1. DR;RIADH ABDULATIF ALOBAIDY
Mumps,Measles,Rubella
DR;RIADH ABDULATIF ALOBAIDY

2. differential diagnosis of Fever and rash syndrome
1-Maculopapuler;measles,roseola,fifth disease, EB virus, scarlet fever, ricketsiae. 2-Diffuse erythema; scarlet fever, toxic shock syndrome(staph. aureus). 3-Urticarial; mycoplasma, EB virus 4- vesiculobullous; Herpes simplex, varicella, staphyllococcal bullous impetigo. 5.petechial; meningococcemia

3. 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

4. transmission
Mumps is spread from person to person by respiratory droplets. Virus appears in the saliva from up to 7 days before to as long as 7 days after onset of parotid swelling. The period of maximum infectivity is 1-2 days before to 5 days after onset of parotid swelling

5. CLINICAL FEATURES
The incubation period is 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

6. Mumps and normal

7. Differential diagnosis
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. Submandibular or anterior cervical adenitis due to a variety of pathogens may also be confused with parotitis.

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

9. Meningoencephalitis
Symptomatic m.e. occurs in only10-30% of mumps cases, but CSF pleocytosis has been found in 40-60% of patients as subclinical more than apparent meningitis. The meningoencephalitis is usually benign, may occur before, along with, or following the parotitis

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

11. 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 immunodeficient child.

12. Measles
Measles is highly contagious disease. Owing to widespread vaccination, transmission is limited . RNA virus in the family Paramyxoviridae and genus Morbillivirus

13. 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

14. 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 conjunctivitis with photophobia, coryza, cough, and increasing fever Koplik spots represent the enanthem and are the pathognomonic sign of measles, appearing 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%.

15. KOPLIK SPOTS

16. MEEASLES

17. 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.

18. 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

19. Complications
Pneumonia is the most common cause of death in measles. It may manifest as giant cell pneumonia caused directly by the viral infection or as superimposed bacterial infection.. Vomiting and diarrhea even bloody. Encephalitis 1:3000 of cases infection may be fatal. Rarely Fatal Hemorrhagic measeles (black measles) leading to hemorrhagic skin lesions. Subacute sclerosing panenecephalitis is rare . It is slow virus infection infect the CNS developed in 7-10 years after measles and it is fatal.

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

21. 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 mo of age; the 2nd is recommended at 4-6 yr of age. For immune deficient if exposed to a case immune globulin I M should be given.

22. RUBELLA
Rubella (German measles or 3-day measles) is a mild, often exanthematous disease of infants and children. Adult also can get the infection. Its major clinical significance is transplacental infection when pregnant get it , and fetal damage as part of the congenital rubella syndrome .

23. Clinical Manifestations
Postnatal infection rubella is a mild disease . Following an incubation period of days, a prodrome consisting of low-grade fever, sore throat, red eyes , lymphadenopathy ;Suboccipital, postauricular, and lymph nodes are 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

25. Congenital rubella syndrome
Deafness , Cataracts , Patent ductus arteriosus , pulmonary artery stenosis mental retardation ,Neonatal purpura, Death( intrauterine) %35. As part of TORCHS syndrome