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infectious diseases
Absence of
haemorrhage
Causative organisms
Numerous
Viruses
Bacteria
Fungi (disseminated)
Protozoa (malaria)
In endemic areas,
– epidemic occur at regular intervals
(with shorter interval in populations with high
birth rates)
Incidence, age of patient, and
severity of infection
vary strikingly
in different geographic areas
Incidence
In very isolated areas, in which whole populations are
susceptible, rapid spread through the entire
population, irrespective of age (attack rate ~100%)
Age of patients
Average age of infection 4-6 years
But in developing countries, almost all children are
infected before the age of 2 years
Overcrowding
Early loss of maternal antibodies (many infants
infected between 4 and 6 months of age)
Severity of infection
In developing countries:
Complication rates as high as 80%
Case fatality rate >15-20%
Early age of infection
Increased intensity of exposure and inoculum size
Rapid loss of maternal antibodies
Vitamin A deficiency
Prior or concurrent infection with other pathogens
Depressed cell-mediated immune responses secondary to
malnutrition
Transmission
Large droplets (face-to-face exposure)****
Airborne transmission**
Indirect transmission (fomites)*
Transplacental transmission
(prematurity/congenital measles)
Highly infectious
(secondary attack rate >90% in
susceptibles)
MV replication
• MV proliferates locally in respiratory
mucosa
• Spreads to draining lymph nodes
PRIMARY VIREMIA SECONDARY VIREMIA
Disseminates to tissue
Enter bloodstream (in
throughout body (skin,
infected leucocytes) conjunctivae, oropharynx,
Disseminates respiratory mucosa, lungs,
throughout genital mucosa, kidneys,
reticuloendothelial gastrointestinal tract, liver)
system (+ development of host
immune response)
MIBE
Virus
infection SSPE
Fever
– viremia after 7-9 days after infection
Rash (morbilliform)
– develop on day 13-15 after infection (immunologic basis)
– Starts on the face, extends over the trunk and extremities (3
days)
Lymphadenopathy
Fever (associated with viremia
after 7-9 days after infection)
Rash (morbilliform)
- develop on day 13-15 after
infection (immunologic basis)
- starts on the face, extends
over the trunk and extremities
(3 days)
Lymphadenopathy
Virus Blood
present Throat
Rash
Antibody
titer
r
te
s
of se af
Incubation period
th
s
on ys
on
ar
ra t
sh
Da
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Natural history of primary rubella infection M
Chickenpox
Smallpox
Rubella
Congenital rubella
syndrome
Clinical features grouped in three broad
categories:
1. Transient effect in infants
2. Permanent manifestations that may be apparent at birth
or become recognized during the first year
3. Developmental abnormalities that appear and progress
during childhood and adolescence