1. Infectious diseases with exanthema syndrome Lecturer: Gorishna Ivanna Lubomyrivna

2. Measles Etiology: Measles virus - RNA virus, that belongs to the Paramyxoviridae family, Morbillivirus genus. Etiology: Measles virus - RNA virus, that belongs to the Paramyxoviridae family, Morbillivirus genus.

3. Transmission Source of infection – infected person during last 2 days of incubation period, catarrhal period, and 4 days period of eruption (in case of complications –10 days period of eruption). Source of infection – infected person during last 2 days of incubation period, catarrhal period, and 4 days period of eruption (in case of complications –10 days period of eruption). Infection is spread by inhalation of large and small airborne droplets. Infection is spread by inhalation of large and small airborne droplets. Susceptible organism - no immunized persons, older than 6 month, which never had measles. Susceptible organism - no immunized persons, older than 6 month, which never had measles.

4. Clinical presentation The incubation period 9 - 17 (21!) days. Prodromal period - 3 - 5 days. Prodromal period - 3 - 5 days. – Temperature is usually high at first day. –The classic three “C’s” (cough, coryza, conjunctivitis). –the enanthema or Koplik’s spots. They usually disappear by the second day of the exanthema.

5. Measles conjunctivitis

6. Koplik’s spots

7. Measles enanthema

8. Exanthema period: 3-4 days Second increase of temperature. Second increase of temperature. Initial lesions on the forehead and face. Initial lesions on the forehead and face. During 3-4 days they spread downward During 3-4 days they spread downward The rash is red maculopapular, initially discrete then confluent. The rash is red maculopapular, initially discrete then confluent. Ctarrhal signs progress Ctarrhal signs progress Koplick’s spots and enanthema remain for 1-2 days Pigmentation period (1-1.5 weeks) Pigmentation progresses in the same fashion as the rash, than desquamation (microscalling) Pigmentation progresses in the same fashion as the rash, than desquamation (microscalling) Normalisation of the temperature Normalisation of the temperature Ctarrhal signs resolves Ctarrhal signs resolves

9. Measles, typical rashes, 2 nd day

10. Measles, hemorrhagic rashes

11. Measles, pigmentation period

12. Classification By the form: By the form: –typical, by the severity:  mild;  moderate;  severe (without hemorrhagic syndrome, with hemorrhagic syndrome); –Atypical-  abortive;  mitigious;  hyperreactive;  subclinical;  asymptomatic;  measles in vaccinated;  measles in person who receive antibiotics and hormones. By the course: By the course: –smooth (uncomplicated); –not smooth, uneven (complicated).

13. Laboratory work-up common laboratory tests are non-specific. common laboratory tests are non-specific. – leukopenia, lymphocytosis, eosynophylia, and thrombocytopenia (may be) serological test (DHAR, PHAR), Immune enzyme analysis serological test (DHAR, PHAR), Immune enzyme analysis virus isolation (nasopharyngeal smears) is technically difficult virus isolation (nasopharyngeal smears) is technically difficult Cytoscopic examination presence of typical multinuclear giant cells Cytoscopic examination presence of typical multinuclear giant cells

14. Scarlet fever, localisation of rashes

15. Treatment Adequate hydration, bed rest; vitaminized food; Adequate hydration, bed rest; vitaminized food; Antipyretics for fever control: Antipyretics for fever control: – paracetamol 10-15 mg/kg not often than every 4 hours or ibuprophen 5-10 mg/kg per dose, not often than every 6 hours. Nasal decongestants not more than 3 days, in infants before 6 mo physiologic saline solution Nasal decongestants not more than 3 days, in infants before 6 mo physiologic saline solution Mucosolvents and cough supressors; Mucosolvents and cough supressors; Vitamin A 200 000 Units orally daily Vitamin A 200 000 Units orally daily Care for oral cavity, conjunctiva. Care for oral cavity, conjunctiva.

16. Rubella (German measles) It is caused by RNA rubella virus, which belongs to the Togaviridae family, Rubivirus genus. It is caused by RNA rubella virus, which belongs to the Togaviridae family, Rubivirus genus.

