Infectious diseases with exanthema syndrome Lecturer: Gorishna Ivanna Lubomyrivna.

Infectious diseases Infectious diseases with exanthema with exanthema

syndromesyndrome

Lecturer:Lecturer:Gorishna Ivanna Gorishna Ivanna

LubomyrivnaLubomyrivna

MeaslesMeasles

Etiology: Etiology: Measles virus - RNA Measles virus - RNA virus, that belongs to the virus, that belongs to the Paramyxoviridae family, Morbillivirus Paramyxoviridae family, Morbillivirus genus.genus.

TransmissionTransmission

Source of infectionSource of infection – infected person – infected person during last 2 days of incubation period, during last 2 days of incubation period, catarrhal period, and 4 days period of catarrhal period, and 4 days period of eruption (in case of complications –10 eruption (in case of complications –10 days period of eruption).days period of eruption).

Infection is spreadInfection is spread by inhalation of by inhalation of large and small airborne droplets.large and small airborne droplets.

Susceptible organismSusceptible organism - no immunized - no immunized persons, older than 6 month, which never persons, older than 6 month, which never had measles.had measles.

Clinical presentationClinical presentation

The incubation periodThe incubation period 9 - 17 (21!) days. 9 - 17 (21!) days. Prodromal periodProdromal period - 3 - 5 days. - 3 - 5 days.

– TemperatureTemperature is usually high at first day. is usually high at first day.– The classic three “C’s” (The classic three “C’s” (cough, coryza, cough, coryza,

conjunctivitisconjunctivitis). ). – the the enanthema orenanthema or Koplik’s spotsKoplik’s spots. They . They

usually disappear by the second day of usually disappear by the second day of the exanthema.the exanthema.

Measles conjunctivitisMeasles conjunctivitis

Koplik’s spotsKoplik’s spots

Measles enanthemaMeasles enanthema

Exanthema period:Exanthema period: 3-4 days 3-4 days Second increase of temperature. Second increase of temperature. Initial lesions on the forehead and face. Initial lesions on the forehead and face. During 3-4 days they spread downwardDuring 3-4 days they spread downward The rash is red maculopapular, initially The rash is red maculopapular, initially

discrete then confluent.discrete then confluent. Ctarrhal signs progressCtarrhal signs progress Koplick’s spots and enanthema remain for 1-

2 daysPigmentation periodPigmentation period (1-1.5 weeks) (1-1.5 weeks) Pigmentation progresses in the same fashion Pigmentation progresses in the same fashion

as the rash, than desquamation as the rash, than desquamation (microscalling) (microscalling)

Normalisation of the temperatureNormalisation of the temperature Ctarrhal signs resolvesCtarrhal signs resolves

Measles, typical rashes, 2Measles, typical rashes, 2ndnd dayday

Measles, hemorrhagic Measles, hemorrhagic rashesrashes

Measles, pigmentation period

ClassificationClassification By the formBy the form::

– typicaltypical, , by the severityby the severity:: mildmild;; moderatemoderate;; severesevere ( (without hemorrhagic syndromewithout hemorrhagic syndrome, , with hemorrhagic with hemorrhagic

syndromesyndrome););– AtypicalAtypical - -

abortiveabortive;; mitigiousmitigious;; hyperreactivehyperreactive;; subclinicalsubclinical;; asymptomaticasymptomatic;; measles in vaccinatedmeasles in vaccinated;; measles in person who receive antibiotics and hormonesmeasles in person who receive antibiotics and hormones..

By the courseBy the course: : – smoothsmooth ( (uncomplicateduncomplicated););– not smooth, unevennot smooth, uneven ( (complicatedcomplicated).).

