Varicella ,Measless , Mumps

8/13/2019 Varicella ,Measless , Mumps

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Varicella ,measless ,

mumpsEndemic desease


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Varicella

Etiology :

Transmitted via respiratory droplets and /

or contact with lessions

Infectious peroide begins 2 days before

skin lession and ends when the lessions

crust , usually 5 days later

An episode of varicella confers immunocity

, second episode are exceedingly rare


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Epidemiology

Before varicella vaccine became widespread, 4million cases of chickenpox were reportedannually in the US , with 11.000 hospitalizationand 50100 deaths annualy

Maximum incidence of varicella in children aged16 years

Maximum transmission occurs during late winter

and spring Highly contagius : secondary attack rate is 80

100 % for contacts


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Sign and symptom

Rash ussually start on the head and trunks andspreads to the rest of the body

Varicellas hallmark is the simultaneouspresence of rash in different stages

Each lesion starts as ared macula and passthrough stages of papula , vesicle ( pear ordewdrop on rose petal ), pustule, and thencrusts

Other accompanying manifestasion includeheadache , malaise , anorexia , cough andcoryza , sore throat , and low grade fever


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Diagnosis

Clinical diagnosis based on the

characteristic appearance of the rash

Tzanck smear of scrapping from the base

of veisicles will show multinucleated giant

cells

Serologic test can be done to assess pior

exposure to varicella but have little

diagnostic value during acut infection


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Differential diagnosis

Contact dermatitis

Drug reaction

Enterovirus

Insect bites

Impetigo

Smallpox

Urticaris

Herpes simplex virus ( HSV )


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Treatment

Symptomatic relief of fever and itching

Do not use aspirin ( associated with Reyesyndrome )

Antiviral ( acyclovir ) are used in some cases Progressive or severe varicella

Life threatening complications ( e.g. Encephalitis ,pneumonia )

Neonate or asolescent / adult patient ( because highrisk of severe desease )

Patient with cancer or on steroid or otherimmunosuppresive therapies


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Universal vaccination with live virus has

significantly reduced morbidity and

mortality ; confers protection to 75100%

of those immunizied ( children withimmunodeficiencies ( HIV , cancer ,

steroid or other immunosuppressive

regimen ) should not recive the varicellavaccine or any other live vaccine product


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Prognostic / Clinical course

An other wise helthy child usually has 250500 lessions( but may have as few as 10 or as many as 1.500 )

New lesions continue to erupt for 35 days

Lessions usually crust within 1 week and heal completely

by 2 weeks Contagius from 2 days before skin lessions appear until

the lessionss crust

Nearly 1 in 50 cases of varicella may be associated withcomplication ( i.e. Varicella pneumonia and encephalitis )

Secondary bacterial infection may occur with invasivegroup A streptococcus, a serious infection thet mayenvolve rapidly into necrotizing fascitis or toxic shocksyndrome


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Measles

Primary infection occurs in the respiratory epithelium ofthe nasopharynx

After 23 days , viremia ensues with infection of thereticuloendothelial system

A second viremia occurs 57 days after initial infection Rash develops about 14 days after initial exposure

Highly contagius during both viremia periodsindividuals are also infectious 35 days before and up

to 4 days after the rash Transmitted via respiratory droplets


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Epidemiology

Typically occurs in prschool and young

schoolaged children

Occurs worldwide

Peak incidence in late winter and spring

>99% reduction of disease following

childhood immunizationMost cases in US occur in individuals who

recently entered the country


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Sign / symptoms

Prodome Fever , coryza , hacking or brassy cough , non purulent

conyungtivitis

Koplik spots ( 1- mm bluewith spots, characteristicallyopposite lower premolas and oral mucosa )

Exanthema phase Maculopapular eruption lasting 57 days ; typically begins on

faced/ head and progress to nhand / feet

Desquamation may occur

Generalized lymphadenopathy

Anorexia Diarrhea ( especially infant )

