Angad, JaL

(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  Maximal dissemination occurs by droplet spray during the prodromal period

Virus enters cells of respiratory tract and replicates locally Spreads to local lymph nodes Disseminates hematogenously to skin and mucous membrane

 Incubation Period: Last days  Prodromal stage: Last 3-5 days characterized by low-mod grade fever, dry cough, coryza, photophobia & conjunctivitis. Kopliks spots appear by 2 nd -3 rd 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 picture  Laboratory 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 1 st 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

Intranasal inoculationIgM & IgG developExanthem appears

 Incubation Period: 7 to 28 days  Children: 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.

Erythema Infectiosum 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 B19  PCR, 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: days  High fever with morning remission until the 4 th 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)

RUBEOLARUBELLAROSEOLA ERYTHEMA INFECTIOSUM Etiology ParamyxoviridaeTogaviridaeVirus (prob) Incubation Period 10 – Epid All ages6 -18 monthsAll agesRarely > 3 y/o Rash 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

RUBEOLARUBELLA ROSEOLA ERYTHEMA INFECTIOSUM Fever pattern ↑ T abruptly as rash appears ↓ T when rash reaches legs & feet Sudden onset ↑ T ↓ T on 3 rd -4 th d as rashes appear Absent or low grade InfectivityIsolate- 7 th d post exposure unti l 5 d after rash appeared 9 th – 10 th d post exposure (peak) 3 rd day of fever and 1 st day of rash RashLateral neck, ears, hairline → back, abdomen, thigh → feet on 2 nd Absence of PE findings to explain fever, trunk and extremities Rash 3 stages 1.Slapped cheek 2.Maculopapular on 3 rd as face fades 3.Lacy or reticulated appearance rash – fades central clearing pruritic lasts 2-39 days