Transcript Mumps is an acute self-limited infection, once commonplace but

Mumps,Measles,Rubella
DR;RIADH ABDULATIF
ALOBAIDY
Mumps is an acute self-limited infection, now unusual
in developed countries because of widespread use of
vaccination. It is characterized by fever, bilateral or
unilateral parotid swelling and tenderness, and the
frequent occurrence of meningoencephalitis and
orchitis. Although no longer common in countries
with extensive vaccination programs, mumps remains
endemic.
The infectivity: The transmission is by airborne
droplets from pt. during 1-2 days before to 5 days
after the parotid swelling
CLINICAL FEATURES
The incubation period is 16-18 days resulting in clinical
presentation ranging from asymptomatic to the typical illness
associated with parotitis.
The typical patient presents with a prodrom 1-2 days and
consisting of fever, headache, and vomiting. Parotitis then
appears and may be unilateral ,then becomes bilateral in about
70% of cases .The parotid gland is tender, and may be
accompanied by ear pain on the ipsilateral side. Sour foods or
liquids may enhance pain in the parotid. As swelling progresses,
the angle of the jaw filled and earlobule is pushed outward.
The opening of Stensen duct may be red and edematous. The
parotid swelling peaks in approximately 3 days, then gradually
subsides over 7 days. Submandibular salivary glands may also be
involved or may be enlarged without parotid swelling. Edema
over the sternum due to lymphatic obstruction may also occur
Mumps and normal
Differential diagnosis
1.purulent parotitis, is usually caused by
Staphylococcus aureus, unilateral, extremely
tender, and is associated with an elevated
white blood cell count, and may involve
purulent drainage from Stensen duct.
2.submandibular or anterior cervical adenitis
due to a variety of pathogens may also be
confused with parotitis.
complications
The most common complications of mumps are
meningitis, with or without encephalitis, and
orchitis.
Uncommon complications include deafness, facial
palsy, pancreatitis, and thrombocytopenia.
Congenital infection :with mumps during the 1st
trimester of pregnancy results in increased fetal
loss.
No fetal malformations have been associated with
intrauterine mumps infection.
Meningoencephalitis
Symptomatic apparent meningitis or
encephalitis occurs in only 10-30% of mumps
cases, but subclinical condition with CSF
pleocytosis has been found in 40-60% of
patients as subclinical more than apparent
meningitis. The meningoencephalitis is
usually benign and subside and self-limiting,
may occur before, along with, or following the
parotitis
Orchitis
Orchitis in young boys is rare, but it is more
frequent in adolescent and after puberty, in
30-40% of male cases.
Atrophy of the testes may occur, but sterility is
rare even with bilateral involvement.
prevention
Antibody develops in 95% of children after 1
vaccine dose.. As a live- vaccine, MMR should
not be administered to pregnant women or to
a child with immune deficiency.
Measles
Measles is highly contagious disease.
Owing to widespread vaccination by MMR or
single vaccine( measles vaccine) , transmission
of the infections and its incidence become
rare .
Measles virus is RNA virus in the family of
Paramyxoviridae and the genus Morbillivirus
Transmission
The portal of entry of measles virus is through
the respiratory tract or conjunctivae following
contact with aerosol droplets in which the
virus is suspended. Patients are infectious
from 3 days before to 4-6 days after the
onset of rash
Clinical manifestations
Measles is a serious infection characterized by high fever, and
maculopapular rash.`
The incubation period is 8-12 days.
The prodromal phase (2-4) days begins as characteristic
combinations of conjunctivitis with photophobia, coryza,
cough, ccc and increasing fever
Koplik spots represent the enanthem and are the
pathognomonic sign of measles, appearing 12-24 hours
before the onset of the rash and it last for 1-2 days after rash
appearance. They first appear as sandy white spots on minute
red lesions in the inner aspects of the cheeks at the level of
the lower premolars. Koplik spots present in 50-70% of cases.
KOPLIK SPOTS
MEEASLES
Clinical features con.
The rash begins on the forehead (along the
hairline), and behind the ears as a red
maculopapular eruption. It then spreads to the
face and neck and downward to the trunk and
limbs, and reaching the palms and soles.The rash
last 5-6 days, then fades over about 7 days in the
same manner as it evolved, often leaving a fine
desquamation of skin. Of the major symptoms of
measles, the cough lasts the longest, often up to
10 days. generalized lymphadenopathy may be
present, with cervical and occipital lymph nodes
enlargement together with the fever.
Diagnosis
Mainly clinical but confirming serological test
can be done by high antibody IgM level .
Blood and urine samples for viral culture is the
most commonly WHO protocol for detection
of virus of the illness.
Differential diagnosis ; include other fever
and rash illnesses like rubella , roseola,
erythema infectiosum, scarlet fever
Complications
1. pneumonia is the most common complication and the
cause of death in measles. It may manifest as giant cell
pneumonia caused directly by the viral infection or as
superimposed bacterial infection. Other respiratory
complications like otitis media and croup can occur.
2. vomiting and diarrhea even bloody.
3.encephalitis 1:3000 of cases infection may be fatal.
4.rarely Fatal Hemorrhagic measeles (black measles)
leading to hemorrhagic skin lesions.
5. subacute sclerosing panenecephalitis is rare . It is slow
virus infection of the CNS developed in 7-10 years after
measles and it is fatal.
treatment
Mainly supportive as antipyritics and
rehydration and respiratory suppport ..
Vitamin A deficiency is common in
developing countries and is associated with
high mortality and morbidity in measles, so it
is recommended to give vit A to the patients
with measles.
.
prevention
Exposure of susceptible individuals to patients with
measles should be avoided during period of
infectivity .
A 2-doses schedule (with MMR) is recommended
for full immunity.
The first dose is recommended at 12-15 mo of
age give 93% protection; the 2nd dose is
recommended at 4-6 yr of age with protection
reaches 97%. For immune deficient if exposed to
a case; immune globulin I.M should be given.
RUBELLA
Rubella (German measles or 3-day measles) is a
mild, often exanthematous disease of infants
and children.
Adult can also get the infection.
Its major clinical significance is transplacental
infection during pregnancy leading to fetal
damage ; as congenital rubella syndrome .
Clinical Manifestations
Rubella is a mild disease . Following an incubation period
of 14-21 days, a prodrom consisting of low-grade fever,
sore throat, red eyes , with lymphadenopathy;
;Suboccipital and postauricular lymph nodes are the
most prominent. In children, the 1st manifestation of
rubella is usually the rash, which is variable and not
distinctive. It begins on the face and neck as
maculopapular, and it spreads to involve the trunk and
extrimities .The duration of the rash is generally 3 days,
and it usually resolves without desquamation
Congenital rubella syndrome
Deafness , Cataracts , Patent ductus
arteriosus , pulmonary artery stenosis
mental retardation ,Neonatal purpura,
microcephaly ,jaundice with hepatitis.
Death( intrauterine) in %35 of cases.
it is one cause of the TORCHS syndrome