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www.similima.com
MEASLES, MUMPS & RUBELLA
DR. JOY D’SOUZA
Asst Professor,
Dept of Paediatrics,
Fr Muller Medical College, Mangalore
1
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MEASLES
• RUBEOLA
• Acute viral infection – fever, coryza, cough,
lacrimation and koplik spots, followed by
maculopapular rash on the 4th or 5th day
• Epidemiology
– Developing countries
– Winter and spring seasons
– Decline in cases in India
2
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• Etiology
– RNA virus
– Morbillivirur genus of Paramyxovirus family
– Usually below 3 years
– Unusual below 6 months
– Transmission
• Direct contact
• Droplet infection - highly contagious
MEASLES
3
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• Pathogenesis
– Entry through respiratory epithelium of nasopharynx
replicates buccal mucosa & conjunctiva
– Spreads - viremia
MEASLES
4
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• Clinical features
– 3 stages
• Incubtion period 10-14 days
• Prodromal phase – 2 days
– Fever
– Coryza
– Conjunctivitis
– Enanthem (kopik’s spot)
• Maculaopapular rash
– Starts when fever is present
– Fever subsides
MEASLES
5
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• KOPLIK SPOTS
– Pathgmonic of Measles
– Serous exudation & proliferation of endothelial cells
– 2-3 days after onset of prodomal symptoms
– Greyish white dots (grains of sand) surrounded by
reddish areola, inner side of cheek- oppsite to lower
molars
– Disappears in 12-18 hrs
MEASLES
6
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Measles Koplick Spots
7
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• Rash starts behind the ear, hairline & neck
• Measles march
• Rash disappears in 7 days
• Brawny desquamation
• Infective period
– 2-4 days before & 4 days after the rash disappears
MEASLES
8
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Measles recovering
11
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• COMPLICATIONS
– Respiratory system
• Interstitial / broncho pneumonia
• Flaring of TB
• Bronchectasis
– GIT
• Diarrhea, vomiting, appendicitis, Mesenteric adenitis
– ENT
• Otitis media, laryngo tracheo bronchitis
– Eyes
• Keratitis, conjunctivitis, corneal ulceration
MEASLES
13
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• COMPLICATIONS
– Eyes
• Keratitis, conjunctivitis, corneal ulceration
– CNS
• Measles encephalitis
• Long term – SSPE
• PROGNOSIS
– 1-3% Mortality
– 5-15% complications
MEASLES
14
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• Management
– Symptomatic
– Single dose of Vit A
• < 1 yr – 1,00,000 Units
• > 1 yr – 2,00,000 Units
MEASLES
15
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• Prevention
– Measles vaccine
– MMR at 1 yr 3 months
• Modified measles
• Atypical meales
• Hemorrhagic Measles
• Absence of rash
– HIV, <9 months age, Immunoglobin treatment
MEASLES
16
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MUMPS
17
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• Parotitis is most common illness
• Can affect any organ
• Epidemiology
– Endemic world wide
– Late winter & early spring
MUMPS
18
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MUMPS
• Natural history
– Droplet infection (Saliva)
– Virus proliferates in URT
– Enters circulation
– Localizes in glandular and neural tissue
• Infective period
– 24 hours before onset of swelling
– 3 days after swelling has subsided
20
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MUMPS
• One or both parotid may be involved
• 1/4th cases unilateral
• One parotid swells a day or two earlier than
the other
• Earliest complaints – earache & difficulty in
chewing
• Obliterates the space b/w the post border of
mandible and the mastoid
21
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MUMPS
• Rapidly increases in size, peaks in 1-3 days
• Parotid swelling is better seen than felt
• Earlobe is pushed upwards and backwards
• Pain increases on tasting sour liquids like
lemon juice & vinegar
• Redness around the stenson’s duct
22
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MUMPS
• Tonsils may be displaced medially
• Edema over manubrium due to lymphatic obstn
• Fever subsides in 1-6 days, swelling in 1-2 wks
• Submaxillary, submandibular glands may be
involved
• Testes, pancreas, ovaries, CNS, prostrate may
be involved
23
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www.similima.com 25
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MUMPS
• In pregnant mothers
– Fetus
• Endocardial fibroelastosis
• Aqueductal stenosis
26
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MUMPS
• Differential diagnosis
– Other viral causes of Parotitis
– Acute Suppurative Parotitis = staph aureus
– Salivary calculus
– Anterior cervical lymphadenitis
27
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MUMPS
• Treatment
– No specific treatment
– Analgesics
• Prevention
– MMR vaccination
28
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RUBELLA
29
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Rubella virus
30
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RUBELLA
• GERMAN MEASLES
• 3 Day measles
• Mild disease, known more for teratogenic
effects
31
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RUBELLA
• Etiology
– Rubella virus – family Togaviridea
– RNA virus
– Transmitted via respiratory route
32
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RUBELLA
• Clinical manifestation
– Incubation period – 14-21 days
– Prodomal symptoms – Fever, malaise,
headache
– Rash appears on face, spreads downwards,
fades in 3 days
– Usually accompanied by
• Pre & post auricular lymphadenopathy
• Suboccipital lymphadenopathy
33
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RUBELLA
• Congenital Rubella Syndrome
– 1st trimester
• Triad
– Cataract
– Sensory neural deafness
– Congenital heart disease
– IUGR
– Microcephaly
– Mental and Motor Retardation
36
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Rash of Congenital Rubella
37
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Rash of Congenital Rubella
38
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Rash of Congenital Rubella
39
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Rubellla cataract
40
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RUBELLA
• Prognosis of CRS
– Depends on severity
• Childhood rubella is good
– Complication rare
• Treatment – no specific
• Prevention – MMR vaccine, Rubella vaccine
41
www.similima.com
THANK YOU
42

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