infection

Mumps,Measles,Rubella

DR;RIADH ABDULATIF ALOBAIDY

Mumps is an acute self-limited infection, now unusual in developed countries because of widespread use of vaccination. It is characterized by fever, bilateral or unilateral parotid swelling and tenderness, and the frequent occurrence of meningoencephalitis and orchitis. Although no longer common in countries with extensive vaccination programs, mumps remains endemic. The infectivity: The transmission is by airborne droplets from pt. during 1-2 days before to 5 days after the parotid swelling
Mumps

CLINICAL FEATURES

The incubation period is 16-18 days resulting in clinical presentation ranging from asymptomatic to the typical illness associated with parotitis.
The typical patient presents with a prodrom 1-2 days and consisting of fever, headache, and vomiting. Parotitis then appears and may be unilateral ,then becomes bilateral in about 70% of cases .The parotid gland is tender, and may be accompanied by ear pain on the ipsilateral side. Sour foods or liquids may enhance pain in the parotid. As swelling progresses, the angle of the jaw filled and earlobule is pushed outward. The opening of Stensen duct may be red and edematous. The parotid swelling peaks in approximately 3 days, then gradually subsides over 7 days. Submandibular salivary glands may also be involved or may be enlarged without parotid swelling. Edema over the sternum due to lymphatic obstruction may also occur

Mumps and normal

Differential diagnosis

1.purulent parotitis, is usually caused by Staphylococcus aureus, unilateral, extremely tender, and is associated with an elevated white blood cell count, and may involve purulent drainage from Stensen duct. 2.submandibular or anterior cervical adenitis due to a variety of pathogens may also be confused with parotitis.

complications

The most common complications of mumps are meningitis, with or without encephalitis, and orchitis.
Uncommon complications include deafness, facial palsy, pancreatitis, and thrombocytopenia.
Congenital infection :with mumps during the 1st trimester of pregnancy results in increased fetal loss.
No fetal malformations have been associated with intrauterine mumps infection.


Meningoencephalitis
Symptomatic apparent meningitis or encephalitis occurs in only 10-30% of mumps cases, but subclinical condition with CSF pleocytosis has been found in 40-60% of patients as subclinical more than apparent meningitis. The meningoencephalitis is usually benign and subside and self-limiting, may occur before, along with, or following the parotitis

Orchitis

Orchitis in young boys is rare, but it is more frequent in adolescent and after puberty, in 30-40% of male cases.
Atrophy of the testes may occur, but sterility is rare even with bilateral involvement.

prevention

Antibody develops in 95% of children after 1 vaccine dose.. As a live- vaccine, MMR should not be administered to pregnant women or to a child with immune deficiency.

Measles

Measles is highly contagious disease.
Owing to widespread vaccination by MMR or single vaccine( measles vaccine) , transmission of the infections and its incidence become rare .
Measles virus is RNA virus in the family of Paramyxoviridae and the genus Morbillivirus

Transmission

The portal of entry of measles virus is through the respiratory tract or conjunctivae following contact with aerosol droplets in which the virus is suspended. Patients are infectious from 3 days before to 4-6 days after the onset of rash

Clinical manifestations

Measles is a serious infection characterized by high fever, and maculopapular rash.`
The incubation period is 8-12 days.
The prodromal phase (2-4) days begins as characteristic combinations of conjunctivitis with photophobia, coryza, cough, ccc and increasing fever
Koplik spots represent the enanthem and are the pathognomonic sign of measles, appearing 12-24 hours before the onset of the rash and it last for 1-2 days after rash appearance. They first appear as sandy white spots on minute red lesions in the inner aspects of the cheeks at the level of the lower premolars. Koplik spots present in 50-70% of cases.


KOPLIK SPOTS

MEEASLES

Clinical features con.

The rash begins on the forehead (along the hairline), and behind the ears as a red maculopapular eruption. It then spreads to the face and neck and downward to the trunk and limbs, and reaching the palms and soles.The rash last 5-6 days, then fades over about 7 days in the same manner as it evolved, often leaving a fine desquamation of skin. Of the major symptoms of measles, the cough lasts the longest, often up to 10 days. generalized lymphadenopathy may be present, with cervical and occipital lymph nodes enlargement together with the fever.

Diagnosis

Mainly clinical but confirming serological test can be done by high antibody IgM level .
Blood and urine samples for viral culture is the most commonly WHO protocol for detection of virus of the illness.
Differential diagnosis ; include other fever and rash illnesses like rubella , roseola, erythema infectiosum, scarlet fever

Complications

1. pneumonia is the most common complication and the cause of death in measles. It may manifest as giant cell pneumonia caused directly by the viral infection or as superimposed bacterial infection. Other respiratory complications like otitis media and croup can occur.
2. vomiting and diarrhea even bloody.
3.encephalitis 1:3000 of cases infection may be fatal. 4.rarely Fatal Hemorrhagic measeles (black measles) leading to hemorrhagic skin lesions.
5. subacute sclerosing panenecephalitis is rare . It is slow virus infection of the CNS developed in 7-10 years after measles and it is fatal.


treatment
Mainly supportive as antipyritics and rehydration and respiratory suppport .. Vitamin A deficiency is common in developing countries and is associated with high mortality and morbidity in measles, so it is recommended to give vit A to the patients with measles.
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prevention

Exposure of susceptible individuals to patients with measles should be avoided during period of infectivity .
A 2-doses schedule (with MMR) is recommended for full immunity. The first dose is recommended at 12-15 mo of age give 93% protection; the 2nd dose is recommended at 4-6 yr of age with protection reaches 97%. For immune deficient if exposed to a case; immune globulin I.M should be given.

RUBELLA

Rubella (German measles or 3-day measles) is a mild, often exanthematous disease of infants and children.
Adult can also get the infection.
Its major clinical significance is transplacental infection during pregnancy leading to fetal damage ; as congenital rubella syndrome .

Clinical Manifestations

Rubella is a mild disease . Following an incubation period of 14-21 days, a prodrom consisting of low-grade fever, sore throat, red eyes , with lymphadenopathy; ;Suboccipital and postauricular lymph nodes are the most prominent. In children, the 1st manifestation of rubella is usually the rash, which is variable and not distinctive. It begins on the face and neck as maculopapular, and it spreads to involve the trunk and extrimities .The duration of the rash is generally 3 days, and it usually resolves without desquamation






Congenital rubella syndrome
Deafness , Cataracts , Patent ductus arteriosus , pulmonary artery stenosis mental retardation ,Neonatal purpura, microcephaly ,jaundice with hepatitis.
Death( intrauterine) in %35 of cases.
it is one cause of the TORCHS syndrome