Download Measles

Mumps,Measles,Rubella
DR;RIADH ABDULATIF
ALOBAIDY
differential diagnosis of
Fever and rash syndrome
1-Maculopapuler;measles,roseola,fifth disease,
EB virus, scarlet fever, rheumatic fever,
ricketsiae.
2-Diffuse erythroderma; scarlet fever, toxic shock
syndrome(staph. aureus); Scarlentiform rash.
3-Urticarial; mycoplasma, EB virus
4- vesiculobullous; Herpes simplex, varicella,
staphyllococal bullous impetigo,
staphyliococcal scalded skin syndrome
5-petechial -purpuric
Viruses; congenital rubella syndrome,
cytomegalovirus.
Bacteria; sepsis; meningococcal,
pneumococcal, H. influenza,
Mumps is an acute self-limited infection, now unusual
in developed countries because of widespread use of
vaccination. It is characterized by fever, bilateral or
unilateral parotid swelling and tenderness, and the
frequent occurrence of meningoencephalitis and
orchitis. Although no longer common in countries
with extensive vaccination programs, mumps remains
endemic
transmission
Mumps is spread from person to
person by respiratory droplets. Virus
appears in the saliva from up to 7
days before to as long as 7 days after
onset of parotid swelling. The period
of maximum infectiousness is 1-2
days before to 5 days after onset of
parotid swelling
CLINICAL FEATURES
The incubation period is 16-18 days resulting in clinical
presentation ranging from asymptomatic to the typical illness
associated with parotitis. The typical patient presents with a
prodrome 1-2 days and consisting of fever, headache, and
vomiting. Parotitis then appears and may be unilateral ,then
becomes bilateral in about 70% of cases .The parotid gland is
tender, and may be accompanied by ear pain on the ipsilateral
side. Sour foods or liquids may enhance pain in the parotid. As
swelling progresses, the angle of the jaw filled and earlobule is
pushed outward. The opening of Stensen duct may be red and
edematous. The parotid swelling peaks in approximately 3 days,
then gradually subsides over 7 days. Submandibular salivary
glands may also be involved or may be enlarged without parotid
swelling. Edema over the sternum due to lymphatic obstruction
may also occur
Mumps and normal
Differential diagnosis
Purulent parotitis, is usually caused by
Staphylococcus aureus, unilateral, extremely
tender, and is associated with an elevated
white blood cell count, and may involve
purulent drainage from Stensen duct.
Submandibular or anterior cervical adenitis
due to a variety of pathogens may also be
confused with parotitis.
complications
The most common complications of mumps are
meningitis, with or without encephalitis, and
orchitis. Uncommon complications include
deafness, facial palsy, pancreatitis, and
thrombocytopenia.
Maternal infection with mumps during the 1st
trimester of pregnancy results in increased fetal
wastage. No fetal malformations have been
associated with intrauterine mumps infection.
Meningoencephalitis
Symptomatic m.e. occurs in only10-30% of
mumps cases, but CSF pleocytosis has been
found in 40-60% of patients as subclinical
more than apparent meningitis. The
meningoencephalitis is usually benign, may
occur before, along with, or following the
parotitis
Orchitis
Involvement in young boys is rare, but in
adolescent and after puberty, orchitis occurs
in 30-40% of male cases. Atrophy of the testes
may occur, but sterility is rare even with
bilateral involvement.
prevention
Antibody develops in 95% of children after 1
vaccine dose.. As a live- vaccine, MMR should
not be administered to pregnant women or to
immunodeficient child.
Measles
Measles is highly contagious disease. Owing to
widespread vaccination, transmission is
limited .
Measles virus is a single-stranded, lipidenveloped RNA virus in the family
Paramyxoviridae and genus Morbillivirus
Transmission
The portal of entry of measles virus is through
the respiratory tract or conjunctivae following
contact with aerosol droplets in which the
virus is suspended. Patients are infectious
from 3 days before -to 4-6 days after the onset
of rash
Clinical manifestations
Measles is a serious infection characterized by high
fever,cough,coryza, conjunctivitis ,enanthem ,and
a prominent exanthem (the rash). `
After an incubation period of 8-12 days, the prodromal phase
(2-4) days begins with a mild fever followed by conjunctivitis
with photophobia, coryza, a prominent cough, and increasing
fever.
