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3. Measles, Mumps, and Rubella

3. Measles, Mumps, and Rubella - Virus associated with skin...

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Unformatted text preview: Virus associated with skin and mucous membrane infections Measles Human Herpes virus - 6, 7 Parvovirus B19 Smallpox Molluscum Contagiosum Enteroviruses Virus Infections of the Skin and Mucous Membranes Mumps Rubella Herpes Simplex Varicella Zoster Virus Epstein Barr Virus Measles, Mumps, Rubella Common Features: humans are the only natural host world wide distribution live virus vaccines available late winter, early spring immunity after on attack (vaccine) is life long RNA viruses; single serologic type: Paramyxovirus (Measles, Mumps) Togavirus (Rubella) Measles, Mumps, Rubella Common Features: Transmission - direct contact, respiratory droplet spread Pathogenesis: respiratory tract replicates locally lymph nodes viremia skin, mucous membranes (measles) salivary glands, CNS (mumps) skin, internal organs (rubella) Measles ( Rubeola) Virus (Rubeola) General Characteristics: recent outbreaks in 1989, 1991 - 2, 1995 - Ontario 1991& Quebec 1 0 vaccine failure importation of cases failure to immunize everyone waning immunity (20 vaccine failure) epidemics every 2 -5 years, however it is now a 2rare disease in North America Measles ( Rubeola) Virus (Rubeola) Clinical Manifestations: incubation period 10 - 14 days; rarely asymptomatic infectious 3 days before to 5 days after rash 20 attack rate >90% 7 - 10 days from late prodrome to complete recovery Measles (Rubeola) Virus (Rubeola) Measles ( Rubeola) Virus (Rubeola) Clinical Manifestations: Prodrome - fever, malaise, anorexia, conjunctivitis, cough, coryza Koplik spots - mucous membranes (enanthem); (enanthem); before skin rash; persists for several days Rash - 2 -3 days later; starts at hairline, and spreads down; erythematous, maculopapular; lasts about 5 erythematous, maculopapular; days; desquamation; no scarring Atypical Measles: occurs in person who received killed virus vaccine (1963 - 1967) then exposed to natural measles prodrome - fever and pain x 1 - 2 days rash begins peripherally (hands / feet) more severe / prolonged than usual; pneumonia, hepatitis 2 0 to hypersensitivity in partially immune host immunize with live vaccine in those who received killed vaccine Measles ( Rubeola) Virus (Rubeola) Complications: 'd in adults, malnourished children, immunocompromised, immunocompromised, infants < 1 year pneumonia, otitis media in 10% of cases bacterial superinfection encephalitis (1 in 1000 cases) - 4 -7 days after rash; measles in brain but also autoimmune demyelination mortality - 1 in 3000 cases pregnancy - more severe; no congenital anomalies but spontaneous miscarriage or premature labour Measles ( Rubeola) Virus (Rubeola) Subacute sclerosing panencephalitis (SSPE): chronic degenerative disease occurring years after an attack of measles (usually children <2 yrs) due to persistent infection with measles virus in CNS rare if vaccinated fatal Measles ( Rubeola) Virus (Rubeola) Diagnosis and Treatment: clinical suspicion - coryza, conjunctivitis, koplik spots coryza, and maculopapular rash virus isolation - throat washing, blood, urine direct demonstration - viral antigen by immunofluorescence in nasopharyngeal aspirates serology - measles IgM no specific therapy; supportive care post - exposure prophylaxis in susceptible persons: immunoglobulin given within 6 days of exposure measles vaccine given within 72 hrs Mumps Clinical Manifestations: incubation period 18 - 21 days; asymptomatic infection common; less infectious than measles fever, parotitis (painful, swollen; unilateral 25%, bilateral 75%), trismus other salivary glands may be involved resolves within 1 week complications: meningitis (10%) orchitis (5- 20%); (5oophoritis (5%); pancreatitis, thyroiditis pancreatitis, pregnancy: no congenital malformations; 'd spontaneous abortion Rubella Mumps Diagnosis and Treatment: serology isolation - CSF, throat washings, blood no specific therapy; treatment supportive Congenital Disease: teratogenic during first 16 wks of pregnancy: 1st 2 months: 40 - 80% abnormal 3rd month: 20 - 40% abnormal 4th month: 10% abnormal main defects are triad of cataracts, nerve deafness, cardiac abnormalities multiple organs affected; fetal growth retardation Rubella Congenital Disease: prevention - screening of females prior to childbearing - vaccinate non -immune non rubella screening of pregnant women in 1st trimester 5 - 15% of women will be antibody negative do NOT vaccinate during pregnancy Rubella Diagnosis and Treatment: rash easily confused with other causes serology IgM antibodies; seroconversion isolation difficult; used in diagnosis of congenital rubella no specific treatment ...
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