Академический Документы
Профессиональный Документы
Культура Документы
Epidemiolog
y
Measles
Endemic throughout
the world
Peak age incidence: 510 y/o
German Measles
Distributed worldwide
and affects both sexes
Roseola Infantum
>95% of roseola cases
occur in children younger
than 3 yr, with a peak at
6-15 mo of age
Erythema Infectiosum
prevalent in school-aged
children, with 70% of
cases occurring between
5 and 15 yr of age
Chicken Pox
peak incidence is 5-9
years old
HAND-FOOT-MOUTH DISEASE
usually affects infants and
children younger than 5 years old
Etiology
Measles virus
Rubella Virus
Parvovirus B19
Varicella-zoster virus
Transmissio
n
Droplet aerosols
Oral droplet
Transplacentally
Infectious
Period
Clinical
Manifestatio
ns
incubation period
9 days
Prodromal Period
Usually asymptomatic but
may include mild upper
respiratory tract signs
Febrile Period
Usually ranging from 37.9
40 C
Most children become
anorexic and irritable
Febrile Period(preeruptive)
3-5 days then resolves
abruptly
Fever may diminish
gradually over 24-36
hours
Enanthem
Exanthem
Koplik spots
Begins on the
forehead, behind the
ears and upper neck
as red maculopapular
eruptions
Spread downwards to
the torso and
extremities
Onset of rash,
symptoms begin to
subside
Branny desquamation
and brownish
discoloration of the
skin disappearing in 710 days
FORCHEIMER SPOTS
begins on the face and
neck as small, irregular
pink macules that
coalesce
it spreads centrifugally
to involve the torso and
extremities, where it
tends to occur as
discrete macules
rash fades from face as
it extends to the rest of
the body
3 days duration
Nagayama spots
begins as discrete, small
(2-5 mm), slightly raised
pink lesions on the trunk
and usually spreads to
the neck, face, and
proximal extremities
appears within 12-24 hrs
of fever resolution and
fades after 1-3 days
rash is rose colored and
fairly distinctive. not
usually pruritic and no
vesicles or pustules
develo
Central clearing of
macular lesions occurs
promptly, giving the rash
a lacy, reticulated
appearance
characteristic sparing of
palms and soles
resolves spontaneously
without desquamation
but tends to wax and
wane over 1-3 weeks
characteristic:
simultaneous presence of
lesions in various stages
of evolution appear first
on the scalp, face, or
trunk
consists of intensely
pruritic erythematous
macule
papular stage
clear, fluid-filled vesicles
(Clouding and
umbilication of the lesions
begin in 2448 hrs
Crusting
distribution:
predominantly central or
centripetal
Laboratory
Findings
- diagnosis of measles
is almost always
based on clinical and
epidemiologic findings
Acute phase:
decreased WBC
count,decreased
lymphocytes
Diagnosis
identification of IgM
antibody in serum
-demonstration of a 4fold rise in IgG
antibodies in
acute and
convalescent
specimens taken 24
wk later
Leukopenia
Neutropenia
Mild thrombocytopenia
Rubella IgM
enzyme
Immunosorbent
assay
Complicatio
ns
Pneumonia
Otitis media
Encephalitis
M tuberculosis
Exacerbation
Subacute sclerosing
panencephalitis
Treatment
Maintenance of
hydration,
oxygenation are goals
of therapy
Antipyretics:
Paracetamol 1015mkd q4-6 prn
Airway humidification
and supplemental
oxygen
Vitamin A: <1yr
100000 IU; >1yr
200000 IU
Supportive
Prevention
Isolation precautions
7th day after exposure
until 5 days the rash
has appeared
Immunization: 1st dose
12-15mos
2nd dose 4-6 years
old
Postexposure
MMR vaccine
1st dose @ 1215 mos
2nd dose after 4
wks of 1st dose
Pregnant
patients should
NOT be given
rubella vaccine
Postinfectious
thrombocytopenia
Arthritis
Encephalopathy
Most serious
complication
Progressive Rubella
Panencephalitis
leukopenia is typical
during the 1st 72 hr
-relative and absolute
lymphocytosis
Supportive
Encephalitis
Cerebellar Ataxia
Pneumonia- accounts for
most of the increased
morbidity and mortality in
adults and other high-risk
populations
Antiviral therapy: HHV-6
-inhibited by ganciclovir,
cidofovir, and foscarnet
(but not acyclovir) at
levels that are achievable
in serum; HHV-7- inhibited
by cidofovir and
foscarnet
adequate fluid balance
should be maintained
no specific antiviral
therapy
prophylaxis
Should be given w/in
72hrs of exposure
Immunocompetent:
0.25 mL/kg; max
15mL
Immunocompromised:
0.50 mL/kg; max
15mL
Females should
avoid becoming
pregnant for 3
months after
vaccination
* Catch-up vaccination
with the second dose is
recommended for
children and adolescents
who received only 1 dose
varicella vaccine within 3
days of exposure
High-titer anti-VZV
immune globulin is
recommended for
immunocompromised
children, pregnant
women, and newborns
exposed to maternal
varicella
Recommended dose:1
vial (125 units) for each
10 kg increment
(maximum 625 units)
given IM as soon as
possible but within 96 hr
after exposure