Exanthematous diseases - Etiology ________________________________________________________________ Diseases Etiology __________________________________________________________ Measles Morbillivirus (RNA) (Rubeola) (Paramyxoviridiae family) (5-10 yr) Rubella Rubivirus (RNA) German measles (Togaviridiae family) (6-9 yr) Erythema infectiosum Parvovirus B19 (1995) (2-12 yr) Erythrovirus genus (Parvoviridiae family) Exanthema subitum HHV-6 (1986) and HHV-7 (1990) (Roseola) (<3 yr)

Exanthematous diseases - Source and Spreading ________________________________________________________________ Diseases Source Spreading __________________________________________________________ Measles man droplet, airborne (Rubeola) Rubella man droplet, urine, (German measles) transplacental Erythema infectiosum man droplet, blood (Fifth disease) Exanthema subitum man droplet (Roseola)

Exanthematous diseases - Communicability and Season _______________________________________________________________ Diseases Communicability Season __________________________________________________________ Measles 5 d before rash winter, spring 5 d after rash Rubella 7 d before rash winter, spring 7 d after rash Erythema infectiosum unknown spring Exanthema subitum unknown throughout the year

Exanthematous diseases – Clinical manifestation ___________________________________________________________________ Diseases Clinical manifestation ____________________________________________________________ Measles Incubation time: 8-12 days. cough, coryza, conjunctivitis, enanthema, Koplik’s spots, leucopenia; confluent, maculopapules, erythematous exanthems Rubella Incubation: 14-21 days. 50 % asymptomatic; lymphadenopathy, low-grade fever, malaise, leucopenia; polyarthralgia, polyarthritis; discrete, maculopapules, pink exanthemas Erythema Incubation: 4-28 days. infectiosum fever (<30%), MURTI; Rash in three phases: 1) slapped cheek; 2) maculopapular, lace-like (arms-trunk-thigh) 3) fluctuating rashes Exanthema Incubation: 7-14 days. subitum fever (3 d), MURTI; Rash (2 d); Irritability, febrile seizures, mononucleosis-like illness. Fever without rash.

Exanthematous diseases – Diagnosis and treatment _______________________________________________________________ Diseases Diagnosis Treatment __________________________________________________________ Measles Serology Supportive Virus isolation Vitamin A Rubella Serology Supportive Virus isolation Erythema infectiosum Serology Supportive PCR Exanthema subitum Serology Supportive

9 - TSS Fever: temperature 38.9°C ( 102.0°F) Rash: diffuse macular erythroderma Desquamation: 1–2 wk after onset, particularly on palms, soles, fingers, and toes Hypotension: systolic pressure 90 mm Hg for adults; lower than fifth percentile for age for children younger than 16 years of age; orthostatic drop in diastolic pressure of 15 mm Hg from lying to sitting; orthostatic syncope or orthostatic dizziness

TSS Multisystem organ involvement: >3 of the following: Gastrointestinal: vomiting or diarrhea at onset    Muscular: severe myalgia or CPK greater than twice the upper limit of normal   Mucosal hyperemia vaginal, oropharyngeal, or conjunctival    Renal: CN or Cr greater than twice the upper limit of normal Hepatic: SeBi, GOT, GPT greater than 2x the upper limit of N Hematologic: Thrombocytopenia   CNS: disorientation or alterations in consciousness without focal neurologic signs