Laboratory work-upLaboratory work-up common laboratory testscommon laboratory tests are non- are non-

specific.specific.– leukopenia, lymphocytosis, leukopenia, lymphocytosis,

eosynophylia, and thrombocytopenia eosynophylia, and thrombocytopenia (may be) (may be)

serological testserological test (DHAR, PHAR), (DHAR, PHAR), Immune enzyme analysis Immune enzyme analysis

virus isolationvirus isolation (nasopharyngeal (nasopharyngeal smears) is technically difficultsmears) is technically difficult

Cytoscopic examinationCytoscopic examination presence of presence of typical multinuclear giant cellstypical multinuclear giant cells

Scarlet Scarlet fever, fever,

localisatiolocalisation of n of

rashesrashes

TreatmentTreatment Adequate hydration, bed rest; Adequate hydration, bed rest;

vitaminized food; vitaminized food; Antipyretics for fever control: Antipyretics for fever control:

– paracetamol paracetamol 10-15 mg/kg not often than 10-15 mg/kg not often than every 4 hours or every 4 hours or ibuprophenibuprophen 5-10 mg/kg per 5-10 mg/kg per dose, not often than every 6 hours. dose, not often than every 6 hours.

Nasal decongestants Nasal decongestants not more than 3 daysnot more than 3 days, in , in infants before 6 mo physiologic saline solution infants before 6 mo physiologic saline solution

Mucosolvents and cough supressors; Mucosolvents and cough supressors; Vitamin A 200 000 Units orally dailyVitamin A 200 000 Units orally daily Care for oral cavity, conjunctiva. Care for oral cavity, conjunctiva.

Rubella Rubella (German measles) (German measles)

It is caused by RNA rubella virus, It is caused by RNA rubella virus, which belongs to the Togaviridae which belongs to the Togaviridae family, Rubivirus genus. family, Rubivirus genus.

TransmissionTransmission

the source of infectionthe source of infection is a patient is a patient or carrieror carrier

the mechanism of transmissionthe mechanism of transmission is is air-droplet, transplacentalair-droplet, transplacental

receptivityreceptivity is common, especially is common, especially high in children 2-9 yearshigh in children 2-9 years

CLINICAL PICTURE CLINICAL PICTURE of the of the Acquired RubellaAcquired Rubella

Incubation period Incubation period is 14-21daysis 14-21days

Prodromal phase:Prodromal phase: 1-2 days before the onset of 1-2 days before the onset of rash: rash:

– Headache; Low-grade fever; Chills; Anorexia; Headache; Low-grade fever; Chills; Anorexia; Nausea;Nausea;

– Eye pain, Conjunctivitis; Eye pain, Conjunctivitis; – Sore throat;Sore throat;– Tender lymphadenopathy (particularly Tender lymphadenopathy (particularly

posterior auricular and suboccipital lymph posterior auricular and suboccipital lymph nodes); nodes);

– Forchheimer signForchheimer sign - pinpoint or larger - pinpoint or larger petechiae that usually occur on the soft palatepetechiae that usually occur on the soft palate

ChickenpoxChickenpox

ChickenpoChickenpox, typical x, typical localizatiolocalizatio

n of n of rashesrashes

Chickenpox, rashes on Chickenpox, rashes on mucus membranesmucus membranes

ClassificationClassification– By the typeBy the type: :

typical formstypical forms atypical forms (subclinical, bullous, atypical forms (subclinical, bullous,

hemorrhagic, gangrenous, generalized)hemorrhagic, gangrenous, generalized)– By the severityBy the severity: :

MildMild ModerateModerate SevereSevere

– By the courseBy the course: : smooth (uncomplicated)smooth (uncomplicated) uneven (complicated)uneven (complicated)

Hemorrhagic form

ComplicationsComplicationssecondary bacterial secondary bacterial - - Staphylo- or streptodermiaStaphylo- or streptodermia otitis, pneumoniaotitis, pneumonia

Viral: Viral: pneumonia pneumonia croup croup Encephalitis (involvement of the Encephalitis (involvement of the

cerebellum, or cerebrum)cerebellum, or cerebrum) less common – Guillain-Barre syndrome, less common – Guillain-Barre syndrome,

transverse myelitis, optic neuritis, and transverse myelitis, optic neuritis, and facial nerve palsy.facial nerve palsy.

