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Viral Exanthems

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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Viral Exanthems

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  1. Angad, JaL Viral Exanthems

  2. RUBEOLA (MEASLES)

  3. 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

  4. Pathogenesis

  5. 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

  6. Physical Examination

  7. 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.

  8. Diagnosis • Based on Clinical picture • Laboratory confirmation is rarely needed • Measles IgM – detectable for 1 month after the illness but sensitivity is limited

  9. Management • Prevention – MMR • Acute Infection – treatment is entirely supportive (antipyretics, bed rest, adequate fluid intake) • Secondary Bacterial Infection – administration of appropriate antibiotics

  10. Rubella (GERMAN MEASLES / 3 DAYS MEASLES)

  11. 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

  12. 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)

  13. Physical Examination • Skin Lesions • Petechiae on soft palate • Enlarged lymph nodes

  14. Diagnosis • Maybe apparent from clinical symptoms and PE • Usually confirmed by serology or viral culture • Latex agglutination, enzyme immunoassay & fluorescent immunoassay

  15. 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

  16. 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

  17. ErythemaInfectiosum FIFTH DISEASE

  18. 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

  19. Pathogenesis

  20. 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.

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

  22. Diagnosis • Usually based on clinical presentation of the typical rash • Serologic test for B19 • PCR, nucleic acid hybridization

  23. 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

  24. Treatment • No specific antiviral therapy • IVIG have been used to treat episodes of anemia and bone marrow failure

  25. RoseolaInfantum EXANTHEM SUBITUM

  26. 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

  27. 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.

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

  29. Diagnosis • Based on age, history and PE findings • Serology, virus culture, Antigen detection and PCR

  30. 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

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

  32. SUMMARY

  33. Good Day!!!!!!

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