Varicella ,measless , mumps

Endemic desease

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

Epidemiology

Before varicella vaccine became widespread, 4 million cases of chickenpox were reported annually in the US , with 11.000 hospitalization and 50 100 deaths annualy Maximum incidence of varicella in children aged 1 6 years Maximum transmission occurs during late winter and spring Highly contagius : secondary attack rate is 80 100 % for contacts

Sign and symptom

Rash ussually start on the head and trunks and spreads to the rest of the body Varicellas hallmark is the simultaneous presence of rash in different stages Each lesion starts as ared macula and pass through stages of papula , vesicle ( pear or dewdrop on rose petal ), pustule, and then crusts Other accompanying manifestasion include headache , malaise , anorexia , cough and coryza , sore throat , and low grade fever

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

Differential diagnosis
Contact

dermatitis Drug reaction Enterovirus Insect bites Impetigo Smallpox Urticaris Herpes simplex virus ( HSV )

Treatment

Symptomatic relief of fever and itching Do not use aspirin ( associated with Reye syndrome ) Antiviral ( acyclovir ) are used in some cases

Progressive or severe varicella Life threatening complications ( e.g. Encephalitis , pneumonia ) Neonate or asolescent / adult patient ( because high risk of severe desease ) Patient with cancer or on steroid or other immunosuppresive therapies

 Universal

vaccination with live virus has significantly reduced morbidity and mortality ; confers protection to 75 100% of those immunizied ( children with immunodeficiencies ( HIV , cancer , steroid or other immunosuppressive regimen ) should not recive the varicella vaccine or any other live vaccine product

Prognostic / Clinical course

An other wise helthy child usually has 250 500 lessions ( but may have as few as 10 or as many as 1.500 ) New lesions continue to erupt for 3 5 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 with complication ( i.e. Varicella pneumonia and encephalitis ) Secondary bacterial infection may occur with invasive group A streptococcus, a serious infection thet may envolve rapidly into necrotizing fascitis or toxic shock syndrome

Measles

Primary infection occurs in the respiratory epithelium of the nasopharynx After 2 3 days , viremia ensues with infection of the reticuloendothelial system A second viremia occurs 5 7 days after initial infection Rash develops about 14 days after initial exposure Highly contagius during both viremia periods individuals are also infectious 3 5 days before and up to 4 days after the rash Transmitted via respiratory droplets

Epidemiology
Typically

occurs in prschool and young school aged children Occurs worldwide Peak incidence in late winter and spring >99% reduction of disease following childhood immunization Most cases in US occur in individuals who recently entered the country

Sign / symptoms

Prodome

Fever , coryza , hacking or brassy cough , non purulent conyungtivitis Koplik spots ( 1- mm blue with spots, characteristically opposite lower premolas and oral mucosa ) Maculopapular eruption lasting 5 7 days ; typically begins on faced/ head and progress to nhand / feet Desquamation may occur

Exanthema phase

Generalized lymphadenopathy Anorexia Diarrhea ( especially infant ) Fever may persist 7- 10 days

Diagnosis

Primarily a clinical diagnosis : Kopliks spots are pathognomonic 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 day of rash but may be falsely negative in 20 % Measurement of meales IgG helaps to distinguish acute infection from prior vaccination

Differential Dx

Enteroviral infection Parvoviral infection Rubella Rosola Kawasaki desease Toxic shock syndrome Rocky mountain spotted fever Drug reaction ( e g. Stevens Johnsons syndrome )

Treatment

Supportiv care Appropiate antimicrobial agents should be used if bacterial superinfection is suspected Vitamin A supplementation agent has be shown to decrease morbidity and mortality in developing countries where vitamin A deficiency occurs ( consider vitamin A supplementation in children > 6 months , immunodeficiency, clinical evidence of vitamin A deficiency , malnutrition, and/ or recent emigration to US ) Ribavirin is controversial

 Prevention

with MMR vaccine is routinely given at 12 15 mont and 4 - years of age ( vaccine failure after a single dose occurs in 2 5 % of children , however , most cases will respond to the second dose )

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 of rash , may result in seizures and / or neurologis damage Subacute slerosing panencephalitis is a rare but fatal neurologis disese with progressive intelectual deterioration , ataxia , seizures, and death : occurs an average of 7 years after meales infection

Mumps
A

viral infection that primary result in parotitis Transmision via respiratory droplet Contagius 2 days before through 5 days after the onset of parotitis Incubation period of 2 weeks , average duration of illness 7 10 days Prior MMR vaccine , mumps was the greteast cause of aseptic meningitis

Epidemiology
Seasonal

peaks in winter and spring but can occur any time Peak incidence in children ages 5 9 Fewer than 1.000 cases per year in US since MMR vaccine was introduced Despite high immunization rates , outbreaks of mumps still occur Permanent unilateral deafnes occur in 1 / 20.000 persons

Sign/ symptoms

Prodome : myalgia , anorexia , malaise headeache, low grade 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 bacterial parotitis ) Trismus may be prsent Asymptomatic in 20 %

Diagnosis
Primarly

a clinical diagnosis Serologic assay are the most common methode of diagnosis presence 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

Differensial Dx
Cytomegalovirus

infection Entroviral infection Influenza infection Para influenza infection Parotis ductu obstruction Bacterial parotitis Tumor of salivary gland Mikulicz syndrome

Treatment
Supportive

care MMR is alive vaccine thet confers life long immunity ;given in two doses at 12 15 month and then again at 4 6 years

Prognosis / Clinical Course

Menungoencephalitis is the most common complication

Most cases are symptomatic Symptomatic meningitis occurs in 15 % of cases but generrally resolves withour sequale

In the pervaccin era , mumps was the most common cause of aquired sensorineural hearing loss Orchitis is the most common complication in post pubertal males ( 50% ) , resulting in abrupt onset of testicular swelling , pain , nause , vomiting , fever , and possible atrophy Oophoritis , pancreatitis , and myocardium may occur Increased severity of disease in adults

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