DISEASE CHICKEN POXVaricella

MEASLESRubeola

GERMAN MEASLESRubella

MUMPSInfectious Parotitis

DIPTHERIA

CAUSE Varicella-zoster virus RNA virus Virus Rubulavirus in the Paramyxoviridae family

Corynebacterium diphtheriae

INCUBATION 10-21 days 8-12 days 14-23 days 16-18 days 2-7 days or longerCommunicability 5 days after onset of rash

and until all lesions are crusted.

From 4 days before to 5 days after rash appears.

During prodromal period and for 5 days after appearance of rash.

1-2 days before swelling to 5 days after onset of swelling.

In untreated persons, organisms can be present in discharges from the nose and throat and from eye and skin lesions for 2-6wk after infection.

ROUTE Airborne, droplet infection; direct or indirect contact. Dry scabs are no infectious.

Direct contact; airborne by droplets and contaminated dust.

Direct contact with secretions of nose and throat of infected person; airborne by contaminated dust particles.

Direct or indirect contact with salivary secretions of infected person. Droplet.

Droplets from respiratory tract of infected person or carrier; contact with discharges from skin lesions.

MAJORSYMPTOMS

General malaise, slight fever, anorexia, headache. Successive crops of macules, papules, vesicles, crusts. These may all be present at the same time. Itching of the skin. Generalized lymphadenopathy.

Coryza, conjunctivitis, and photophobia are present before rash. Koplik spots in mouth, hacking cough, high fever, rash, and enlarged lymph nodes. Rash consists of small reddish brown or pink macules changing to papules; fades on pressure. Rash begins behind ears, on forehead or cheeks, progresses to extremities, and last about 5 days.

Fetus may contract rubella in utero if mother has disease; slight fever, mild coryza. Rash consists of small pink or pale red macules closely grouped to appear as scarlet blush that fades on pressure. Rash fades in 3 days. Swelling of posterior cervical and occipital lymph nodes. No Koplik spots or photophobia as in measles.

Salivary glands are chiefly affected. Parotid, sublingual, and submaxillary glands may be involved. Swelling and pain occur in these glands either unilaterally or bilaterally. Child may have difficulty swallowing, headache, fever, and malaise.

Local and systemic manifestations. Membrane over tissue in nose or throat at site of bacterial invasion. Hoarse, brassy cough with stridor. Toxin from organism produces malaise and fever. Toxin has affinity for renal, nervous, and cardiac tissue.

TREATMENT Oral acyclovir should be considered for otherwise healthy people at increased risk (e.g. people older than 12 yr of age, individuals with pulmonary disorders). IV antiviral therapy is recommended for immunocompromised children.

Symptomatic. Keep child in bed until fever and cough subside. Light in room should be dimmed. Keep hands from eyes. Irrigate eyes with physiologic saline solution to relieve itching. Tepid baths and soothing lotion relieve itching of skin. Encourage fluids during fever. Humidify the child’s room. Antimicrobial therapy given for complications.

Symptomatic. Bed rest until fever subsides. Children should be excluded from school or daycare for 7 days after onset of rash.

Local application of heat or cold to salivary glands to reduce discomfort. Liquids or soft foods are given. Foods containing acid may increase pain. Bed rest until swelling subsides.

A single dose (IV preferred) of equine antitoxin should be administered on the basis of clinical diagnosis, even before culture results are available (test for sensitivity to horse serum).Equipment for suctioning should be available. Oxygen and emergency tracheostomy may be necessary. Isolate.

TREATMENTcontinued

Symptomatic. Prevent child from scratching. Keep fingernails short and clean. Sedation may be necessary. Use soothing lotions to allay itching. If secondary infections occur, antimicrobials may be given. Do no give aspirin because of high risk for reye syndrome. Salicylate therapy should be stopped in a child who is exposed to varicella.

Vitamin A supplementation is recommended once daily for 2 days to reduce mortality. Immunoglobulin (IG) can help prevent or modify measles within 6 days of exposure.

Infants with congenital rubella should be considered contagious until 1yr of age unless cultures are repeatedly negative.

Children are excluded from school or daycare for 9 days from onset of parotid gland swelling. Mumps vaccine should be given at least 2wk before or 3mos after administration of IG or blood transfusion.

Antimicrobial therapy with erythromycin or penicillin G procain is given for 14 days in addition to antitoxin. Strict bed best. Prevent exertion. Cleansing throat gargles may be ordered. Liquid or soft diet. Gavage or parenteral administration of fluids may become necessary. Observe for respiratory obstruction.

COMPLICATIONS Bacterial superinfection; thrombocytopenia, arthritis, encephalitis, nephritis, Reye syndrome (with aspirin use).

Vary with severity of disease: otitis media, pneumonia, tracheobronchitis, nephritis. Encephalitis with permanent brain damage may occur. Death

Chief danger of disease is damage to fetus if mother contracts infection during first trimester of pregnancy. Neonate may have congenital rubella syndrome with permanent

Complications are less frequent in children than in adults.Meningoencephalitis, inflammation of ovaries or testes, or deafness may occur.

Local infections: low-grade fever with gradual onset. Serious complications include severe neck swelling (bull neck), upper airway obstruction, myocarditis,

from respiratory and neurologic complications.Subacute sclerosing panencephalitis (SSPE), a rare degenerative central nervous syndrome (CNS) disease, may occur. The mean incubation period is 7 yr after measles illness.

defects (e.g. cataracts, cardiovascular anomalies, deafness, microcephaly, mental retardation). Virus can be isolated from blood, urine, throat, cerebrospinal fluid, lens, and other involved organs.Infants may shed virus for 12-18 months.Severe complications are rare. Encephalitis may occur.

and peripheral neuropathies.