Dr.

Rehab Aljerbi
Assistant lecturer- Department of Family and Community
Medicine
Tripoli University
 General Presentation
 Children frequently present at the physician’s
office or emergency room with a fever and rash.
Although the differential diagnosis is very broad,
adequate history and physical examination can
help the clinician narrow down a list of more
probable etiologies. It is important for physicians
to be diligent, as the differential diagnosis can
include contagious infections or life-threatening
diseases.
 Even though there is a strong link between the
presentation of fever and rash and infectious
disease, it is important to keep in mind that
other non-infectious diseases can also have
similar presentations (e.g. drug reactions,
cutaneous lupus erythematosus, inflammatory
bowel disease).
Measles: Rubella:

 Blanching erythematous  Rash resembles measles,

maculopapular rash but patient is not ill
looking
 Begins in head and neck à  Prominent postauricular,
spreads centrifugally to posterior cervical +/-
trunk and exrtremities
suboccipital adenopathy
 Forschemier spots: small,
 Associated symptoms:
fever, cough and red spots (petechiae) on
conjunctivitis soft palate in 20% of
rubella patients
Epidemiology:
 Measles is one of the leading causes of death among
young children even though a safe and cost-effective
vaccine is available.
 In 2013, there were 145 700 measles deaths globally –
about 400 deaths every day or 16 deaths every hour.
 Measles vaccination resulted in a 75% drop in
measles deaths between 2000 and 2013 worldwide.
 In 2013, about 84% of the world's children received
one dose of measles vaccine by their first birthday
through routine health services – up from 73% in
2000.(Source: WHO)
 During 2000-2013, measles vaccination
prevented an estimated 15.6 million deaths
making measles vaccine one of the best buys
in public health. (Source: WHO)
 Measles occurs throughout the world, both in
endemic and epidemic forms. In
unimmunized communities most children
develop the disease before the age of 18 years
and two yearly epidemics being common.
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 In Libya the disease has decreased
considerably over the past few decades.
 vaccination and better standard of living.
 3000 cases were reported annually from 2002-
2005 with an age shift from young children to
25-30 year age group
 2010…62 cases were confirmed and in 2012
about 230 case.(Source: www.nidcc.org.ly)
AGENT

 RNA paramyxovirus
 Source of infection: case of
measles.
 No carrier state.
 Communicability : 4 days
before and 5 days after the
rash.
 Infective materials are
secretion from nose, throat
and respiratory tract
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HOST
 Age: no age is immune,
–6months to 3 years in
developing countries,
–Over 5 years in
developed countries.
 Gender: equal.
 Immunity: life long after one
attack. infants are protected by
maternal antibodies up to 6
months.
 Nutrition: very sever measles
is common among poorly
nourished children

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ENVIRONMENT

 Seasonal variation:
–Any season
–It’s winter disease in
climate countries due to
overcrowding and indoor
 Population density
 Socioeconomic

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 It is transmitted directly from person to person
by droplet infection.
 Infectivity started 4 days before rash up to 5
days after rash.
 Portal of entry is the respiratory tract.
Conjunctivitis recreation may transmitting
measles.
 Incubation period 10 days from exposure to
onset of fever and 14 days to appearance of
rash.
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 Prodromal stage: fever, coryza (Rhinitis), nasal
discharge, cough, redness of the eyes.
 Koplik's spots :small, bluish-white spots appear
on the buccal mucosa.
 Eruptive phase: red macular or maculo-papular
rash begins behind the ears and spreads rapidly
over the face, neck and the body.
 Complications: Diarrhoea, pneumonia, otitis
media. Others; febrile convulsion, encephalitis,
sub acute sclerosing pan- encephalitis(SSPE)=
progressive mental deterioration

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 Measles vaccine with coverage rate over 95%. It
is safe, effective and inexpensive. The measles
vaccine is often incorporated with rubella and/or
mumps vaccines (MMR).
 Freeze dried live attenuated vaccine.
Subcutaneous 0.5ml the diluting fluid should be
kept cold. The reconstituted vaccine should be
kept on ice and used within one hour. When
injected the attenuated virus multiplies and
induces mild illness 5-10 days after.