17. Transmission the source of infection is a patient or carrier the source of infection is a patient or carrier the mechanism of transmission is air- droplet, transplacental the mechanism of transmission is air- droplet, transplacental receptivity is common, especially high in children 2-9 years receptivity is common, especially high in children 2-9 years

18. CLINICAL PICTURE of the Acquired Rubella Incubation period is 14-21days Prodromal phase: 1-2 days before the onset of rash: –Headache; Low-grade fever; Chills; Anorexia; Nausea; –Eye pain, Conjunctivitis; –Sore throat; –Tender lymphadenopathy (particularly posterior auricular and suboccipital lymph nodes); –Forchheimer sign - pinpoint or larger petechiae that usually occur on the soft palate

19. Chickenpox

20. Chickenpox, typical localization of rashes

21. Chickenpox, rashes on mucus membranes

22. Classification –By the type:  typical forms  atypical forms (subclinical, bullous, hemorrhagic, gangrenous, generalized) –By the severity:  Mild  Moderate  Severe –By the course:  smooth (uncomplicated)  uneven (complicated)

23. Hemorrhagic form

24. Complications secondary bacterial - Staphylo- or streptodermia Staphylo- or streptodermia otitis, pneumonia otitis, pneumoniaViral: pneumonia pneumonia croup croup Encephalitis (involvement of the cerebellum, or cerebrum) Encephalitis (involvement of the cerebellum, or cerebrum) less common – Guillain-Barre syndrome, transverse myelitis, optic neuritis, and facial nerve palsy. less common – Guillain-Barre syndrome, transverse myelitis, optic neuritis, and facial nerve palsy.

25. Scarlet fever Scarlet fever is an acute infectious disease, that is caused by group A β- hemolytic streptococcus Scarlet fever is an acute infectious disease, that is caused by group A β- hemolytic streptococcus

26. Clinical presentation: acute onset acute onset fever (often above 39  C), fever (often above 39  C), sore throat (often with dysphagia), sore throat (often with dysphagia), Erythema and enanthema on the soft palate. Erythema and enanthema on the soft palate. purulent tonsilar exudates. purulent tonsilar exudates. Anterior cervical lymph nodes are tender and enlarged. Anterior cervical lymph nodes are tender and enlarged. Coated than swollen, red tongue (strawberry tongue). Coated than swollen, red tongue (strawberry tongue). Other features are nausea and vomiting, headache, abdominal discomfort. Other features are nausea and vomiting, headache, abdominal discomfort.

27. Scarlet fever, pharyngitis, enanthema

28. Scarlet fever, pharyngi- tis, tonsillitis

29. Strawberry tongue

30. a rash appears 1-2 days after the onset. a rash appears 1-2 days after the onset.rash first on the neck and then on the trunk and extremities through 24 hours. first on the neck and then on the trunk and extremities through 24 hours. dusky red, blanching tiny papules that have a rough texture ("sand paper" sign). dusky red, blanching tiny papules that have a rough texture ("sand paper" sign). flushing face with circumoral pallor (Filatov’s sign). flushing face with circumoral pallor (Filatov’s sign). the rash is intensified in skin folds and at sites of pressure. the rash is intensified in skin folds and at sites of pressure. Pastia’s lines: In the antecubital and axillary fosses linear petechiae with accentuation of the erythema. Pastia’s lines: In the antecubital and axillary fosses linear petechiae with accentuation of the erythema. Papules are usually absent at palms, and soles Papules are usually absent at palms, and soles

31. Scarlet fever, localisation of rashes

32. Scarlet fever, morphology of rashes

33. Scarlet fever, intensive rashes in the sites of pressure

34. Filatov’s sign

35. Pastia’s lines

36. The exanthema lasts 4 - 5 days The exanthema lasts 4 - 5 days then desquamate, first on the face last on the palms and soles. then desquamate, first on the face last on the palms and soles. Pharyngitis usually resolves in 5 to 7 days. Pharyngitis usually resolves in 5 to 7 days.

37. Desquamation of the skin

38. Classification 1.Form: 1.Form: –typical; –atypical:  subclinical;  extra pharyngeal (burns, wounds, post-natal, after operations, delivery);  with aggravated symptoms (hypertoxic, hemorrhagic). 2.Severity: 2.Severity: –mild; –moderate; –severe: toxic, septic, toxic-septic. 3.Course: 3.Course: –smooth; –uneven (relapses, complications).

39. Purulent Complications: otitis media, otitis media, lymphadenitis, lymphadenitis, perytonsilar abscess, perytonsilar abscess, necrotizing tonsillitis, necrotizing tonsillitis, sepsis, sepsis, Pneumonia, Pneumonia, Sinusitis, Sinusitis, Meningitis, Meningitis, Bone or joint problems (osteomyelitis or arthritis) Bone or joint problems (osteomyelitis or arthritis)