Scarlet feverScarlet fever

Scarlet fever Scarlet fever is an acute infectious is an acute infectious disease, that is caused by group A disease, that is caused by group A ββ--hemolytic streptococcushemolytic streptococcus

Clinical presentation:Clinical presentation: acute onsetacute onset fever (often above 39fever (often above 39C), C), sore throat (often with dysphagia), sore throat (often with dysphagia), Erythema and enanthema on the soft palate. Erythema and enanthema on the soft palate. purulent tonsilar exudates. purulent tonsilar exudates. Anterior cervical lymph nodes are tender and Anterior cervical lymph nodes are tender and

enlarged. enlarged.

Coated than swollen, red tongue (Coated than swollen, red tongue (strawberry strawberry tonguetongue). ).

Other features are nausea and vomiting, Other features are nausea and vomiting, headache, abdominal discomfort. headache, abdominal discomfort.

Scarlet fever, pharyngitis, Scarlet fever, pharyngitis, enanthemaenanthema

Scarlet Scarlet fever, fever,

pharyngpharyngi-tis, i-tis,

tonsillititonsillitiss

Strawberry Strawberry tonguetongue

a a rash appears 1-2 days after the onset. appears 1-2 days after the onset. first on the neck and then on the trunk and first on the neck and then on the trunk and

extremities through 24 hours.extremities through 24 hours. dusky red, blanching tiny papules that have a dusky red, blanching tiny papules that have a

rough texture ("rough texture ("sand papersand paper" sign)." sign). flushing face with circumoral pallor (flushing face with circumoral pallor (Filatov’s Filatov’s

signsign). ). the rash the rash is intensified in skin foldsis intensified in skin folds and at and at

sites of pressure. sites of pressure. Pastia’s lines:Pastia’s lines: In the antecubital and axillary In the antecubital and axillary

fosses linear petechiae with accentuation of fosses linear petechiae with accentuation of the erythema.the erythema.

Papules are usually absent at palms, and solesPapules are usually absent at palms, and soles

Scarlet Scarlet fever, fever,

localisatiolocalisation of n of

rashesrashes

Scarlet fever, morphology of Scarlet fever, morphology of rashesrashes

Scarlet Scarlet fever, fever,

intensive intensive rashes in rashes in the sites the sites

of of pressurepressure

Filatov’s Filatov’s signsign

Pastia’s linesPastia’s lines

The exanthema lasts 4 - 5 days The exanthema lasts 4 - 5 days then desquamate, first on the face last on then desquamate, first on the face last on

the palms and soles. the palms and soles. Pharyngitis usually resolves in 5 to 7 days.Pharyngitis usually resolves in 5 to 7 days.

Desquamation of the skin Desquamation of the skin

ClassificationClassification 1.1. Form: Form:

– typical;typical;– atypical: atypical:

subclinical;subclinical; extra pharyngeal (burns, wounds, post-natal, after extra pharyngeal (burns, wounds, post-natal, after

operations, delivery);operations, delivery); with aggravated symptoms (hypertoxic, hemorrhagic).with aggravated symptoms (hypertoxic, hemorrhagic).

2.2. Severity: Severity: – mild;mild;– moderate;moderate;– severe: toxic, septic, toxic-septic.severe: toxic, septic, toxic-septic.

3.3. Course: Course: – smooth;smooth;– uneven (relapses, complications).uneven (relapses, complications).

Purulent Complications:Purulent Complications: otitis media, otitis media, lymphadenitis, lymphadenitis, perytonsilar abscess, perytonsilar abscess, necrotizing tonsillitis, necrotizing tonsillitis, sepsis, sepsis, Pneumonia, Pneumonia, Sinusitis, Sinusitis, Meningitis, Meningitis, Bone or joint problems (osteomyelitis Bone or joint problems (osteomyelitis

or arthritis)or arthritis)