Measles is caused by a virus that spreads through the air via coughing or sneezing. It has an incubation period of 8-12 days and early symptoms include fever, runny nose, eye inflammation, and cough. A rash then develops on the face and spreads downward over 3 days. Complications can include ear infections, pneumonia, and neurological issues. Rubella is caused by a virus spread through respiratory secretions. While usually mild, it can cause fetal death or defects if a pregnant woman is infected. Both measles and rubella can be prevented through vaccination with the MR vaccine at 9 months and 15 months of age.

1. Fever with rash

2. Causative organism

6. Spread
• Droplet infection

11. Early Symptoms in Measles
• The incubation period (from exposure to
onset of symptoms):
ranges from 8-12 days
• The prodromal phase:
 malaise, fever, anorexia,
 conjunctivitis, cough, and coryza (the "3
Cs").
Kopliks spot

13. Final stage

14. • Typically begins at the hairline
• spreads caudally over the next 3 days as the
prodromal symptoms resolve.
• The rash lasts 4-6 days and then fades from
the head downward.
• Desquamation may be present but is generally
not severe.
• Complete recovery from the illness generally
occurs within 7-10 days from the onset of the
rash

16. Complications
 Acute otitis media
 Pneumonia : viral pneumonia
due to secondary bacterial infection
 Neurological manifestations: encephalitis (subacute
sclerosing pan encephalitis SSPE)
 Others:
oral ulcers (noma)
Clouding of cornea
myocarditis
laryngitis, bronchitis
conjunctivitis
DIC

17. CBIMCI guideline
any general danger sign, clouding of cornea, or deep or extensive mouth ulcers,

24. VACCINATION
Measles vaccine is given at 9 months and 15
months of age as MR vaccine
Child has a transpacental transimission of
immunoglobulins which provides immunity
against measles.

25. Rubella
Epidemiology

29. Mode of Transmission
• Direct or droplet contact with an infected
person’s respiratory secretions, from 1 week
prior to onset of rash to 1-2 weeks after
disappearance of rash (spreads when an
infected person coughs or sneezes)
• Transplacental transmission from mother with
an active infection (while pregnant, she can
pass it to her developing baby and cause
serious harm)

30. Key facts
• Rubella is a contagious, generally mild viral
infection that occurs most often in children and
young adults.
• Rubella infection in pregnant women may cause
fetal death or congenital defects known as
congenital rubella syndrome (CRS).
• Worldwide, over 100 000 babies are born with
CRS every year.
• There is no specific treatment for rubella but the
disease is preventable by vaccination

39. Congenital Rubella

41. Prevention
• rubella vaccine is given at 9 months and 15
months of age as MR vaccine

42. Varicella/ Chicken Pox
• Agent: varicella zoster virus
• Transmission: airborne, direct contact
• Incubation period: 10-21 days
• Humans are the only reservoir
• Affects 90% of children between 1 to14 years
• Highly contagious (>90% in household contacts)
• Period of infectivity:
– 2days prior to rash and 5 days after crusts
– Scabs are non infective
• Lifelong latent infection in the sensory ganglia

43. Varicella/ Chicken Pox
• Agent: varicella zoster virus
• Transmission: airborne, direct contact
• Incubation period: 10-21 days
• Humans are the only reservoir
• Affects 90% of children between 1 to14 years
• Highly contagious (>90% in household contacts)
• Period of infectivity:
– 2days prior to rash and 5 days after crusts
– Scabs are non infective
• Lifelong latent infection in the sensory ganglia

45. • Complication:
• Secondary skin infection
• Pneumonia
• Meningoencephalitis
• Hemiplegia
• Gullain barre syndrome

46. • Neonatal varicella:
– If mother has varicella 5 days prior and 2 days
after rash
• Congenital varicella:
– VZV embryopathy
– Infection in 1st 20 wks of gestation
– cicatrical skin lesion
– Hypoplasia of extremities
– Micropthalmia, cataract
– Brain calcification

47. • Herpes zoster:
– Reactivation of latent virus in sensory ganglia
– Vesicular rash with dermatomal distribution

48. • Diagnosis:
– Clinical
– PCR
– Anti IgM antibody
– Tzanck smear
(multinucleated cells)
• Treatment:
– symptomatic
• Antipyretic
• Antipruritic
• Good hygiene
– Isolation
– Acyclovir
– VZIg

49. • Treatment of
complications

50. Fever and rash in children
Varicella /chickenpox
Treatment

51. • Prevention:
• Varicella zoster vaccine
– Live attenuated vaccine
– Route: I/M
– 2 doses: 4-6 weeks apart
– Children >1 year

52. Differential diagnosis of fever with
rash
Very: varicella
sick: scarlet fever
person : small pox
Must: measles
take: typhus
double: dengue
egg : enteric fever
Others: roseola infantum
erythema toxicum