MEASLES

Rubeola/Morbilli

Measles
is an acute, contagious and exanthematous disease that usually affects children which are susceptible to Upper Respiratory Tract Infection (URTI). one of the most common and most serious of all chidhood diseases

Etiologic agent: Filtrable virus that belongs to genyus Morbilivirus of the family paramyxoviridae is the agent of measles

MODE OF TRANSMISSION by droplet spread or direct contact with infected persons, or indirectly through articles freshly soiled with secretions of nose and throat, in some instances probably airborne

INCUBATION PERIOD 10-12 days (the longest is 20 days and the shortest is 8 days)

PERIOD OF COMMUNICABILITY

Usually lasts about 9-10 days, measured from the beginning of the prodromal symptoms to the fading of rash. The disease is communicable 4 days before and 5 days after the appearance of rashes The disease is communicable during the height of rash

PATHOGNOMONIC SIGN Kopliks Spots - these are inflammatory lesions of the buccal mucosa glands with superficial necrosis.
1.

They appear on the mucosa of the inner cheek opposite to the 2nd molars, or near the junction of the gum and the inner cheek 2. They usually appear 1-2 days before the measles rash.

CLINICAL MANIFESTATION 3 STAGES: 1. Pre-eruptive stage a. Fever catarrhal symptoms (rhinitis, conjunctivitis, photophobia, coryza) b. Respiratory symptoms start from common colds to persistent coughing c. Enanthema sign (kopliks spot)

2. ERUPTVE STAGE a. the rash is usually seen late on the 4th day b. macula-papular rash appears 1st on the cheeks, bridge of nose, along the hairline, at the temple or at the earlobe c. the rash is fully developed by the end of the 2nd day and all the symptoms are at the maximum at this time. d. High grade fever comes on and off e. Anorexia and irritability f. Abdominal typanism, pruritus lethary g. The throat is red and often extremely sore. h. As fever subsides, coughing may diminish, but more often it hangs on for a week or 2, become looser and less metallic

3. STAGE OF CONVALESCENCE a. Rashes fade away in the manner as they erupted b. Fever subsides as eruption disappears c. When the rashes fade, desquamation begins d. Symptoms subside and appetite is restored

Laboratory exams 1. nose and throat swab 2. urinalysis 3. blood exams (CBC, leukopenia, leukocytosis) 4. complement fixation or hemogglutinin test

Drug of choice 1. anti-viral drugs(Isoprenosine) 2. Antibiotics if with complication 3. Supportive therapy (oxygen inhalation, IV fluids)

NURSING INTERVENTION
1. Isolation of the patient is necessary ( the room must be quiet, well-ventilated, and must have subdued light. 2.Control of the patients high temperature with warm or tepid sponges. 3. Skin care is utmost. The patient should have a daily cleansing bed bath. The water should be comfortably warm. 4.Oral and nasal hygiene is a very important aspect of nursing care of patient with measles. 5. Care of the eye is necessary. The patient is sensitive to light, therefore, position the patient where a direct glare of light is avoided.

measles virus lymphoid tissueblood (first virusemia) epithelial cells(multiply) tract blood (second virusemia) MPS(multiply) respiratory general toxic symptoms

PATHOPHYSIOLOGY
measles virus respiratory tract epithelial cells(multiply) lymphoid tissueblood (first virusemia) MPS(multiply) blood (second virusemia) general toxic symptoms

Chicken pox
(Varicella)

Definition: is highly contagious disease caused by herpes virus varicella, characterized by vesicular eruptions on the skin and mucous membranes usually with mild constitutional manifestations

Incubation Period: From10-21 days with a mean of 14 days or 2 weeks Period of Communicability: The patient is contagious about a day before the eruption of rashes and continuous to be so up to the 5th or 6th day after the last scab formation or until all vesicles have become encrusted.

Modes of Transmission:

1. Direct Contact with patient who sheds the virus from vesicles 2. Indirect Contact through articles fresh soiled by discharges of infected persons 3. Airborne or spread by droplet infection

PATHOGNOMONIC SIGN - vesiculo-papular rash

 Clinical Manifestations: Pre- eruptive manifestations are mild fever and malaise Eruptive stage Rash starts from the trunk (unexposed area), then spread to other parts of the body Initial lesions are distinctively red papules whwere contents become milky and pus-like within 4 days In adult and bigger chidren, the lesions are more widespread and more severe. There is srapid progression so that transition is completed in 6-8 hours. Vesicular lesions are very puritic. All stages are present simultaneously before all are covered with scabs, known as Celestial Map All lesions appear in different stages at one time or it will pass through the ff: stages:

H. Macule is a lesion that is not elevated above the skin surface I. Papule is a lesion that is elevated above the skin surface with a diameter of about 3mm J. Vesicle is a pop-like eruption filled with fluid. The thin walled vesicle easily bursts and dries up in 3-5 days K. Pustule is a vesicle that is infected or filled with pus. L. If the lesion becomes infected the scar may be big and wide. M. Crust is a scab or eschar. This is a secondary lesion caused by the secretion of vesicle drying on the skin. N. The scars are superficial, depigmented and take time to fade out.

