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Childhood Exanthemata

Childhood Exanthemata. Dr. Philip G. Murphy Consultant Microbiologist, AMNCH,Tallaght. Aetiology. Exanthem = exterior rash Measles Rubella Varicella (chickenpox) Scarlet fever Parvovirus HH6 (Kawasaki Disease)

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Childhood Exanthemata

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  1. Childhood Exanthemata Dr. Philip G. Murphy Consultant Microbiologist, AMNCH,Tallaght.

  2. Aetiology • Exanthem = exterior rash Measles Rubella Varicella (chickenpox) Scarlet fever Parvovirus HH6 (Kawasaki Disease) Other childhood fevers:Mumps, Whooping cough, Diphtheria NSROC

  3. MeaslesRubeola (RNA morbillivirus) • Incubation: 7-14 d • Prodrome: 4 -5 d before rash fever, malaise, coryza, sneezycough, Koplik spots1-3 d before rash • Rash: day 4-7 of illness starts behind ears, forehead, around mouth dusky red, florid maculopapular rash spreads over trunk and limbs. Lasts 5 d. • Infectivity: prodrome to 4 d after the rash • Transmission: respiratory droplet or direct contact • Complications: ears & OM, lungs & pneumonia conjunctivitis CNS encephalitis at d 10, SSPE after several years

  4. Measles • Highly contagious acute viral illness caused by a paramyxovirus, genus Morbillivirus • One of the leading causes of child mortality in developing countries - 10% of all deaths of children < 5 years. • Measles eradication possible – no longer endemic in U.S. • Europe: Outbreaks reported in Germany 1996, 1999 and 2000, Netherlands 1999 (2600 cases and 3 deaths).

  5. Measles vaccination • Measles vaccination in Ireland since 1985 • Vaccination rates of 95% necessary to eliminate spread • Vaccination coverage of 70 – 80% at 24 months of age in the Eastern Regional Health Authority • Outbreak of measles occurred between December 1999 and July 2000. Majority of cases in TCH catchment area.

  6. Eastern Regional Health Authority

  7. Number (%) • Total number attending TCH 355 • Number admitted to TCH 111 • Underlying chronic or acute illnesses 29 (26) • Number admitted to ICU 13 (11) • Mortality 3 • Range Median • Inpatient stay 1 - 43 5 • ICU stay 1 - 28 6

  8. MMR Status of Measles Cases in Northern Area Health Board (n=567):

  9. Indication for admission

  10. Symptoms and Signs 95% 95% 84% Number Of Patients 54% 40% 39% 33% 8% Apnoea Exanthem Cough Vomiting Otitis Media Febrile Seizure Pyrexia Conjunctivitis Diarrhoea

  11. Control • Public Health • Outbreak Control Team set up by NDSC • Measles/Mumps/Rubella (MMR) vaccination • Brought forward to 12 months of age • Given at 6 months in our area • Repeated at 15 months • Second MMR brought forward to 4 years of age • Opportunistic vaccination in schools and creche • Recalled non-attenders • Press releases

  12. Future • Oireachtais Committee Report • Co-ordinator to oversee vaccine program • Dedicated administrative and nursing staff • Modernisation of Civil Registration Service • Personal public service number • Improved IT at health board level • Vaccine information statements to parents • Continuous immunisation campaigns in media until rate > 95% • Guidelines for future outbreaks

  13. Varicella (chickenpox, shingles) • Incubation: 12-21 d • Prodrome: 1 d before rash fever, malaise • Rash: oval macule progressing to macule and then pustules which heal and crust. Appears as crops centrally then peripherally • Other: may be marked fever for 2-3 d., then settles • Infectivity: 5d before to 5 d after the rash • Transmission: respiratory droplet or direct contact • Complications:Rare:encephalitis after 10d pneumonia especially immune suppressed 20 bacterial skin infection Shingles • Diagnosis: EM, CFT • Treatment: aciclovir, topical disinfectants, ZIG if immune suppressed

  14. Rubella • Incubation: 14-23 d • Prodrome: none or mild fever1d before rash • Rash: none or for 1-3 d a pink macular rash on face and trunk otherwise well sub-occipital lymphadenopathy arthralgia /polyarthritis in older child or adult rarely thrombocytopaenia • Infectivity: 7d before to 5 d after the rash • Transmission: respiratory droplet or direct contact • Complications: in utero - congenital rubella syndrome, deafness,cataracts, cardiac abnormalities hepatomegaly, splenomegaly, purpura. 30% mortality. 25% if exposure in first 4months, 60-80% in 1st month rarely encephalitis at 10d

  15. Kawasaki Disease • Unknown aetiology ?? Infective • fever, rash, • conjunctivitis, hand/feet dorsae induration • stomatitis, strawberry tongue, lymphadenopathy • coronary artery narrowing - aneurysm, thrombosis and MI • desquamation in recovery • Rx: Immuneglobulin

  16. Erythema infectiosum (Fifth Disease, Slapped ckeek syndrome) • Parvovirus B19, ssDNA, 22 nm diameter • Rash on cheeks, flitting and later lace-like on trunk • More severe in adults with arthritis and lymphadenopathy • benign course and rare complications • transient marrow depression and rarely aplastic crisis

  17. Exanthem subitumRoseola infantum;Sixth Disease • Human Herpes virus 6 • commonly seroconversion by 2 years • 3-5 d fever, urti • 20% exanthem: classic maculopapular rash • common in CNS • but ? Role in multiple sclerosis

  18. Scarlet fever • Aetiology; Streptococcus pyogenes (Group A) • Pathogenesis: erythrogenic toxin • Incubation: 1-3 d • Prodrome: 1-2 d fever,sorethroat,headache,flushed cheeks • Rash: punctate erythematous central and blanches • Signs: circumoral palor, strawberry tongue, desquamation post rash • Infectivity: up to 3 weeks or 24h after pen • Transmission: respiratory • Complications: septicaemia, endocarditis, OM, Quinsy rheumatic fever, acute nephritis

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