1. Department of Pediatric, Corse of Children Infectious Diseases
Sumy State University
Medical Institute
Department of Pediatric,
Corse of Children Infectious Diseases
Differential diagnosis infectious diseases with exanthemas
Part Lecturer
Bynda Tetiana P.

3. Rubella (German measles, 3-days measles, roseola)
The name rubella is derived from a Latin term meaning "little red."
The incubation is usually days

4. Prodromal phase
Prodromal symptoms are unusual in young children but are common in adolescents and adults.
The following signs and symptoms usually appear 1-5 days before the onset of rash: Eye pain, conjunctivitis; sore throat; headache; general body aches; low-grade fever;
tender lymphadenopathy (particularly posterior auricular and suboccipital lymph nodes);

5. Rubella: rash phase
The exanthema of rubella consists of a discrete rose-pink maculopapular rash ranging from 4-10 mm.
The exanthema that starts initially on the face and neck and spreads centrifugally to the trunk and extremities within 24 hours. It then begins to fade on the face on the second day and disappears throughout the body by the end of the third day.

6. Fever usually is not higher than 38.5°C (101.5°F).
Rubella: rash phase
Fever usually is not higher than 38.5°C (101.5°F).
Lymph nodes: enlarged posterior auricular and suboccipital lymph nodes are usually found on physical examination.

7. Rubella

8. Rubella

9. Краснуха
Rubella

10. Measles
Measles is an acute infectious disease that is caused by Morbillivirus; it is characterized by disturbance of general condition, inflammation of upper respiratory tracts, of mucous coat of oral cavity, of eyes and by appearence of maculo-papulous rash.

11. In most cases it occurs in children 2-7 years age.
Epidemiology
Measles is highly contagious.
In most cases it occurs in children 2-7 years age.
Postinfectious immunity is stable lifelong.

12. Clinical presentation
The incubation period is from 9 to 17 days.
In children who have been vaccinnated, or were given blood or plasma transfusions, the incubation period may even be as long as 21 days.

13. Prodromal period (the initial catarrhal period)
It is lasting 3 to 5 days (range 1–7 days).
It is characterized by
Fever.
The classic three “C’s” (cough, corryza, conjunctivitis).

14. Very typical alterations of the buccal and palatal mucosa occur
One or two days before the outbreak of the skin rash red irregular spots varying in size can be seen on the mucosa of the soft, and in part of the hard, palate.

15. Very typical alterations of the buccal and palatal mucosa occur
This eruption, known as enanthema, is an important early diagnostic sign of measles.
Fusing in one or two days, these spots become indistinguishable against the general background of hyperemic mucosa.

16. Belsky - Filatov - Koplik’s spots
At this time, the typical initial symptom of measles - Belsky - Filatov - Koplik’s spots – appears.
This spots mostly break out on the mucosa on the line of opposition of the molar teeth, and less commonly on the lip inner surfaces and on the gums, occasionally on the conjunctiva.

17. Belsky - Filatov - Koplik’s spots
Each element looks like a whitish papule, the size of a poppy-seed, surrounded by a narrow band of hyperemia, or areola. These specks are located in clusters, and are sometimes very numerous, but never fuse. They adhere closely to the mucosa and cannot be removed by swabbing.

18. Belsky - Filatov - Koplik’s spots
The spots persist for two or three days, and not infrequently can still be found on the first (even the second) day of the eruptive stage.
After their disappearance the mucosa remains hyperemic and velvety.

19. Belsky - Filatov - Koplik’s spots

20. Whitish depositions on the gums
Another symptom that should be looked for in the oral cavity during the catarrhal stage is whitish depositions on the gums resulting from necrosis and desquamation of the epithelium.

21. but may sometimes be 1-7 days
The catarrhal stage
The catarrhal stage of measles usually lasts for 3 or 4 days,
but may sometimes be 1-7 days

22. Exanthema period
The eruptive stage begins with a new rise of temperature which reaches its maximum on the second or third day.
The first elements of the rash are found behind the ears, at the hair line and in the centre of the face.
Within 24 hours it spreads rapidly over the whole face, neck, and upper part of the chest; it also covers the skin of the circumoral region.

23. Exanthema period
On the second day the exanthema rapidly spreads over the trunk and the proximal parts of the extremities, and on the third day covers the limbs.
This order of succession in the spread of the eruption is typical of measles.

24. The patients appearance is characteristic
the face is swollen,
the eyelids slightly hyperemic and edematous,
the eyes water, photophobia is apparent,
and there is a serous discharge from the nose.

30. On the second day

31. Elements of the rash
At first the elements of the rash look like pink papules of a soft consistency, the size of a grain of millet or buckwheat. Within a few hours each papule becomes surrounded by a zone of bright erythema. Soon adjacent maculopapules become confluent, forming large blotches of irregular outline, with the initial papules in the centre.

32. Large maculopapular elements have a tendency to fuse further.
Elements of the rash
Large maculopapular elements have a tendency to fuse further.
Lesions blanch with fingertip pressure.
The unaffected pale areas of the skin show up distinctly against the background of the bright rash.

37. The rash exanthema persists for 3 days;
Elements of the rash
The rash exanthema persists for 3 days;
from the fourth day it begins to fade in the order of its appearance.

38. Pigmentation period
The elements of the rash, gradually fading, leave spots of a light-brown pigmentation which persists for one or two weeks.

39. Desquamation
Fine branny desquamation (on the face and trunk) sometimes following the decrease in eruption lasts around 5 to 7 days.

40. Blood picture
At the end of the incubation period the blood picture shows mild leukocytosis and neutrophilosis,
At the end of the catarrhal stage and at the eruptive stage – leukopenia, neutropenia and lymphocytosis

41. Thanks for attention