Exanthemas in children:-

Definition:

Exanthemas is a group of diseases with clinical presentations of rash on the skin and mucous membranes.

Classification of exanthems:-

1. Measles

2. Scarlet fever

3. Rubella

4. Filatov-Dukes disease

5. Erythema infectiosum = fifth disease, parvoviral B19 infection

6. Roseola infantum = sixth disease, HHV-6

Type of Rash of exanthems :-

• Roseolar rash : is a small macula (d=2…5 mm) of pink, red color, often of round shape

• Papullar rash : is a non-cavity superficial rash, elevated over the skin

• Small roseolar rash : is a Small in diameter, 1 mm, roseolar red elements

• Macular rash : is an element similar to roseola, but larger (5…20 mm),

• Erythema rash: is a non-cavity superficial hyperemic rash

• Vesicular rash : small rash with cavities filled with serous

• Hemorrhagic rash : Rash does not disappear at stretching the skin

Measles

Definition :

Viral infection with airborne way of transmission, cyclical course and presence of syndromes of intoxication, catarrhal inflammation and exanthema.

Etiology:

• RNA-containing

• Paramyxoviridae, genus Morbillivirus

Epidemiology:

• Way of transmission – airborne

• Incubational period – 9-17 days (21 if human Ig injected)

• The source of infection patient from 2 last days of incubational period and till 4 days after appearance of rash (10 days in case of complications)

• Maximal contagiosity – during catarrhal period

• Index of contagiosity is 100%

Pathogenesis:

• Entry of infection – respiratory mucous.

• First virusemia – on 3^rd day of incubational period (→ anti-measles Ig is effective during first 3 days)

• Virus damages respiratory mucosa

• Respiratory tract damage and immunosupression → bacterial infections

• Pneumonia can be early (viral) or late (bacterial)

• Immunosupression is seen some time after recovery

Clinics – periods:

1. Incubational period - 9-17 days (21 day after injection of Ig)

2. Catarrhal period – 3-4 days. Syndromes of intoxication and catarrhal inflammation (of respiratory tract, conjunctiva, intestinal). Dry cough, rhinitis, conjunctivitis, slight face edema.

3. Rash period - since 4^th-5^th day. Intoxication and catarrhal syndrome still increase. Croup or dyspepsia in young children can appear

4. Pigmentation period

Clinics:

Pathognomic sigh – Filatov-Koplik spots: whitish small points on the inner cheek mucosa , Appears on the 1^st day of the disease, disappears by the 3^rd day.

Clinics – rash characteristics (MEASLES) :

1. Character of the elements – macular-papulous

2. Prevalent localization – all over the body

3. Background skin color – normal

4. Time of appearance – 3^rd – 4^th day of the disease

5. Connection to fever – intoxication increases

6. Itching – very rare

7. Fusion of rash elements – yes

8. Step-wise appearance – 3 days (face → trunk → extremities)

9. Presence of enanthema – Koplik spots (first 3 days) and palate enanthema (concurrent with rash)

10. Disappearance of the rash – pigmentation

Classification (MEASLES) :

1. Typical (mild, moderate, severe) and atypical (abortive, mitigated, low-grate, asymptomatic) – 5-7%.

2. 2. With / without complications

Complications (MEASLES) :

1. Etiology:

• viral (measles virus)

• bacterial;

2. Time of appearance:

• early – catarrhal and rash periods;

• late – pigmentation period;

3. Topics:

• respiratory system

• gastro-intestinal

• nervous system

• eyes

• Ears

• urinary tract

Laboratory diagnosis (MEASLES) :

• CBC: leucopenia, lymphocytosis

• Cytology of nasal discharge – typical multinuclear giant cells

• Virusology – pcr and ifa (in rash period can already be negative)

• Serological – titer of IgM increases, IgG → measles in anamnesis

Treatment (MEASLES) :