Download MACULOPAPULAR 2010

Viruses Causing
Maculopapular Rash
By: Dr. Mona Badr
Assistant Professor & Consultant Virologist
Viruses Causing Maculopapular
Rash
Definition of Maculopapular Rash:
 A small cicumscribed, solid, discoloured spot, slightly
elevated lesion on the skin
 Some important viruses causing maculopapular rash
mainly in children:
1. Measles virus
Paramyxvirus family
2. Rubella virus
Togavirus family
3. Parvovirus B19
Parvoviridae family
4. Herpes virus type-6
Herpesvirus family
Viruses Causing Maculopapular Rash (Continued)
Measles:
 Measles is a highly contagious, serious disease affecting
young children mainly and occasionally adults.
A- Virology Aspects:

Family paramyxoviridae

ss-RNA, negative polarity ,enveloped virus.

Virion contain enzyme transcriptase

Paramyxovirus are able to induce cell-cell
multinucleated giant cell (syncytia)

Measles virus
-One
serotype only
- Infect human only
fusion
Viruses Causing Maculopapular Rash (Continued)
B-
Pathogenesis and Immunity:

Measles virus transmitted from respiratory secretion by direct
contact OR droplet and air borne transmission mainly in
winter and spring.

Virus infects first epithelial cells of respiratory tract, then
virus spreads in lymphatic system blood then measles
viruses wildly disseminated to the skin and other internal
organs.

Cell-mediated immunity is essential for the control of
measles infection will be fatal in immunocompromised.

Long-life immunity to measles virus develop after recovery
from rash.
Viruses Causing Maculopapular Rash (Continued)
C-
Clinical Symptoms:

Incubation period 7-13 days

Prodromal symptoms:
conjunctivitis, (1-2 days).
Fever,
cough,
runny
nose,
 Koplik’s spot: Small, white papules appear mostly in
buccal mucosa, of 70-80% of patients for 2 days

Rash: typical maculopapular rash first on the face, trunk and
extremities.

The patient become very sick and temperature become very
high (39-40oC) when this rash appear.

Recovery can be complete, but complication also can occur.

Diagnosed by detection of Measles IgM Ab in the serum.
Viruses Causing Maculopapular Rash (Continued)
D-
Complication:
Common complication
Croup, bronchitis, otitis media and 2nd bacterial pneumonia
Rare Complication:
1. Encephalitis occur in 1 per 1000 of infected children.
Occur 7-10 days after the onset of measles,its serious its fatal.
2. Giant cell pneumonia (Intestinal pneumonia)

Occur in immunocompromised children, due to direct
invasion of the virus to the lung.
Koplik”s Spot
Measles
Measles
Viruses Causing Maculopapular Rash (Continued)
D- Complication:
Very rare Complication:
Subacut-slerosing-pan-encephalitis (SSPE)

Is very rare complication (5/million)

Develops several month or years after recovery average
after 7 years.

It occur when measles virus persist in brain tissue and
act as slow virus and replicate in brain cells.

Patients develops change in personality, behavior,
memory blindness and convulsion will lead to coma then
death.

SSPE is confirmed by characteristic EEG patterns and
demonstration of measles Ab in CSF with increased CSF
measles Ab ratio to serum measles Ab.
Viruses Causing Maculopapular Rash (MEASLES)
E- Treatment and Prevention
 No specific treatment

Prevention
1. Active

Live attenuated vaccine (MMR)

Contain live attenuated measles, mumps and rubella viruses

Given by I.M. or subcutaneously in one dose.

Excellent immunity

Should not be given to pregnant or immunocompromised
patient.
2. Passive
Exposed people who are immunocompromised should be given
passive immunization with immune serum globulin must be
given within 6 days of exposure.
Viruses Causing Maculopapular Rash (Continued)
Rubella
Rubella is a mild exanthematous moderately contagious disease.
When the disease is acquired by the mother during first 4 months
of pregnancy. The virus may infect the
TERATOGENIC EFFECT.
1. Virology Aspects:

Family Togavirus

Enveloped, nucleocapsid virus

Single stranded RNA, positive polarity

Agglutinate avian erythrocytes
fetus
and cause
Viruses Causing Maculopapular Rash (Continued)
2. Epidemiology:

Humans are the only
host

Virus is spread in respiratory secretion and is generally
acquired during childhood.

The incidence of infection peaks in the spring

Before the development and use of the rubella vaccine,
cases of rubella in school children would be reported evey
spring.
for rubella
Viruses Causing Maculopapular Rash (Continued)
3- Clinical Syndromes:

Rubella is a mild disease of children

But if contracted in early pregnancy (first 4 months) the
virus can cause severe congenital abnormalities in the
fetus (Teratogenic)

So we have 2 different
Clinical Syndrome
Post –natal
(CHILDHOOD)
Rubella Infection
Congenital
Rubella Infection
Viruses Causing Maculopapular Rash (RUBELLA)
A- Post –natal Rubella(CHILDHOOD)

It is mild self limiting disease occur in childhood.

Incubation period 14-21 days

Prodromal symptoms as fever, cough, conjunctivitis and
enlarged of post cervical lymph node.

Macupapular rash first appear in face then trunk and limbs
(usually mild), with complete recovery.

