ERUPTIVE DISEASES
PROF.DR. AYÇA VİTRİNEL
MEASLES
 Measles virus is a RNA virus of the genus ;
MORBILLIVIRUS in the family PARAMYXOVIRIDAE
 During the prodromal period , short time
after the rash appears=» found in nasopharenx, blood, urine
 Endemic throughout the world
 Maximal dissemination; Occurs by droplet
spray during the prodromal period
MEASLES
 Contagious from 1-2 days before onset of
symptoms to 4 days after apperance of the
rash.
 Infants acquire immunity transplacentally
from mothers who have had measles or measles immunization. This immunity is
usually complete for the first 4-6 months of
life.
Koplik spots
MEASLES
 Essential lesion is found in the skin, in the
mucous membranes of the nasopharynx,
bronchi, intestinal tract, conjunctivae
 Serous exudate and proliferation of mononuclear and a few polymorphonuclear cells
occur around the capillaries.
 Hyperplasia of lymphoid tissue usually
occurs particulary in the appendix.
MEASLES
 CLINICAL MANIFESTATIONS : 3
clinical stages
 1)Incubation period: 10- 12 days
 2)Prodromal stage: 3-5 days(av: 4 days)
fever; subside rapidly within 2 days of rash.
Dry cough. Coryza. Conjuctivitis. Koplik
spots, patognomonic sign of measles
MEASLES
 Consist of serous exudate, proliferation of
endothelial cells, grayish white dots have
slight reddish areola opposite to the molars
(rarely found within the mid partion of lowerlip, on the palate and on the lacrimal
caruncle.
MEASLES
 3) Final stage: Rash starts as faint macules
on the upper parts of the neck, behind the
ears, along the hairline ,become maculopapular as the rash spreads rapidly over the
entire face, neck, upper arms, upper part of
the chest in the first 24 hours.
 Second day; spreads over the back, abdomen, arm and thigh It finally reaches the
feet on the 2nd.-3rd. days. It begins to fade
on the face.
MEASLES
 In the severe cases the rash is confluent, the
skin is completely covered including the
palms and soles.
 Often slightly hemorrhagic
 As the rash fades BROWNY DESQUAMATION
and BROWNISH DISCOLORATION OCCUR.
 Hemorrahagic type: BLACK MEASLES bleeding
may occur (mouth, nose, bowel)
 Atypical measles : occurs in recipient of killed
measles virus vaccine
MEASLES
 Rash appears firstly ; palms, wrists, soles,
ankles maculopapuler; vesicules, purpurical
hemorrhagic.
 Koplic spots rarely occurs
 Headache, severe abdominal pain, vomiting
myalgia, respiratory symptoms, pneumoniae
can occur.
MEASLES
 DIAGNOSIS: Clinical picture.
 Laboratory confirmation: rarely needed.
 Prodrome: multinucleated giant cells can be
demonstrated in smears of nasal mucosa.
 Abs: IgM detectable at least 1 month after
rash onset. Acute-convelascent sera 4 fold
increase
 Virus culture
 Leukopenia---»» Lekocytosis
MEASLES
 TREATMENT: No spesific antiviral thera-
py.
 Supportive (antipyretics, bedrest, fluid intake)
 Treatment with oral Vit A reduces morbidity and mortality in children with severe measles in developing world.
 6 mn-1 yr: 100.000 U PO
 >1 yrs :
200.000 U PO
MEASLES
 Hospitalized with measles and its
complications
 Having risk factors:
 Evidence of vit A def
 Immundeficiency
 İmpaired intestinal absorbtion
 Severe malnutrition
MEASLES
 COMPLICATIONS:
 Acute otitis media ‘’most common’’
 Pneumonitis ; interstisiel primer pneumonia/
secondary bacterial
 Encephalitis
 Exacarbation of undelying tbc-SSPE after 7/10
years
 Myocarditis-infrequate
 Appandicitis
 Laryngitis, tracheitis, bronchiolitis
MEASLES
 PREVENTION : Vaccine license in 1963
(12-15 months/4-6 years)
 Postexposure prophylaxia. Within 6 days of
exposure, Ig (0.25 ml /kg IM max 15 ml)
within 72 hrs VACCINE
RUBELLA
 Rubella virus- RNA virus of genus Rubi-
virus in the family Togaviridae.