Fever may persist 7- 10 days


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Diagnosis

Primarily a clinical diagnosis : Kopliks spots arepathognomonic

Lekopenia / lympophenia

Elevated transaminases Serologigies are the most common methode for

diagnosis A single measuremet of measles Ig M confirms the

diagnosis; may be detected as earlty as the first dayof rash but may be falsely negative in 20 %

Measurement of meales IgG helaps to distinguishacute infection from prior vaccination


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Differential Dx

Enteroviral infection

Parvoviral infection

Rubella

Rosola Kawasaki desease

Toxic shock syndrome

Rocky mountain spotted fever Drug reaction ( e g. Stevens Johnsons

syndrome )


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Prevention with MMR vaccine is routinely

given at 1215 mont and 4 - years of

age ( vaccine failure after a single dose

occurs in 25 % of children , however ,most cases will respond to the second

dose )


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Prognosis / clinical course

Complication are most common in children < age 5 or >age 20 ( 30% of cases have at least one complication )

Acute otitis media ( 10 % ) , diarrhea ( 10 % )

Lower respiratory tract infection, bacterial infection (5%):

Bronkiolitis , bronkopneumonia, laryngotrakheobronkhitis, intersitial or lobar pneumonia

Acute ensephalitis (0,1%): occurs 6 days after onset ofrash , may result in seizures and / or neurologis damage

Subacute slerosing panencephalitis is a rare but fatalneurologis disese with progressive intelectualdeterioration , ataxia , seizures, and death : occurs anaverage of 7 years after meales infection


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Mumps

A viral infection that primary result inparotitis

Transmision via respiratory droplet

Contagius 2 days before through 5 daysafter the onset of parotitis

Incubation period of 2 weeks , average

duration of illness 710 days Prior MMR vaccine , mumps was the

greteast cause of aseptic meningitis


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Epidemiology

Seasonal peaks in winter and spring butcan occur any time

Peak incidence in children ages 59

Fewer than 1.000 cases per year in USsince MMR vaccine was introduced

Despite high immunization rates ,

outbreaks of mumps still occur Permanent unilateral deafnes occur in 1 /

20.000 persons


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Sign/ symptoms

Prodome : myalgia , anorexia , malaise headeache, lowgrade fever , chill

Patrotitis is the most common manifestasion (30-40%) Occurs within the first 2 days of illness , unilateral or bilateral

involvement of parotid gland, salivary gland involment Manifest as ear pain

Tender to palpation at angle of jaw, edema anterior to ear ,overlying skin is not erythematous ( as opposed to bacterialparotitis )

Trismus may be prsent

Asymptomatic in 20 %


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Diagnosis

Primarly a clinical diagnosis

Serologic assay are the most common

methode of diagnosispresence of mump

IgM alone confirm diagnosis , may be

detected within first week of desease viral

culture of urine , saliva , and /or CSF

Labs may show lymphocytosis and

increase amylase


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Differensial Dx

Cytomegalovirus infection

Entroviral infection

Influenza infection

Para influenza infection

Parotis ductu obstruction

Bacterial parotitis

Tumor of salivary gland

Mikulicz syndrome


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Treatment

Supportive care

MMR is alive vaccine thet confers life long

immunity ;given in two doses at 1215

month and then again at 46 years


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Prognosis / Clinical Course

Menungoencephalitis is the most common complication Most cases are symptomatic

Symptomatic meningitis occurs in 15 % of cases but generrallyresolves withour sequale

In the pervaccin era , mumps was the most commoncause of aquired sensorineural hearing loss

Orchitis is the most common complication in postpubertal males ( 50% ) , resulting in abrupt onset oftesticular swelling , pain , nause , vomiting , fever , and

possible atrophy Oophoritis , pancreatitis , and myocardium may occur

Increased severity of disease in adults


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Kepustakaan

Buku kuliah 2 Ilmu kesehatan anak FK UI :

Morbili ( campak,measles,Rubeola ) hal

624

Parotitis epidemika ( Gondong, Mumps)

hal 629

Varisela ( Cacar air, Chicken Pox ) hal

637

Varicella ,Measless , Mumps

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