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Fifth stage
Pediatric
Lec. 1
.د
رياض
22/2/2017
Mumps,Measles,Rubella
Mumps
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.
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
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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
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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.
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
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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
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Treatment
Mainly supportive as antipyretics and rehydration and respiratory support ..
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.
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 2
nd
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.
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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 trans placental 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.
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