 Distributed worldwide and affects both
sexes equally
 Peak incidence; 5-14 yr of age
 During clinical illness: the virus is present
in nasopharyngeal secretions, blood, feces,
urine
RUBELLA
 Virus has been recovered from the nasopha-
rynx 7 days before the exanthem and 7-8
days after its disappereance.
 The risk for congenital defects and disease
is greatest with primary maternal infection
during the first trimester.
RUBELLA
 CLINICAL MANIFESTATIONS :
 Incubation period: 14-21 days, no prodro-
mal phase or milder, 2/3 of infections are
subclinical
 Congenital rubella syndrome ophtalmologic, cardiac, auditory, neurologic anomalies
 Most characteristical signs; retroauricular,
postcervical and postoccipital LAP ; appears 24 hr before and 1 wk after rash.
RUBELLA
 Forsheimer spots : enantem appears in 20%
of patients just before the onset of the rash
on the soft palate
 Exanthem begins on the face spreads quickly. Discrete maculopapules. 2.day-pinpoint
appereance. Mild itching. Pharengeal
mucosa and the conjuctivativae are slightly
inflamed. Fever is low greade or absent. In
older girls and women polyarthritis may
occur
RUBELLA
Congenital RUBELLA
RUBELLA
 DIAGNOSIS : Clinical symptoms. Physical
appearance. Serology : IgM (+) in the first
day. Virus culture :nasopharynx, blood.
 TREATMENT: No spesific treatment, supportive.
 COMPLICATIONS: Encephalitis, trombocytopenia, rubella panencephalitis,arthritis
RUBELLA
 PREVENTION: Rubella vaccine
 Especially important for girls to have immunity to
rubella before they reach childbearing age.
 The susceptable pregnant woman exposed to
rubella for whom abortion is not an obtion Ig
should be administered in a dose of 0.55 ml/kg
which reduces the attack rate but doesn’t eliminate
the risk of fetal infection.
 Vaccine theoretically could prevent illness if
administered within 3 days of exposure.
ERYTHEMA INFECTIOSUM
(FIFTH DISEASE)
 Parvovirus B 19 ( discovered in 1975) member of
Erythrovirus in the family Parvoviridae.
 DNA virus
 5-15 years
 Late winter and spring
 Transmission; respiratory route.
 Beningn selflimited exanthematous illness of
childhood.
 Incubation period 4-28 days (av :16-17 days)
Parvovirus B 19
ERYTHEMA INFECTIOSUM
 Prodromal lesion phase ; mild, lowgrade fever ,
headache, URI signs.
 RASH:
 1st stage: erithematous facial flushing slapped
ceak
 2nd stage: diffuse macular erthrema on the trunk
and proximal extremities
 3rd stage: central clearing of macules (reticuler
apperance). Resolves without desqumation. Prominent on extansor surface. Tends to wax over 1-3
wks
ERYTHEMA INFECTIOSUM
 Recur with exposure to sunlight, heat,
exercise, stress
 LAP, atypical papular, purpuric, vesicular
rashes are described.
 DIAGNOSIS: clinical presentation
 IgM detection: 6-8 wks
 Virus can’t be isolated by culture
ERYTHEMA INFECTIOSUM
 TREATMENT: No spesific antiviral thera-
py.
 COMPLICATIONS: Arthralgies, arthritis,
trompbocytopenic purpura, aseptic meningitis.
PAPULAR – PURPURIC GLOVES and SOCKS
SYNDROME
 Rare disease with a cutaneous involvement and with
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lesions in the oral cavity by parvovirus B19
Affects children and young adults
Appears in both sexes in spring and summer
Edema and pruritus of hands and feet followed by a
purpura at the same site
Erythema and petechiae on the hard and soft palate
Small erosions in the oral mucosa and tongue
Commissural chelitis
Nonspesific urethritis can appear
PAPULAR – PURPURIC GLOVES and
SOCKS SYNDROME
 Diagnosis is made by the clinical dermatological
chracteristics and is confirmed by spesific serology
for Parvovirus B19 using ELISA or PCR
 Supportive treatment
ROSEOLA INFANTUM (SIXTh
DISEASE)
 Human Herpes Virus (HHV) type 6 was
discovered in 1986 ( etiologic agent for
most cases)
 HHV 7 was discovered 1990 in few cases
 HHV-6 and 7 belong to the ß- herpesvirus
subfamily of herpesviruses
 Peak acquisition of primary HHV-6
infection 6-15 months of age ( occur
younger than 3 yr)
ROSEOLA INFANTUM
ROSEOLA INFANTUM
 Higher incidense during spring and fall months
 Incubation period, 5-15 days (av:10 days)
 Most adults excrete HHV-6 and 7 in saliva and
may serve as primary sources for virus
transmission to children
 Prodromal period is usually asymptomatic ;mild
URI signs
 Mild cervical or less frequently occipital LAP may
be noted
 Some chidren may have mild palpebral edema.
