varicella ,measless , mumps
TRANSCRIPT
-
8/13/2019 Varicella ,Measless , Mumps
1/25
Varicella ,measless ,
mumpsEndemic desease
-
8/13/2019 Varicella ,Measless , Mumps
2/25
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
-
8/13/2019 Varicella ,Measless , Mumps
3/25
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
-
8/13/2019 Varicella ,Measless , Mumps
4/25
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
-
8/13/2019 Varicella ,Measless , Mumps
5/25
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
-
8/13/2019 Varicella ,Measless , Mumps
6/25
Differential diagnosis
Contact dermatitis
Drug reaction
Enterovirus
Insect bites
Impetigo
Smallpox
Urticaris
Herpes simplex virus ( HSV )
-
8/13/2019 Varicella ,Measless , Mumps
7/25
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
-
8/13/2019 Varicella ,Measless , Mumps
8/25
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
-
8/13/2019 Varicella ,Measless , Mumps
9/25
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
-
8/13/2019 Varicella ,Measless , Mumps
10/25
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
-
8/13/2019 Varicella ,Measless , Mumps
11/25
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
-
8/13/2019 Varicella ,Measless , Mumps
12/25
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
-
8/13/2019 Varicella ,Measless , Mumps
13/25
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
-
8/13/2019 Varicella ,Measless , Mumps
14/25
Differential Dx
Enteroviral infection
Parvoviral infection
Rubella
Rosola Kawasaki desease
Toxic shock syndrome
Rocky mountain spotted fever Drug reaction ( e g. Stevens Johnsons
syndrome )
-
8/13/2019 Varicella ,Measless , Mumps
15/25
-
8/13/2019 Varicella ,Measless , Mumps
16/25
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 )
-
8/13/2019 Varicella ,Measless , Mumps
17/25
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
-
8/13/2019 Varicella ,Measless , Mumps
18/25
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
-
8/13/2019 Varicella ,Measless , Mumps
19/25
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
-
8/13/2019 Varicella ,Measless , Mumps
20/25
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 %
-
8/13/2019 Varicella ,Measless , Mumps
21/25
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
-
8/13/2019 Varicella ,Measless , Mumps
22/25
Differensial Dx
Cytomegalovirus infection
Entroviral infection
Influenza infection
Para influenza infection
Parotis ductu obstruction
Bacterial parotitis
Tumor of salivary gland
Mikulicz syndrome
-
8/13/2019 Varicella ,Measless , Mumps
23/25
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
-
8/13/2019 Varicella ,Measless , Mumps
24/25
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
-
8/13/2019 Varicella ,Measless , Mumps
25/25
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