FEVAR AND RASH pdf - محمد ادريس

Pediatrics Fifth Stage – G:E FEVAR AND RASH

FEVAR AND RASH

MEASLES

Agent that cause the infection

  Agent- RNA virus (Paramyxo virus family, genus Morbillivirus)
  Source of infection-cases of measles,
  but not carriers.
  No animal reservoir
  Infective material- Nasal secretion, Respiratory tract &Throat
  Communicability- Highly infectious during prodromal period and at the

time of eruption.

 Secondary attack rate- > 80%

Clinical features

-  Prodromal stage
-  Eruptive stage
-  Post-measles stage

 I. P 1-2 wks. Prodromal symptoms - fever, malaise, dry (occasional

croupy) cough, coryza, conjunctivitis c clear d/c, marked photophobia

 1-2 days’ prodromal symptoms - Koplik spots on the buccal mucosa
 Koplik spots - tiny, bluish-white dots surrounded by red halos opposite

to 2

molar teeth.

 Day 4-7 blotchy, erythematous, blanching, maculopapular exanthem

appears

 Rash begins at the hairline and spreads cephalocaudally and involves

palms and soles

 Rash typically lasts 5 - 6 days
 Can see desquamation in severe cases

Pediatrics Fifth Stage – G:E FEVAR AND RASH

 Patients can be systemically ill
 Patients contagious from 4 days prior to the rash until 4 days after

the resolution of the rash

 Highly contagious - 90% for susceptible people
 High morbidity and mortality common in children in underdeveloped

countries

 Peak season is late winter to early spring
 Potential complications - OM, PNA, obstructive laryngotracheitis,

acute encephalitis

 Vaccination is highly effective in preventing disease

Pediatrics Fifth Stage – G:E FEVAR AND RASH

Rubella (german measles)

 Little or no prodrome in children
 In adolescents - 1-5 days of low-grade fever, malaise, headache,

adenopathy, sore throat, coryza

 Exanthem - discrete, pinkish red, fine maculopapular eruption - begins

on the face and spreads cephalocaudally

 Rash becomes generalized in 24 hours and clears by 72 hours
 Forchheimer spots - small reddish spots on the soft palate - can

sometimes be seen on day 1 of the rash

 Arthritis and arthralgias - frequent in adolescents and young women -

beginning on day 2 or 3 lasting 5-10 days

 Up to 25% of patients are asymptomatic - serology testing may be

necessary to establish the diagnosis

 Important in establishing the diagnosis if the patient is pregnant or has

been in contact c a pregnant woman

 Peaks in late winter to early spring

Pediatrics Fifth Stage – G:E FEVAR AND RASH

 Contagious from a few days before the rash to a few days after the

rash

 Incubation period 14-21 days
 Complications - rare in childhood - arthritis, purpura c or s

thrombocytopenia, mild encephalitis

Congenital rubella syndrome

 Infection of seronegative mother during pregnancy
 Risk of fetal infection

– I. trimenon: 75-90%

– II. trimenon: 20-40%

– III.trimenon: 25-50%

– Fetal lesion

» 1-8. gest. week: 80%

» 9-12. gest. week: 30%

» 13-20. gest. week: 10%

Varicella (chickenpox)

  Caused by varicella-zoster virus
  Highly contagious
  Brief prodrome of low-grade fever, URI symptoms, and mild malaise

may occur

  Rapid appearance of pruritic exanthem
  Lesions appear in crops - typically have 3 crops
  Crops begin in trunk and scalp, then spread peripherally
  Lesions begin as tiny erythematous papules, then become vesicles

surrounded by red halos

Pediatrics Fifth Stage – G:E FEVAR AND RASH

 Lesions began to dry - umbilicated appearance, then surrounding

erythema fades and a scab forms

  Hallmark - lesions in all stages of evolution
  All scabs slough off 10-14 days
  Scarring not typical unless superinfected
  Cluster in areas of previous skin irritation
  Puritic lesions on the skin
  Painful  lesions  along  the  oral,  rectal,  and  vaginal  mucosa,  external

auditory canal, tympanic membrane

 Occurs year-round, peaks in late autumn and late winter through early

spring

  Incubation period ranges from 10-20 days
  Contagious 1-2 days prior to rash until all lesions are crusted over
  Complications  -  secondary  bacterial  skin  infections  (GAS),

pneumonia, hepatitis, encephalitis, Reye syndrome

 Severe in the immunocompromised host - can be fatal
 Can have severe CNS, pulmonary, generalized visceral involvement

(often hemorrhagic)

 Need to get varicella-zoster immunogloblin 96 hours post-exposure to

possible varicella

Pediatrics Fifth Stage – G:E FEVAR AND RASH

Roseola infantum (exanthem subitum)

 Febrile illness affecting children 6-36

months

 Human herpesvirus 6 is causative agent
 Symptoms include:

