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Download Lecture 01. Infectious diseases with exanthema syndrome
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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 39C), 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)