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 pregnancy, deficient immunity, steroids,
immunosuppressive drugs.
 Adverse effects: Toxic shock syndrome: due
to contamination of the vial, it reflect poor
quality of immunization services.
 Measles may be prevented by
immunoglobulin.

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 Rubella is a contagious, generally mild viral
infection that occurs most often in children and
young adults.
 Rubella infection in pregnant women may cause
fetal death or congenital defects known as
congenital rubella syndrome (CRS).
 Worldwide, an estimated 110 000 babies are born
with CRS every year.
 There is no specific treatment for rubella but the
disease is preventable by vaccination.
AGENT
 RNA virus of the togavirus
family
 Only one antigen
 Source of infection: cases and
subclinical cases
 No carriar
 communicability: less than
measles (due to absence of
cough) 1wk before symptoms
and 1wk after rash appears.
 The rubella virus is
transmitted by airborne
droplets

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HOST

 Age: 3-10 years (now shift

of age).
 Gender: equal.
 Immunity: one attack
results in life-long
immunity, second attacks
are rare

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ENVIRONMENT

 Seasonal variation:
–winter and spring
–epidemics every 4-9
years.

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 Droplet infection: from person to person, the
virus can cross the placenta (vertical
transmission).
 Incubation period: 2-3 wks

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 In children, the disease is usually mild, with symptoms
including a rash, low fever (<39°C), nausea and mild
conjunctivitis.
 The rash, which occurs in 50–80% of cases, usually starts
on the face and neck before progressing down the body, and
lasts 1–3 days.
 Swollen lymph glands behind the ears and in the neck are
the most characteristic clinical feature.
 Infected adults, more commonly women, may develop
arthritis and painful joints that usually last from 3–10 days.
 Symptoms usually appear 2 to 3 weeks after exposure. The
most infectious period is usually 1–5 days after the
appearance of the rash.

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 When a woman is infected with the rubella virus
early in pregnancy, she has a 90% chance of
passing the virus on to her fetus.
 This can cause miscarriage, stillbirth or severe
birth defects known as CRS. Infants with CRS
may excrete the virus for a year or more.
 Children with CRS can suffer hearing
impairments, eye (Cataract–Retinopathy)and
heart defects and other lifelong disabilities,
including autism, diabetes mellitus and thyroid
dysfunction – many of which require costly
therapy, surgeries and other expensive care.
 MMR vaccine.
 Seroprophylaxis for pregnant women exposed to
infection.

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 Mumps is a viral infection.
 It is sometimes called infectious parotitis, and it
primarily affects the salivary glands.
 Mumps is mostly a mild childhood disease. It
most often affects children between 5 and 9 years
old. When it does, complications are more likely
to be serious.
 Mumps virus is present throughout the world. It
is spread by airborne droplets released when an
infected person sneezes or coughs and by direct
contact with an infected person.
 Agent:Myxovirus
 Source of infection: clinical and sub clinical
cases
 Communicability: 4-6 days before symptoms
and a week or more thereafter infection.
 I-P: 2-3 wks
 Age: No age is immune, Children under age
of 6 month are immune, Children of 5-15
usually infected. Severity increased by age
 Sex: Equal
 Immunity: one attack clinical or sub clinical
induce life-long immunity
 second attack can occur (SAR: 86%.)
 Endemic disease
 No seasonal variation
 Overcrowding is associated of epidemics
 Mode of transmission: by droplet infection
and direct contact with an infected person.
 30% sub clinical.
 Pain, stiffness and swelling in the parotid
gland(1 or 2), may involve the sublingual and
submandibular glands
 Ear ache- fever- headache last 3-5 days.
 Testes, pancreas ,CNS, ovaries and prostate
may be affected
 The swelling subside over 1-2 weeks.
 orchitis,
 oophritis,
 pancreatitis,
 meningo-encephalitis,
 Myocardititis
 Nephritis
 neuritis
 By highly effective live attenuated vaccine
(MMR).
 Mumps may be prevented by
immunoglobulin.
 MMR= Measles, Mumps and Rubella vaccine
 MMR= Maternal Mortality Rate
 MMR= Mass Miniature Radiography.