3. MEASLES
·RUBEOLA VIRUS
·SSRNA VIRUS
·FAMILY: PARAMYXOVIRUSES
MOT: respiratory droplets
Incubation period: 7-21 days
Contagious: 4 days after onset of rash
CLINICAL FEATURES
Investigation:
Measles IgM and IgG
1.
Measles RNA via PCR from
nasopharyngeal swab
2.
Management:
MMR Vaccine 2,3,5, 18 months
1.
Booster MR Vaccine 7y/o
2.
Isolation (4 days after rash
onset)
3.
Supportive treatment
4.
Virus penetrates (nasopharyngeal or conjunctival mucosa)
>>
reaches is the regional lymph nodes to infects lymphocytes→multiplies→starts to
spread systematically (primary viremia).
>>
virus then reaches the lymphoreticular cells of the spleen, liver, bone marrow, and
other organs (secondary viremia )
Pathogenesis:
4. 1
2
3
4
RUBELLA ( GERMAN MEASLES)
Common communicable disease
Often occurring in the endemic waves
Affecting the school age child, adolescent
& young adult
Incubation period is 14-21 days (infectious
from 1 week before & after rash)
OVERVIEW
CAUSATIVE ORGANISM Mode of Transmission
PATHOGENESIS
Rubella Virus
Togaviridae family
Enveloped
Single stranded RNA
virus (ssRNA)
Respiratory droplet
Transplacentally
(Congenital Rubella)
Cough and
Sneezes
Respiratory
tract
Virus replicates Multiply in lymph
node Viremia
Skin (
maculopapular
rash Joint(
arthalgia)
Lymph
node(
lymphade
nopathy
Character of Rash
Discrete erythematous
maculopapular rash
Early Onset
Day 1 : From face rapidly spread to
whole body (within 24h)
Day 3 : rash will fade on the trunk only
Day 4 : the rash will disappear rapidly
(not followed by desquamation)
6. 1
2
3
Congenital Rubella Syndrome (CRS)
Fetal infection depends on stage of
gestation eg : First trimester (10-85%)
Occurs when a non-immune
pregnant women is infected during
the 1st trimester (usually 1st month)
Transplacental transfer of virus during
viraemia phase
OVERVIEW
Investigation TREATMENT
CLINICAL MANIFESTATION
Diagnosis is usually clinical and Antibody detection :
- Rubella specific IgM antibody
Diagnosis can confirmed by urine culture or serology
test (haemagglutination test or
PCR of throat swab
CRS : Rubella IgM in cord and infant blood,PCR of
urine and cerebrospinal fluid sample, Maternal IgG
antibodies
Supportive treatment
No antiviral therapy
Prevention : Isolation for
at least 9 days from rash
onset and Active
immunization with MMR
vaccine
Classical Triad:
Cataracts
Deafness
Cardiac
abnormalities
PDA
VSD
General :
Growth
retardation
Learning
disability
Others:
Microcephaly
Mental
retardation
7. Prodrome of 24 hours fever &
malaise
Skin lesion in crops
Rash: macules> papules>
vesicles> pustules> crusted>
scabbed
Head> trunk> extrimities
Intense pruritic
VARICELLA
INFECTION
CLINICAL MANIFESTATION
REACTIVATION
varicella zooster virus
(herpesvirus family)
Mode of transmission:
Inhalation of droplets & direct
contact
Incubation period: 10-23 days
Period of infectivity: 2 days
before onset of rash and last
approximately 5 days until all
lesion is scabbed
Latent VZV: shingles
Established latency in dorsal root
of sensory ganglia
During immunocompromised state
Lesions characteristic:
Crops of vesicle in different
stages
1.
Pruritus and pain may be severe
2.
Dermatomal(spread lesion)
3.
SOURCE: BUKU POKOK, TOM LISS
8. INVESTIGATIONS
Diagnosed clinically
For confirmation:
Serology: VZV IgM
1.
Skin lesion swab for PCR
2.
COMPLICATIONS
MANAGEMENT
PREVENTION
SECONDARY BACTERIAL INFECTIONS: by group A streptococcus.
May lead to bacteremia, toxic shock syndrome
ENCEPHALITIS: May be generalized. Occurs about a week
after onset of the rash
PURPURA FULMINANS: Consequences of vasculitis in the skin
and subcutaneous tissue
RESPIRATORY: Pneumonia
IN IMMUNOCOMPROMISED HOST, MAY RESULT IN SEVERE
PROGRESSIVE DISSEMINATED DISEASE. VESICULAR ERUPTIONS
PERSIST AND MAY BECOME HAEMORRHAGIC.
Treatment is supportive
Isolation
Antiviral drugs: acyclovir/valacyclovir (determined by)
Host factor
1.
Duration of illness
2.
Extend of infection
3.
Varicella vaccine
1.
12 months or older
2 dose
For individual exposed to varicella (immunised within 3-
5 days)
Varicella zooster immunoglobulin
2.
Within 96 hours after exposure
Indicated for immunocompromised individuals with
deficient T lymphocyte function.
9. HAND-FOOT-MOUTH
DISEASE
Endemic in Malaysia
The majority of outbreaks
occurred at:
-nurseries and preschool
-household
-day-care centres
EPIDEMIOLOGY
ETIOLOGY
Coxsackevirus A16 (most cases)
Coxsackievirus A5, A7, A9, A10,
B2 and B5
Enterovirus 71 (associated with
neurologic complication)
PATHOGENESIS
Incubation period: 3-5 days
Direct or indirect transmission
-close contact (e.g. blister fluid)
-coughing or sneezing
-touching contaminated objects
-contact with faeces
SYMPTOMS
Prodromal: fever, sore mouth &
throat, reduced appetite, malaise
1-2 days after -> vesicular rash
Tongue, buccal mucosa, hard palate
Hands (palms), feet (soles)
DIAGNOSIS & MANAGEMENT PREVENTIVE MEASURES
Clinically diagnosed
-lab tests are not required
Supportive treatment
-paracetamol for fever and pain
-throat spray to relieve pain
-maintain adequate hydration
meningoencephalitis, myocarditis
