Download Lecture 01. Infectious diseases with exanthema syndrome

Infectious diseases with
exanthema syndrome
Lecturer:
Gorishna Ivanna Lubomyrivna
Measles

Etiology: Measles virus - RNA virus, that
belongs to the Paramyxoviridae family,
Morbillivirus genus.
Transmission

Source of infection – infected person
during last 2 days of incubation period,
catarrhal period, and 4 days period of
eruption (in case of complications –10
days period of eruption).
 Infection is spread by inhalation of
large and small airborne droplets.
 Susceptible organism - no immunized
persons, older than 6 month, which never
had measles.
Clinical presentation
The incubation period 9 - 17 (21!) days.
 Prodromal period - 3 - 5 days.
– Temperature is usually high at first day.
– The classic three “C’s” (cough, coryza,
conjunctivitis).
– the enanthema or Koplik’s spots. They usually
disappear by the second day of the
exanthema.
Measles conjunctivitis
Koplik’s spots
Measles enanthema
Exanthema period: 3-4 days
 Second increase of temperature.
 Initial lesions on the forehead and face.
 During 3-4 days they spread downward
 The rash is red maculopapular, initially discrete
then confluent.
 Ctarrhal signs progress
 Koplick’s spots and enanthema remain for 1-2
days
Pigmentation period (1-1.5 weeks)
 Pigmentation progresses in the same fashion as
the rash, than desquamation (microscalling)
 Normalisation of the temperature
 Ctarrhal signs resolves
Measles, typical rashes,
nd
2
day
Measles, hemorrhagic rashes
Measles, pigmentation period
Classification

By the form:
– typical, by the severity:
 mild;
 moderate;
 severe (without hemorrhagic syndrome, with hemorrhagic syndrome);
– Atypical  abortive;
 mitigious;
 hyperreactive;
 subclinical;
 asymptomatic;
 measles in vaccinated;
 measles in person who receive antibiotics and hormones.
 By the course:
– smooth (uncomplicated);
– not smooth, uneven (complicated).
Laboratory work-up

common laboratory tests are non-specific.
– leukopenia, lymphocytosis, eosynophylia,
and thrombocytopenia (may be)

serological test (DHAR, PHAR), Immune
enzyme analysis
 virus isolation (nasopharyngeal smears) is
technically difficult
 Cytoscopic examination presence of
typical multinuclear giant cells
Scarlet
fever,
localisation
of rashes
Treatment
Adequate hydration, bed rest; vitaminized
food;
 Antipyretics for fever control:

– paracetamol 10-15 mg/kg not often than
every 4 hours or ibuprophen 5-10 mg/kg per
dose, not often than every 6 hours.
 Nasal decongestants not more than 3 days, in
infants before 6 mo physiologic saline solution
Mucosolvents and cough supressors;
 Vitamin A 200 000 Units orally daily
 Care for oral cavity, conjunctiva.

Rubella (German measles)

It is caused by RNA rubella virus, which
belongs to the Togaviridae family,
Rubivirus genus.
Transmission

the source of infection is a patient or
carrier

the mechanism of transmission is air-
droplet, transplacental
 receptivity is common, especially high in
children 2-9 years
CLINICAL PICTURE
of the Acquired Rubella
Incubation period is 14-21days
Prodromal phase: 1-2 days before the onset of rash:
– Headache; Low-grade fever; Chills; Anorexia;
Nausea;
– Eye pain, Conjunctivitis;
– Sore throat;
– Tender lymphadenopathy (particularly posterior
auricular and suboccipital lymph nodes);
– Forchheimer sign - pinpoint or larger
petechiae that usually occur on the soft palate
Chickenpox
Chickenpox,
typical
localization
of rashes
Chickenpox, rashes on mucus
membranes
Classification
– By the type:
 typical forms
 atypical forms (subclinical, bullous,
hemorrhagic, gangrenous, generalized)
– By the severity:
 Mild
 Moderate
 Severe
– By the course:
 smooth (uncomplicated)
 uneven (complicated)
Hemorrhagic form
Complications
secondary bacterial -
Staphylo- or streptodermia
 otitis, pneumonia

Viral:
pneumonia
 croup
 Encephalitis (involvement of the
cerebellum, or cerebrum)
 less common – Guillain-Barre syndrome,
transverse myelitis, optic neuritis, and
facial nerve palsy.

Scarlet fever

Scarlet fever is an acute infectious
disease, that is caused by group A βhemolytic streptococcus
Clinical presentation:







acute onset
fever (often above 39C),
sore throat (often with dysphagia),
Erythema and enanthema on the soft palate.
purulent tonsilar exudates.
Anterior cervical lymph nodes are tender and
enlarged.
Coated than swollen, red tongue (strawberry
tongue).
 Other features are nausea and vomiting,
headache, abdominal discomfort.
Scarlet fever, pharyngitis,
enanthema
Scarlet
fever,
pharyngitis,
tonsillitis
Strawberry tongue







a rash appears 1-2 days after the onset.
first on the neck and then on the trunk and
extremities through 24 hours.
dusky red, blanching tiny papules that have a
rough texture ("sand paper" sign).
flushing face with circumoral pallor (Filatov’s
sign).
the rash is intensified in skin folds and at
sites of pressure.
Pastia’s lines: In the antecubital and axillary
fosses linear petechiae with accentuation of the
erythema.
Papules are usually absent at palms, and soles
Scarlet
fever,
localisation
of rashes
Scarlet fever, morphology of rashes
Scarlet
fever,
intensive
rashes in
the sites of
pressure
Filatov’s
sign
Pastia’s lines
The exanthema lasts 4 - 5 days
then desquamate, first on the face last on the
palms and soles.
 Pharyngitis usually resolves in 5 to 7 days.


Desquamation of the skin
Classification

1.
Form:
– typical;
– atypical:
 subclinical;
 extra pharyngeal (burns, wounds, post-natal, after operations,
delivery);
 with aggravated symptoms (hypertoxic, hemorrhagic).

2.
Severity:
– mild;
– moderate;
– severe: toxic, septic, toxic-septic.

3.
Course:
– smooth;
– uneven (relapses, complications).
Purulent Complications:
otitis media,
 lymphadenitis,
 perytonsilar abscess,
 necrotizing tonsillitis,
 sepsis,
 Pneumonia,
 Sinusitis,
 Meningitis,
 Bone or joint problems (osteomyelitis or
arthritis)
