ERUPTIVE FEVER DISEASE ERUPTIVE FEVER DISEASE CHICKEN POX EXANTHEM SUBITICUM GERMAN MEASLES HERPES ZOSTER MEASLES CHICKEN POX VARICELLA-OTHER NAME An acute and highly contagious disease of viral etiology Characterized- vesicular eruptions on the skin and mucous membrane and mild constitutional symptoms INFECTIOUS AGENT- HERPESVIRUS VARICELLAE Man is the only source of infection Closely related or identical to herpes zoster virus Incubation Period 10-21 days or maybe prolonged after passive immunization against chicken pox
MODE OF TRANSMISSION Direct contact with patients who sheds the virus from the vesicles Indirect contact, through linen or fomites Airborne or spread by droplet infection PERIOD OF COMMUNICABILITY The patient is capable of transmitting the disease about a day before the eruption of the first lesion up to about 5 days after the appearance of the last crop CLINICAL MANIFESTATION PRE-ERUPTIVE MANIFESTATION- mild: fever and malaise ERUPTIVE STAGE- Rash start from the trunk then spread to th other parts of the body Initial lesions are distinctively red papules where contents become milky and pus-like within 4 days In adult and bigger children, the lesions are more wide spread and more severe CLINICAL MANIFESTATION ERUPTIVE STAGE- There is rapid progression so that transition is completed in 6-8 hours Vesicular lesion are very pruritic All stages are present simultaneously before all are covered with scabs known as celestial map All lesions appear in different stages at one time or it will pass through the following stages: macule, papule, vesicles, pustule, crust Macule- a lesion that is not elevated above the skin surface Papule- a lesion that ie elevated above the skin surface with a diameter of about 3 mm Vesicle a pop-like eruption filled with fluid; the thin-walled vesicle early burst and dry up in 3-5 days Pustule- a vesicle that is infected or filled with pus. If lesion become infected the scar may be big and wide Crust- a scab or eschar. This is a secondary lesion caused by the secretion of visicle drying on the skin The scar are superficial, depigmented and take time to fade out DIAGNOSTIC TEST Determination of V-Z through complement fixation test Determination of V-Z virus through electron microscopic examination of vesicular fluid Complications Secondary infection of the lesions; furuncles, cellulites, skin abscess, erysipelas Meningoencephalitis Pneumonia Sepsis Hemorrhagic varicella Treatment Zoveraz 500mg/tablet 1 tab 2x aday for 7 days Oral acyclovir 800 mg 3x a day for 5 days Oral anti-histamine for symptomatic pruritus Calamine lotion Do not give salicylates Antipyretic for fever Nursing Management Respiratory isolation until all vesicles have crusted Prevention of secondary infection Disinfection of contaminated articles Cut nail short For a child, apply mittens Provide activities to keep child occupied to lessen pruritus
PREVENTIVE MEASURES Active immunization with live attenuated varicella vaccine Avoid exposure as much as possible to infected persons ROSEOLA INFANTUM, ROSE RASH OF INFANT EXANTHEM SUBITUM DEFINITION A benign disease that occur almost exclusively in infants and young children
ETIOLOGIC AGENT The agent causing the disease still unknown but believed to be virus
INCUBATION PERIOD: 8-14 DAYS with an average of 10 days CLINICAL MANIFESTATION High grade fever ranging from 38.3-39.8 degree celcius or may have febrile convulsions
Fever, irritability and anorexia may last for 2-5 days after which the fever suddenly drops to normal and infants appear well Morbilliform eruption spread all over the body that start on the trunk, spread to the neck, the abdomen, the upper and lower extremities CLINICAL MANIFESTATIONS The rash disappear within a few hours or may persist for 2 days with no mark left The region above the nose and cheeks are free from rash The pharynx slightly inflamed, tonsils are slightly reddened or covered with follicular exudates Treatment/Management Symptomatic with some antipyretic No isolation needed RUBELLA; 3- DAY MEASLES GERMAN MEASLES DEFINITION A mild viral illness caused by rubella virus It causes mild feverish illness associated with a rash, and aches in joints It has teratogenic effect on the fetus INFECTIOUS AGENT: RUBELLA VIRUS ( FAMILY- TOGAVIRIDAE; GENUS RUBIVIRUS)
INCUBATION PERIOD: FROM EXPOSURE TO THE APPEARANCE OF RASH IS USUALLY 14-21 DAYS PERIOD OF COMMUNICABILITY Approximately one week before and four days after the onset of rashes, but is at its worst when the rash is at its peak. Highly communicable infants with congenital rubella may shed virus for months after birth Mode of Transmission Direct contact with nasopharyngeal secretions Air droplets Transplacental in placental in congenital rubella Infants with congenital rubella shed large quantities or virus in their pharyngeal secretions and urine which serve as source of infection to other contacts CLINICAL MANIFESTATION PRODROMAL PERIOD -Low grade fever -headache -malaise Mild coryza Conjunctivitis Post-auricular, sub-occipital and posterior cervical lymphadenopathy with occur on the 3 rd to the 5 th day after onset ERUPTIVE PERIOD A pinkish rash on the soft palate (Forchheimers spot) An exanthematous rash that appear first on the face, spreading to the neck, the arms, trunk and legs Eruption appears after onset of adenopathy The rash may last for 1-5 days and leaves no pigmentation, no desquamation Tonsillar pain in young adults Transient poly arthralgia and poly arthritis may oocur Treatment
Very little treatment is necessary; it is essentially symptomatic
Risk of congenital malformation 100% - when maternal infection occurs on the first trimester of pregnancy or first month of gestation 4% in the second trimester 90% -of congenital rubella cases will excrete the virus at birth and are therefore infectious 10% remain contagious until one year of age Nursing Management Isolation Bedrest until fever subsides Darken room to avoid photophobia Mild liquid diet but nourishing Irrigate eyes with warm saline to relieve irritation Care of the ears-do not apply heat or cold unless so ordered Good ventilation Prevent spread of infection Prevent complications PREVENTION Administration of live attenuated vaccine (MMR) Pregnant women should avoid exposure to patient with rubella administration of Immune Serum Globulin one week after exposure to Rubella SHINGLES:ACUTE POSTERIOR GANGLIONITIS 1 HERPES ZOSTER DEFINITION An acute viral infection of the sensory nerve caused by variety of chicken pox virus
ETIOLOGIC AGENT VARICELLA-ZOSTER VIRUZ INCUBATION PERIOD: 13-17 DAYS
PERIOD OF COMMUNICABILITY A day before the appearance of the first rash to 5-6 days after the last crust
MODE OF TRANSMISSION Direct contact-through droplet infection; airborne spread Indirect contact Primary infection varicella zoster virus may persist in a dominant state in the dorsal nerve root ganglia Virus may emerge from the site in later years either spontaneously or in association with immunosuppression to cause herpes zoster Produce localized vesicular lession confines to a dermatone and severe neurologic pain in the peripheral areas innervated by the nerves arising in the inflamed root ganglia Clinical Manifestation Any part of the trunk maybe affected but the thoracic segment is commonly involved Other areas that maybe affected are the extremities and branches of he 5 th and 7 th
cranial nerves Erythematous base of the skin lesion appears first is followed within 24 hours by the appearance of the vesicles Clinical Manifestation Cluster of vesicles appear to form patches Eruption are unilateral and never cross the midline of the body The vesicles become pustular, break down and form crusts. Lesions may last for 1-2 weeks Pain of varying intensity Pain occurs from one to five days prior to the development of rash, described as burning or stabbing Clinical Manifestation Patient may complain of pruritus, pain usually worse at night and is intensified by movement Regional lymph nodes When opthalmic or the 5 th cranial nerve is affected, corneal anesthesia may occur, it is known as Gasserian ganglionitis Paralysis of the facial nerve and vesicles in the external auditory canal affecting the 7 th
