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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

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Angad jal

Angad, JaL

Viral Exanthems


Rubeola
RUBEOLA

(MEASLES)


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

    • Maximal dissemination occurs by droplet spray during the prodromal period



Clinical manifestations
Clinical Manifestations

  • Incubation Period: Last 10-12 days

  • Prodromal 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



Course and prognosis
Course and Prognosis

  • 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.


Diagnosis
Diagnosis

  • Based on Clinical picture

  • Laboratory confirmation is rarely needed

  • Measles IgM – detectable for 1 month after the illness but sensitivity is limited


Management
Management

  • Prevention – MMR

  • Acute Infection – treatment is entirely supportive (antipyretics, bed rest, adequate fluid intake)

  • Secondary Bacterial Infection – administration of appropriate antibiotics


Rubella
Rubella

(GERMAN MEASLES / 3 DAYS MEASLES)


Rubella1
Rubella

  • 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


Clinical manifestations1
Clinical Manifestations

  • 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)


Physical examination1
Physical Examination

  • Skin Lesions

  • Petechiae on soft palate

  • Enlarged lymph nodes


Diagnosis1
Diagnosis

  • Maybe apparent from clinical symptoms and PE

  • Usually confirmed by serology or viral culture

  • Latex agglutination, enzyme immunoassay & fluorescent immunoassay


Course and prognosis1
Course and Prognosis

  • 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


Management1
Management

  • 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


Erythema infectiosum
ErythemaInfectiosum

FIFTH DISEASE


Fifth disease
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



Clinical manifestations2
Clinical Manifestations

  • 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 infectiosum1
ErythemaInfectiosum

Diffuse erythema and edema of the cheeks with “slapped cheek” facies in a child


Diagnosis2
Diagnosis

  • Usually based on clinical presentation of the typical rash

  • Serologic test for B19

  • PCR, nucleic acid hybridization


Course and prognosis2
Course and Prognosis

  • “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


Treatment
Treatment

  • No specific antiviral therapy

  • IVIG have been used to treat episodes of anemia and bone marrow failure


Roseola infantum
RoseolaInfantum

EXANTHEM SUBITUM


Exanthem subitum
ExanthemSubitum

  • 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


Clinical manifestation
Clinical Manifestation

  • Incubation period: 7 -17 days

  • High 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.


Physical examination2
Physical Examination

  • Multiple, blanchable macules and papules on the back of a febrile child, which appeared as the temperature fell


Diagnosis3
Diagnosis

  • Based on age, history and PE findings

  • Serology, virus culture, Antigen detection and PCR


Course and prognosis3
Course and Prognosis

  • Self-limited with rare sequelae

  • High fever maybe associated w/ seizures

  • HHV-6 & HHV-7 persist throughout the life of the patient


Treatment1
Treatment

  • Treatment is supportive (antipyretics, bed rest, adequate fluid intake)