubella Infection
15 Viruses Causing Maculopapular Rash (RUBELLA) A- Post –natal Rubella(CHILDHOOD)It is mild self limiting disease occur in childhood.Incubation period daysProdromal symptoms as fever, cough, conjunctivitis and enlarged of post cervical lymph node.Macupapular rash first appear in face then trunk and limbs (usually mild), with complete recovery.Fever is low grade or absent during the rash. The general condition is good.If infection occur in adult (especially female) arthritis reported.Diagnosed by detection Rubella IgM Ab in the serumComplication:Post – infectious encephalitis, Thrombocytoninic purpura
16 Viruses Causing Maculopapular Rash (RUBELLA) A- Congenital RubellaCongenital defect occur mainly if the mother has rubella in the first 16 weeks of pregnancy (first trimester), after that rubella does not damage the fetus.Virus can replicate in the placenta and then spread to fetal blood supply and so, Rubella virus can replicate in most tissue of the fetus, this can lead to improper development of the fetus and teratogenic effect associate with Congenital Rubella infections.In about 15% of cases infection of the fetus leads to spontaneous abortion.
18 Viruses Causing Maculopapular Rash (RUBELLA) The main defects IN THE BABY are:Eye defect: cataract, glucoma, chorioretenitisNerve deafnessCardiac abnormalities:e.g.: Fallot’s tetralogyVentricular septal defect.Mental retardationHepatosplenomegallyLow birth weightNotes: Infected infants shed the virus into throat and urine for 2 years and can infect susceptible individual.
19 Viruses Causing Maculopapular Rash (Continued) 5- Laboratory DiagnosisPost –natalCHILDHOOD RubellaCongenital Rubella1- Clinical diagnosis2- Serological detection of IgM Ab3- Detection of IgG Ab indicatepast infection OR immunization.1- History of Infection of mother2- Virus isolated by immuno-flourescent assay from:UrineCSFBlood3- Serological diagnosis bydetection of IgM Ab from Cord blood4- Detection of IgG Ab Not diagnostic
20 Viruses Causing Maculopapular Rash (RUBELLA) Treatment and Prevention:No specific treatment available.Prevention:Active Immunization:Immunization of all children at age of 15 months with MMR-vaccine (live attenuated vaccine).Natural infection or vaccination give good immunity, but not solid, re-infection can happen.Booster, dose of Rubella vaccine is recommended for female at age of puberty (14-15 years), or before marriage.Contraindication of MMR:Pregnancy: must be avoided 1-3 months after vaccinationImmunodeficiency patientHypersensitivity to egg.
21 Viruses Causing Maculopapular Rash 3- PARVO-VIRUS B19 Erythema Infectiosum (Fifth disease )Parvovirus B19 replicates in erythroid cells of human bone marrow or erythroid cells of fetal liver.Parvovirus B19 is cytocytic for erythroid cells cause severe fall of Hb due to transient aplastic anemia especially in patient with chronic hemolytic disorder.Virology AspectsFamily parvovirus ,,The only ssDNA,the smalles DNA virus.Un-enveloped virus,ONE SEROTYPE,INFECT ONLY HUMAN..
22 Viruses Causing Maculopapular Rash (Parvovirus B19) 2- Clinical SyndromesParvovirus in normal childThe common form of the disease( Fifth disease) or “Slapped Cheek”, Erythema infectiosum.Is childhood disease, transmitted from child to child by respiratory droplets with I.P: days, symptoms started as fever, sore throat, malaise, with decrease Hb. Due to transient arrest of erythropoiesis.Then followed by rash on the cheeks that look like person has been slapped, then rash spread to trunk and limbs with complete recovery within one week.
24 Viruses Causing Maculopapular Rash (Continued) Parvovirus B19 in patient with chronic hemolytic anemia:Infection in these group of patient e.g. sickle cell anemia, thalassemia can lead to severe aplastic crisis which can be fatal.Parvovirus B19 in adult:Usually can lead to polyarthritis without appearing of rash especially in adult female.Parvovirus B19 in pregnant lady:The virus can infect the fetus and kill erythrocyte precursors, causing anemia, and congestive heart failure hydrops fetalis.But No congenital abnormalities Not Teratogenic
25 Viruses Causing Maculopapular Rash (Continued) Laboratory Diagnosis:Detection of IgM Ab.Treatment and Prevention:No specific treatmentNo way of prevention except we can screen the blood before transfusion especially if we give it to chronic heamolytic patient.
26 Viruses Causing Maculopapular Rash (Continued) 4- HERPES VIRUS TYPE 6 Roseola infantum Sixth diseaseExanthema subitumVirology AspectsHerpes virus type 6- Family Herpes virusDouble stranded DNA. Enveloped virus.Has the characteristic of latency.latent virus persists for long period to be activated when immunity become less.
27 Viruses Causing Maculopapular Rash (Continued) 2- Clinical Syndromes:It is mainly a childhood diseaseIt is transmitted by respiratory dropletRapid onset of high fever, followed by generalized rash, with mild lymphadenopathy.Complete recovery after 3-5 days.3- Treatment and PreventionNo specific way of treatment or preventionNo vaccine available