– fever, usually >39

– anorexia

– irritability

– these symptoms subside in 72

hours

 As fever subsided, usually an erythematous, maculopapular rash that

appear on the trunk and then spread to the extremities, face, scalp,
and neck

  Occurs year-round
  More common in late fall and early spring
  Incubation period thought to be 10-15 days

Scarlet fever

Introduction

1- A kind of acute infectious disease of respiratory tract
2-

Group A β-hemolytic streptococcus

3- Main clinical manifestation:

-  acute fever
-  pharyngitis
-  diffuse and red exanthem(rash)

Pediatrics Fifth Stage – G:E FEVAR AND RASH

desquamation and hyperpigmentation

-  2~3weeks later
-  rheumatic fever
-  glomerulonephritis
-  arthritis

Etiology

Group A β-hemolytic streptococci

1- Morphology and structure
- Gram-positive spherical cocci

Diameter: 0.6~1.0 μm

- Capsule (+) flagellum and spore (-)

- Streptococcus groups: A~H & K~U on the basis of C-carbohydrate

within the cell wall

- Group A: more than 80 immunologically distinct types that are based

on differences in the M protein.

2- Pathogenecity
- M protein: resists phagocytosis

- resist phagocytosis,

- promote Schwartzman

- reaction

- Streptokinase

- Streptodornase

- Streptolysin O & S: WBC, RBC & platelet

- Hyaluronidase: hyaluronic acid

Epidemiology

1- Source of infection:

- Patients in scarlet fever or pharyngitis

Pediatrics Fifth Stage – G:E FEVAR AND RASH

-  Carriers with streptococci in nasal and pharyngeal
2- Route of transmission:
-  droplet, skin lesion, food, milk and water and so on.
3- Susceptibility of population
–  Anti-bacterium immunity anti-M
–  Anti-pyrogenic toxin immunity
4- The feature of epidemiology

- season, age, endemic area, variation of this disease

Pathogenesis

1- Suppurative change
- Pathogenepithelial cellsdiffusion in local tissue

LTA hyaluronidase

M protein streptokinase, streptodornase

capsule streptolysin

 Suppurative change

-  pharyngitis, tonsillitis
-  peritonsillar abscess
-  retropharyngeal abscess
-  otitis media, sinusitis
-  lymphangitic-----lymphadenitis
-  bacteremia (sepsis, osteomyelitis, pneumonia)

2- Toxic change

pyrogenic exotoxin (erythrogenic exotoxin)

fever

scarlatina rash other toxic symptoms

Pediatrics Fifth Stage – G:E FEVAR AND RASH

3- Allergic reactive change 2~3weeks later,

Heart-------rheumatic fever

Kidney-----glomerulonephritis

joint---------arthritis

Reason:

1- similar antigencrossed immune reaction
2- immune complex

Clinical manifestation

- Incubation period 2~3days(1~7days)

Character of clinical manifestation:

Fever, Pharyngitis, scarlatina rash

1- Fever

a- feature: persistent, fever & rash
b- temperature.: 39~40

℃

c- accompanied symptoms: headache, weakness, poor appetite
d- course: 1 week

2- Pharyngitis

- Symptom
- sign

3- Rash

a- fever & rash: 24 hours
b- initial position: ear, neck, upper chest

c- feature: diffuse papular (punctate or finely), miliary sudamina (not so

many),  circumoral  pallor,  strawberry  tongue,  red  strawberry  tongue,
Pastia  lines(antecubital  fossate),  desquamation  and  hyperpigmenta-
tion

Pediatrics Fifth Stage – G:E FEVAR AND RASH

Type of clinical manifestation

-  light type
-  toxic type
-  sepsis type
-  surgery type
-  obstetrics type

Scarlat fever

(Group A Streptococcus, erythrogenic toxin, fine papular exanthem,
palmar/ plantar peeling).

Laboratory examination

1- peripheral picture: WBC, neutrophil 80%
2- Urine allergic reaction: protein RBC, WBC, cylindruria
3- bacteriology test: Immunological fluorescence, assay(IFA), bacteria

culture

Pediatrics Fifth Stage – G:E FEVAR AND RASH

Complication 2~3 weeks later

-  rheumatic fever
-  glomerulonephritis
-  arthritis

Diagnosis

1- clinical data: fever, pharyngitis, rash
2- laboratory test: peripheral picture,

-  Urine
-  Bacteriology test
-  Dick test (pyrogenic test)

3- epidemiology data

Pediatrics Fifth Stage – G:E FEVAR AND RASH

Differential diagnosis

1- staphylococcus infection
2- drug rash
3- Virus rash: measles, rubella etc.

Treatment

A. Supportive
B. Specific
1- penicillin

- adult: 80万U/ time, bid 5~7days.

- child:20万U/ (kg d), 10days

- 800万U/d(adult)

2- erythromycin

Prevention

1. Isolation: patients in scarlet fever

2. protection: