Disease

Epidemiolog
y

Measles
Endemic throughout
the world
Peak age incidence: 510 y/o

German Measles
Distributed worldwide
and affects both sexes

Roseola Infantum
>95% of roseola cases
occur in children younger
than 3 yr, with a peak at
6-15 mo of age

Erythema Infectiosum
prevalent in school-aged
children, with 70% of
cases occurring between
5 and 15 yr of age

Chicken Pox
peak incidence is 5-9
years old

HAND-FOOT-MOUTH DISEASE
usually affects infants and
children younger than 5 years old

Etiology

Measles virus

Rubella Virus

Parvovirus B19

Varicella-zoster virus

Coxsackievirus A16 Enterovirus

71

Transmissio
n

Droplet aerosols

Oral droplet
Transplacentally

Human Herpes Virus 6

(HHV6)
Human Herpes Virus 7
(HHV7)-less frequently
via secretions from the
respiratory tract

via secretions from the

respiratory tract

close personal contact, the air

(through coughing or sneezing),
contact with feces,contaminated
objects and surfaces

Infectious
Period

3 days before the rash

up to 4-6 days after
its onset

5 days before to 6 days

following appearance of
the rash

Clinical
Manifestatio
ns

Associated with giant

cell formation
Mild fever
Conjunctivitis
Photophobia
Coryza
Cough
Incubation: 8-12 days

Incubation period- 1421 days

2. Prodromal period characterized by lowgrade fever, sore throat,
red eyes with or without
eye pain, headache,
malaise, anorexia, and
lymphadenopathy
suboccipital,
postauricular, and
anterior cervical lymph
nodes are most
prominent

incubation period
9 days
Prodromal Period
Usually asymptomatic but
may include mild upper
respiratory tract signs
Febrile Period
Usually ranging from 37.9
40 C
Most children become
anorexic and irritable
Febrile Period(preeruptive)
3-5 days then resolves
abruptly
Fever may diminish
gradually over 24-36
hours

via respiratory secretions

and in the fluid of skin
lesions either by airborne
spread or through direct
contact
24 to 48 hrs before the
rash appears and until
vesicles are crusted,
usually 3-7 days after
onset of rash
10-21 days
fever, malaise, anorexia,
headache and
occasionallv mild
abdominal pain
occur 24-48 hr before the
rash appears
fever and other systemic
symptoms persist during
the 1st 2-4 days after the
onset of the rash

Enanthem
Exanthem

Koplik spots
Begins on the
forehead, behind the
ears and upper neck
as red maculopapular
eruptions
Spread downwards to
the torso and
extremities
Onset of rash,
symptoms begin to
subside
Branny desquamation
and brownish
discoloration of the
skin disappearing in 710 days

FORCHEIMER SPOTS
begins on the face and
neck as small, irregular
pink macules that
coalesce
it spreads centrifugally
to involve the torso and
extremities, where it
tends to occur as
discrete macules
rash fades from face as
it extends to the rest of
the body
3 days duration

Nagayama spots
begins as discrete, small
(2-5 mm), slightly raised
pink lesions on the trunk
and usually spreads to
the neck, face, and
proximal extremities
appears within 12-24 hrs
of fever resolution and
fades after 1-3 days
rash is rose colored and
fairly distinctive. not
usually pruritic and no
vesicles or pustules
develo

during prodromal period

but before the rash
appears
4-28 days (ave. 16-17
days)
mild and consists of lowgrade fever, headache
and symptoms of mild
upper respiratory tract
infection
Initial stage:
erythematous facial
flushing, often described
as a slapped-cheek
appearance
Second stage: spreads
rapidly or concurrently
to the trunk and
proximal extremities as
a diffuse macular
erythema

Central clearing of
macular lesions occurs
promptly, giving the rash
a lacy, reticulated
appearance
characteristic sparing of
palms and soles
resolves spontaneously
without desquamation
but tends to wax and
wane over 1-3 weeks

characteristic:
simultaneous presence of
lesions in various stages
of evolution appear first
on the scalp, face, or
trunk
consists of intensely
pruritic erythematous
macule
papular stage
clear, fluid-filled vesicles
(Clouding and
umbilication of the lesions
begin in 2448 hrs
Crusting
distribution:

1st week of illness

oropharynx is inflamed and

contains scattered vesicles on the
tongue, buccal mucosa, posterior
pharynx, palate, gingiva, and/or
lips
maculopapular, vesicular, and/or
pustular lesions may also occur
on the hands and fingers, feet,
and buttocks and groin (hands
are more commonly involved than
the feet, usually tender vesicles
varying in size from 3 to 7 mm
and are more common on dorsal
surfaces but frequently also occur
on palms and soles)
vesicles resolve in about 1 wk
buttock lesions do not usually
progress to vesiculation

predominantly central or
centripetal
Laboratory
Findings

- diagnosis of measles
is almost always
based on clinical and
epidemiologic findings
Acute phase:
decreased WBC
count,decreased
lymphocytes

Diagnosis

identification of IgM
antibody in serum
-demonstration of a 4fold rise in IgG
antibodies in
acute and
convalescent
specimens taken 24
wk later

Leukopenia
Neutropenia
Mild thrombocytopenia

Rubella IgM
enzyme
Immunosorbent
assay

Complicatio
ns

Pneumonia
Otitis media
Encephalitis
M tuberculosis
Exacerbation
Subacute sclerosing
panencephalitis

Treatment

Maintenance of
hydration,
oxygenation are goals
of therapy
Antipyretics:
Paracetamol 1015mkd q4-6 prn
Airway humidification
and supplemental
oxygen
Vitamin A: <1yr
100000 IU; >1yr
200000 IU

Supportive

Prevention

Isolation precautions
7th day after exposure
until 5 days the rash
has appeared
Immunization: 1st dose
12-15mos
2nd dose 4-6 years
old
Postexposure

MMR vaccine
1st dose @ 1215 mos
2nd dose after 4
wks of 1st dose
Pregnant
patients should
NOT be given
rubella vaccine

WBC counts of 8,000

9,000 WBCs/L (1st few
days of fever),but by the
time the exanthem
appears, the WBC count
falls to 4,0006,000
WBCs/L with a relative
lymphocytosis (7090%).
established primarily on
the basis of age, history,
and clinical findings

Usually based on clinical

presentation of the
typical rash and
exclusion of other
conditions
Serologic test for B19:
B19 specific IgM
develops rapidly after
infection and persist for
6-8wks

Postinfectious
thrombocytopenia
Arthritis
Encephalopathy
Most serious
complication
Progressive Rubella
Panencephalitis

leukopenia is typical
during the 1st 72 hr
-relative and absolute
lymphocytosis

Viral culture: gold

standard method for
confirmation

Supportive

Encephalitis
Cerebellar Ataxia
Pneumonia- accounts for
most of the increased
morbidity and mortality in
adults and other high-risk
populations
Antiviral therapy: HHV-6
-inhibited by ganciclovir,
cidofovir, and foscarnet
(but not acyclovir) at
levels that are achievable
in serum; HHV-7- inhibited
by cidofovir and
foscarnet
adequate fluid balance
should be maintained

no specific antiviral
therapy

Oral therapy with

acyclovir (20
mg/kg/dose,maximum
800 mg/dose) given as 4
doseslday for 5 days
(should be initiated as
early as possible,
preferably within 24 hr of
the onset of the
exanthem)
Intravenous therapy is
indicated for severe
disease and for varicella
in immunocompromised
patients (even after 72 hr
duration of rash
available as a monovalent
vaccine and is also
available in combination
with measles, mumps,
and rubella (MMRV)
vaccines
Routine administration:
children at12-18 mo and
at 4-6 yr of age

prophylaxis
Should be given w/in
72hrs of exposure
Immunocompetent:
0.25 mL/kg; max
15mL
Immunocompromised:
0.50 mL/kg; max
15mL

Females should
avoid becoming
pregnant for 3
months after
vaccination

* Catch-up vaccination
with the second dose is
recommended for
children and adolescents
who received only 1 dose
varicella vaccine within 3
days of exposure
High-titer anti-VZV
immune globulin is
recommended for
immunocompromised
children, pregnant
women, and newborns
exposed to maternal
varicella
Recommended dose:1
vial (125 units) for each
10 kg increment
(maximum 625 units)
given IM as soon as
possible but within 96 hr
after exposure