cranial nerve. The condition is called Ramsay Hunt syndrome DIAGNOSTIC EXAM Charactistic skin rash may be diagnostic Tissue culture technique Smear of vesicle fluid Microscopy Complication Encephalitis Paralytic ileus, bladder paralysis Opthalmic herpes which may lead to blindness Modalities of Treatment Symptomatic Antiviral drugs Analgesic to control pain Anti- inflammatory Nursing Management Put patient on strict isolation Apply cool, wet dressing with NSS to pruritic lesions Prevent secondary infection Hygeinic measures should be emphasized Hypoallergenic food is served Prevention avoid exposure to persons with varicella Self protection by increasing resistance RUBEOLA; MORBILLI MEASLES DEFINITION An acute, contagious exanthematous disease usually affect children which are referable to URTI Maybe one of the most common and most serious of a childhood diseases
Etiologic Agent Filtrable virus that belongs to genus Morbilivirus of the family paramyxoviridae
Measles virus is rapidly inactivated by heat, ultraviolet light, and extreme degrees of acidity and alkalinity INCUBATION PERIOD 10-12 DAYS (20 DAYS THE LONGEST 8 DAYS THE SHORTEST)
SINGLE ATTACK CONVEYS A LIFELONG IMMUNITY PERIOD OF COMMUNICABILITY Measles usually lasts about 9-10 days, measured from the beginning of the prodromal symptoms to the fading of the rash
The disease is communicable 4 days before and 5 days after the appearance of rashes
The disease is most communicable during the height of the rash SOURCE OF INFECTION The virus has been found in the patients blood, as well as in the secretions from the eyes, nose and throat
MODE OF TRANSMISSION Direct contact, by droplets spread through coughing or sneezing indirectly PATHOGNOMONIC SIGN KOPLIK SPOTS inflammatory lesions of the buccal mucous glands with superficial necrosis They appear on the mucosa of the inner cheek apposite to the second molars, or near the junction of the gum and the inner cheek Usually appear 1-2 days before measles rash When rashes appear, normally koplik spot will disappear Clinical Manifestastion PRE-ERUPTIVE STAGE ERUPTIVE STAGE STAGE OF CONVALESCENCE Clinical Manifestastion PRE-ERUPTIVE STAGE Fever Catarrhal symptoms (rhinitis, conjunctivitis, photophobia, coryza Respiratory symptoms- starts from common colds to persistent coughing Enanthem sign (koplik spot, stimsons line
Clinical Manifestastion ERUPTIVE STAGE The rash usually seen late in the 4 th day Maculo-papular rash appear first on either the cheeks , bridge of the nose, along the hairline, at the temple The rash is fully developed by the end of he second day and all symptoms are at their maximum at this time High grade fever that comes on and off Anorexia and irritability Abdominal tymphanism, pruritus, lethargy Clinical Manifestastion ERUPTIVE STAGE The throat is red and often extemely sore As fever subsides, coughing may diminish, but more often it hangs on for a week or two Clinical Manifestation Stage of Convalescence Rashes fades away the manner as they erupt Fever subsides as eruption disappears When the rash fades, desquamation begins Symptoms subside, appetite returns DIAGNOSTIC PROCEDURES NOSE AND THROAT SWAB URINALYSIS BLOOD EXAM (CBC leukopenia at the start of the disease, leukocytosis when complication sets in) Complement fixation or hemogglutinin Test Modalities of treatment Anri-viral drugs Antibiotics if with complication supportive therapy (oxygen inhalation, IV fluids COMPLICATIONS BRONCHOPNEUMONIA OTITIS MEDIA PNEUMONIA/BRONCHITIS NEPHRITIS ENCEPHALITIS BLINDNESS NURSING MANAGEMENT ISOLATION (quiet, well ventilated, subdued light in patients room) Control high temperature with warm or tepid sponges Skin care. Daily cleansing bed bath Oral and nasal hygiene Care of the eyes. The patient is sensitive to light Care of the ears-be alert on signs of mastoid infection NURSING MANAGEMENT Daily elimination is important. During febrile stage, limit the diet to fruit juices, milk and water. If the patient is vomiting, give iced juices in small amount and more frequently Change position every 3-4 hours Penicillin or other prescribed medication is usually given in cases where there is complication PREVENTIVE MEASURES Anti-measles at the age of 9 months, as single dose Mumps, measles, rubella (MMR) to give a age 15 months old and 2 nd dose at 11-12 years