Fever is low grade or absent during the rash. The general
condition is good.

If infection occur in adult (especially female) arthritis reported.

Diagnosed by detection Rubella IgM Ab in the serum

Complication:
 Post – infectious encephalitis, Thrombocytoninic purpura
Viruses Causing Maculopapular Rash (RUBELLA)
A-
Congenital Rubella

Congenital defect occur mainly if the mother has rubella in
the first 16 weeks of pregnancy (first trimester), after that
rubella does not damage the fetus.

Virus can replicate in the placenta and then spread to fetal
blood supply and so, Rubella virus can replicate in most
tissue of the fetus, this can lead to improper development of
the fetus and teratogenic effect associate with
Congenital Rubella infections.

In about 15% of cases infection of the fetus leads to
spontaneous abortion.
Congenital Rubella
Viruses Causing Maculopapular Rash (RUBELLA)

The main defects IN THE BABY are:

Eye defect: cataract, glucoma, chorioretenitis

Nerve deafness

Cardiac abnormalities:
e.g.: Fallot’s tetralogy

Ventricular septal defect.

Mental retardation

Hepatosplenomegally

Low birth weight
Infected infants shed the virus into
throat and urine
for 2 years and can
infect susceptible individual.
Notes:
Viruses Causing Maculopapular Rash (Continued)
5- Laboratory Diagnosis
Post –natal
CHILDHOOD
Rubella
1- Clinical diagnosis
2- Serological detection of IgM Ab
3- Detection of IgG Ab indicate
past infection OR immunization.
Congenital
Rubella
1- History of Infection of mother
2- Virus isolated by immunoflourescent assay from:
Urine
CSF
Blood
3- Serological diagnosis by
detection of IgM Ab from Cord blood
4- Detection of IgG Ab Not diagnostic
Viruses Causing Maculopapular Rash (RUBELLA)
Treatment and Prevention:

No specific treatment available.
Prevention:
Active Immunization:

Immunization of all children at age of 15 months with
MMR-vaccine (live attenuated vaccine).

Natural infection or vaccination give good immunity, but not
solid, re-infection can happen.

Booster, dose of Rubella vaccine is recommended for female
at age of puberty (14-15 years), or before marriage.
Contraindication of MMR:

Pregnancy: must be avoided 1-3 months after vaccination

Immunodeficiency patient

Hypersensitivity to egg.
Viruses Causing Maculopapular Rash
3- PARVO-VIRUS B19 Erythema Infectiosum
(Fifth disease )
 Parvovirus B19 replicates in erythroid cells of human bone
marrow or erythroid cells of fetal liver.
 Parvovirus B19 is cytocytic for erythroid cells cause severe
fall of Hb due to transient aplastic anemia especially in
patient with chronic hemolytic disorder.
1. Virology Aspects

Family parvovirus ,,The only
smalles DNA virus.
Un-enveloped
HUMAN.
virus,ONE
ssDNA,the
SEROTYPE,INFECT
ONLY
Viruses Causing Maculopapular Rash (Parvovirus
B19)
2- Clinical Syndromes
Parvovirus in normal child

The common form of the disease( Fifth disease) or
“Slapped Cheek”, Erythema infectiosum.

Is childhood disease, transmitted from child to child by
respiratory droplets with I.P: 4 10 days, symptoms started
as fever, sore throat, malaise, with decrease Hb. Due to
transient arrest of erythropoiesis.

Then followed by rash on the cheeks that look like person
has been slapped, then rash spread to trunk and limbs
with complete recovery within one week.
Parvovirus B19 “Slapped Cheek”
Erythema Infectiosum
Viruses Causing Maculopapular Rash (Continued)
Parvovirus B19 in patient with chronic hemolytic anemia:

Infection in these group of patient e.g. sickle cell anemia,
thalassemia can lead to severe aplastic crisis which can be
fatal.
Parvovirus B19 in adult:

Usually can lead to polyarthritis without appearing of rash
especially in adult female.
Parvovirus B19 in pregnant lady:

The virus can infect the fetus and kill erythrocyte precursors,
causing anemia, and congestive heart failure
hydrops
fetalis.
But No congenital abnormalities Not Teratogenic
Viruses Causing Maculopapular Rash (Continued)
Laboratory Diagnosis:
Detection of IgM Ab.
Treatment and Prevention:

No specific treatment

No way of prevention except we can screen the blood before
transfusion especially if we give it to chronic heamolytic
patient.
Viruses Causing Maculopapular Rash (Continued)
4- HERPES VIRUS TYPE 6 Roseola infantum Sixth
disease
Exanthema subitum
1. Virology Aspects

Herpes virus type 6- Family Herpes virus

Double stranded DNA. Enveloped virus.

Has the characteristic of latency.
latent virus persists for long period to be activated when
immunity become less.
Viruses Causing Maculopapular Rash (Continued)
2- Clinical Syndromes:

It is mainly a childhood disease

It is transmitted by respiratory droplet

Rapid onset of high fever, followed by generalized rash,
with mild lymphadenopathy.

Complete recovery after 3-5 days.
3- Treatment and Prevention

No specific way of treatment or prevention

No vaccine available