ROSEOLA INFANTUM
 Clinical illness is generaly heralded by high
temparature.
 Some children may become irritable and
anorexic.
 Seizures may occur in 15% of children.
 Rhinorrhea, sore throat, abdominal pain,
vomiting and diarrhea
 Fever persists for 3-7 days ; resolves
abruptly
ROSEOLA INFANTUM
ROSEOLA INFANTUM
 A rash appears within 12-24 hr of fever
resolution.
 Rash . Rose colored, distinctive } on the trunk
 to neck, face, prox extremities
 1-3 days later the rash fades.
 The characteristic enanthem ( Nagayama
spot) consist of the soft palate and the base of
the uvula
 The enanthem may be present on the fourth
day in 2/3 of patients with roseola
ROSEOLA INFANTUM
 DIAGNOSIS
 Spesific test for HHV 6-7
 Virus culture, PCR, Ag detection
 TREATMENT
 HHV-6 is inhibited by ganciclovir ( but not
acyclovir. Foscarnet.
SCARLET FEVER
 Group A ß Hemolytic streptococcus is the
cause Pyrogenic (erythrogenic) exotoxins
(A,B,C)  Responsible for the rash of scarlet fever.
 Infection may be spread by droplets, contact
with skin lesions, transmitted by food, milk
and water.
 Incubation period: 1-7 days. (av: 3 days)
Group A ß Hemolytic
streptococcus
SCARLET FEVER
 Onset in acute and is characterized by fever,
vomiting, headache, toxicity, pharangitis
and chills within 12-48 hrs the typical rash
appears.
 Temperature increases abruptly, may peak
39,6 - 40 ºC on the 2nd day and gradually
returns to normal within 5-7 days in untreated patients.
SCARLET FEVER
 The tonsils are hyperemic and edematous
and may be covered with a gray white exudate.
 The tongue may be edematous and reddened. During the early days of illness the
dorsum of the tongue has a white coat.
WHITE STRAWBERRY TONGUE
 After several days the red tongue with
prominant papillae. RED STRAWBERRY
TONGUE
SCARLET FEVER
 THE PALATE AND UVULA MAY BE REDDENED
AND COVERED WİTH PETECHIA.
 THE EXANTEM IS RED,PUNCTATIC OR FINELY
PAPULAR.
 Appears initially in the axillers, groin and neck
and generalized within 24 hrs.
 The area around the mouth is pale: CIRCUMORAL
PALLOR
 Petechia may occur owing to capillary fragility
SCARLET FEVER
SCARLET FEVER
 Area of hyperpigmentation on the antecubi-
tal fossae; PASTIA’S SIGN
 Small vesicular lesions in severe disease :
MILIARY SUDAMINA
 Desquamation begins on the face  over the trunk
 hands and feet
 Scarlet fever may follow infection of wounds,
burns or skin infection
STRAWBERRY TONGUES
SCARLET FEVER
 DIAGNOSIS:
 Throat culture
 Current rapid Ag detection
 WBC 
 ESR,CRP 
 ASO, antiDNA se B (+) (3-6 wks)
SCARLET FEVER
 COMPLICATIONS :
 Sinusitis
 A.O.M.
 Mastoiditis
 Cervical adenitis
 Retropharingeal abscess
 Bronchopneumonia
 Menengitis
 Osteomyelitis
 Septic arthritis
SCARLET FEVER
 TREATMENT:Penicillin 10 days
 Single IM inj of a long active benzathine
penicillin, erytromicin, clindamycin, first
generation cephalosporins
 Successful treatment with shorter causes (5
days) of azithromycin or cefpodoxime has
been reported.