Koplik spots represent the enanthem and are the
pathognomonic sign of measles, appearing 12-24 hours
before the onset of the rash and it last for 1-2 days after rash
appearence. They first appear as sandy white spots on minute
red lesions in the inner aspects of the cheeks at the level of
the lower premolars... Koplik spots have been reported in 5070% of measles cases.
KOPLIK SPOTS
MEEASLES
Clinical features con.
Symptoms increase in intensity for 2-4 days until the 1st
day of the rash. The rash begins on the forehead
(around and before the hairline), and behind the ears
as a red maculopapular eruption. It then spreads to
the face and upper neck and downward to the trunk
and extremities,and reaching the palms and soles in up
to 50% of cases.. The rash last 5-6 days, then fades over
about 7 days in the same manner as it evolved, often
leaving a fine desquamation of skin. Of the major
symptoms of measles, the cough lasts the longest,
often up to 10 days. In more severe cases, generalized
lymphadenopathy may be present, with cervical and
occipital lymph nodes enlargement.
Diagnosis
Mainly clinical but more convenient confirming
serological test can be done by high antibody IgM
level .
Blood and urine samples for viral culture is the most
commonly WHO protocol for detection of the illness.
Differential diagnosis ; include other fever and rash
illnesses like rubella , roseola, erythema infectiosum,
adenovirus, EB virus and enteroviruses.
Scarlet fever and kawasaki synderome.
Drug eruption
Complications
Pneumonia is the most common cause of death in measles. It
may manifest as giant cell pneumonia caused directly by
the viral infection or as superimposed bacterial infection.
Croup, tracheitis, and bronchiolitis are common
complications in infants and toddler.
Acute otitis media and pneumonia are the most
common complication of measles, vomiting and diarrhea.
Encephalitis 1;3000 of cases by direct viral infection or
postinfectious and may be fatal. Rarely Fatal Hemorrhagic
measeles (black measles) leading to hemorrhagic skin
lesions. Subacute sclerosing panenecephalitis is rare . It is
slow virus infection infect the CNS developed in 7-10 years
after measles and it is fatal.
treatment
Mainly supportive as antipyritics and
rehydration and respiratory suppport ..
Vitamine A defeciency is common in
developing countries and is associated with high
mortality in measles so jt is recommended to give
it to the patients.
Single dose of 200,000 IU orally for children ≥1 yr
of age,
100,000 IU for children 6 mo–1 yr of age, and
50,000 IU for infants <6 mo of age .
prevention
Shedding measles virus from 7 days after exposure
to 4-6 days after the onset of rash. Exposure of
susceptible individuals to patients with measles
should be avoided during this period .
A 2-dose schedule (with MMR) is recommended
for full immunity.
The first dose is recommended at 12-15 mo of
age; the 2nd is recommended at 4-6 yr of age. For
immune deficient if exposed to a case immune
globulin I M should be given.
RUBELLA
Rubella (German measles or 3-day measles) is a
mild, often exanthematous disease of infants
and children,
but is more severe and associated with more
complications in adults.
Its major clinical significance is transplacental
infection and fetal damage as part of the
congenital rubella syndrome (CRS
Clinical Manifestations
Postnatal infection rubella is a mild disease . Following an
incubation period of 14-21 days, a prodrome consisting
of low-grade fever, sore throat, red eyes, headache,
malaise, anorexia, and lymphadenopathy begins.
Suboccipital, postauricular, and anterior cervical
lymph nodes are most prominent. In children, the 1st
manifestation of rubella is usually the rash, which is
variable and not distinctive. It begins on the face and
neck as small, irregular pink macules that coalesce, and
it spreads to involve the trunk and extrimities .The
duration of the rash is generally 3 days, and it usually
resolves without desquamation
Congenital rubella syndrome
Deafness 67% Ocular 71% Cataracts 29
% Retinopathy 39% Heart disease
48% Patent ductus arteriosus 78 % Right
pulmonary artery stenosis 70% Left
pulmonary artery stenosis 56 % Valvular
pulmonic stenosis 40 % Low birthweight 60%
Psychomotor retardation 45% Neonatal
purpura 23%.Death %35
MMR vaccine
Vaccine should not be administered during
pregnancy.. Studies of >200 women who had
been inadvertently immunized with rubella
vaccine during pregnancy showed that none
of their offspring developed CRS. Therefore,
interruption of pregnancy is probably not
warranted