VARICELLA (CHICKENPOX)
 Primary infection of VARICELLA ZOSTER
VIRUS (VZV).  HUMAN HERPES VIRIDAE
 Lifelong latent infection of sensory ganglion
neurons  reactivation of the latent infection 
HERPES ZOSTER (SHINGLES)
 Mild illness in childhood
 Occurs in winter-spring
 Within hauseholds of with a case of varicella
transmission of VZV to susceptible individuals
occurs at a rate of 80-90%
VARICELLA VIRUS
VARICELLA
 Contagious from 24-48 hr before the rash
appears and until the vesicles are crusted (37 days after onset rash)
 Susceptible children may also acquire
varicella after close direct contact with
adults who have HZ.
 Transmitted respiratory secretions, fluid of
skin lesions by airborne spread/through
direct contact
VARICELLA
 Incubation period: 10-21 days ( mean 15
days)
 Virus replicated in the resp tract primary
(subclinical) viremia, widespread cutenous
lesions occur during second viremia
 Prodromal symptom: fever, malasia, anorexia, headache, abdominal pain (24-48 hr
before the rash)
VARICELLA
 Varicella lesions appears on the scalp, face
or trunk
 Prurutic erythamatous macules  clear
fluid vesicles (24-48 hr)  clouding and
umblication.
 While initial lesions are crusting  new
crops form on the trunk and then the extremites.
VARICELLA
 Ulcerative lesions  oropharenx and vagi-
na, eyelids and conjuctivae
 Average number of varicella lesions  30
(10-1500)
 VARYING STAGES OF DEVELOPMENT (MACULE,
PAPULE, VESICLE).
 PRESENT AT THE SAME TIME.
VARICELLA
VARICELLA
 Progresivve varicella: visceral organ invol-
vement, coagulopathy, severe hemorhage,.
Highest in children with congenital cellular
immune deficiency.
 High dose CST, HIV, malignancy etc...
VARICELLA
 DIAGNOSIS : Laboratory evaluation is not
necessary
 Leukopenia (first 72 hr)  lymphositosis
 Liver function tests are usually elevated
 Tissue culture method ( virus isolation) (710 days)
 VZV IgG Ab tests ; determine the immune
status of individuals whose clinical history
of varicella, is unknown.
VARICELLA
 TREATMENT : Antiviral treatment
modifies the course: ACYCLOVIR : is not
recommended routinely for uncomplicated
cases
 Oral therapy: 20 mg/kg/dose (max: 800
mg) x4 dose – 5 days
Children older than 12 yrs,receiving
aerosol steroids,having chronic cutaneous
disease
 IV therapy: severe disease and
immunocomprimised patients: 500 mg/m²/
every 8 hrs – 7 days
VARICELLA
 COMPLICATIONS : Mild varicella hepatitis
 Mild trombocytopenia
 Purpura, hemorrhagic vesicles, hematuria, GI
bleeding ‘’rare’’
 Nephritis, NS, HUS, arthritis, myocarditis,
pericarditis, pancreatitis, orchitis
 Secondary bacterial infections (AGBHS, S.aureus)
5%
 Encephalitis and cerebellar ataxia; 5yr, 20 yr 26 days after onset
 Pneumonia: very rare in children
VARICELLA
 PREVENTION : Vaccine : postexposure
within 3 days.
 VZIG: postexposure prophylaxis for
immunocomprimised children. Pregnant
women. Newborn exposed to maternal
varicella, whose mothers develop varicella ,
5 days before to 2 days after delivery
Hand Foot Mouth Disease
 Viral illness that usually affects infants and children
younger than 5 years old
 Caused by viruses that belong to enterovirus genus
– Coxsackievirus A16 is the most common cause
– Incubation period 3-7 days
– Usually starts with a fever, poor appetite, malaise
and sore throat
– 1-2 days after fever starts painful sores usually
develop in the mouth ( herpangina) → ulcers
Skin rash usually on the palms of the hands and
soles of the feet,also may appear on the knees,
elbows,buttocs or genital area
Hand Foot Mouth Disease
 Spread from person to person by direct
contact
 Viruses are found in the nose and throat
secretions, fluid in blisters and stool of
infected persons
 May be spread when infected pensons touch
objects and surfaces that are then touched by
others.
Hand Foot Mouth Disease
 Infected persons are most contagious during
the first week of the of the illness
 Samples from the throat or stool may be
collected for the diagnosis
 No spesific treatment
MENİNGOCOCCEMİA