COMPLICATION
1. secondary to infection of the lesions Furuncles, cellulites, skin abscess, erysipelas 2.meningoencephalitis 2.meningoencephalitis 3. pneumonia 4. sepsis

Antivirals Antiviral drugs can reduce symptoms for people at risk of complications from the chicken pox including: adults, smokers, and people with a compromised immune system. Acyclovir and immune globulin intravenous (IGIV) must be taken no more than a day after the rash first appears. Valacyclovir and famciclovir can be taken after a day,but are only approved for adults. Vaccine The chicken pox vaccine can eliminate or reduce symptoms, even if it is taken after exposure to the virus. Antibiotics Some complications of chicken pox, such as skin infection and pneumonia, may require treatment with antibiotics. Smokers are especially at risk for pneumonia. Itch Relievers Over-the-counter medications such as antihistamines and itch-relief creams can help alleviate itching. This reduces scratching, which increases the chance of skin infection. Pain Relievers Acetaminophen can relieve the pain of chicken pox symptoms. Never use aspirin with the chicken pox; it can lead to Reye's syndrome, which causes liver failure and even death.

NURSING INTERVENTION
Respiratory isolation is a MUST until all vesicles have crusted. Prevent secondary infection of the skin lesion through hygienic care of the patient Attention should be given to nasopharyngeal secretions and discharges. Linens must be didinfected under the sunlight or through biling Cut finger nails short and wash hands more often to minimize bacterial infections that may be introduced by scratching. A child must wear mittens. Provide activities to keep child occupied to lessen pruritus.

PREVENTION
active immunization with live attenuated varicella vaccine is necessary. avoid exposure as much as possible to infected persons

DIAGNOSTIC PROCEDURES
Determination Of V-Z Virus through Complement Fixation Test Determination Of V-Z Virus through Electron Microscopic Examination

DRUGS
Zoverax 500mg/ tablet, 1 tab 2x a aday for 7 days must be administered. Oral acyclovir 800mg 3x a day for 5 days must also be given Oral antihistamine can be taken to symptomatic pruritus. Calamine lotion will ease itchiness. Salicylates must not be given. Antipyretic might be given for fever.

Pathophysiology

CONTAINS VIRUS

VIA AIRBORNE INFECTED PERSON

DROPLET ENTER OTHER LUNGS

NEW VICTIM

ENTER BLOOD STREAM

German measles
(Rubella / three day Measles )

Definition - is a mild viral illness caused by rubella virus - it causes mild feverish illneess associted with rashes and aches in joints - has a teratogenic effect on the fetus

CAUSATIVE AGENT
Rubella virus (Family- Togaviridae; Genus Rubivirus

INCUBATION PERIOD
From exposure to the appearance of rash, the incubation period is usually 14-21 days

PERIOD OF COMMUNOICABILITY
the virus is communicable approximately 1 week before and 4 days after the onset of rashes, but is at its worst when the rash is at its peak. highly communicable infants with congenital Rubella may shed virus for months after births.

MODE OF TRANSMISSION 1. direct contact with nasophayngeal

secretions 2.air droplets 3.transplacental transmission in congenital rubella 4. infants with congenital rubella she d large quantities of virus in the pharyngeal secretions and urine in which serve as source of infection to other contacts.

PATHOGNOMONIC SIGN Forchhmeirs spot

SIGN AND SYMPTOMS

1. Prodromal period Low grade fever Headache Malaise Mild coryza Conjunctivitis Post-auricular, sub-occipital, and posterior cervical lymphadenopathy which occur on the 3rd to the 5th days after onset

2. Eruptive stage
A pinkish rash on the soft palate (Forchheimers spot), an exanthematous rash that appears first on the face, spreading to the neck, the arms, trunk, and legs. Eruption appears after the onset of adenopathy Children usually present less or no constitutional symptoms. The rash may last for one to five days and leaves no pigmentation nor desquamation Testicular pain inyoung adults Transient polyathralgia and polyarthritis may occur in adults and occasionally in children.

COMPLICATION
Encephalitis Neuritis Arthritis Arthralgias Rubella syndrome, manifested by: Microcephally Mental retardation Cataract Deaf-mutism Heart disease

PREVENTION
Adminisration of live attenuated vaccine (MMR) Pregnant women should avoid exposure to patients infected with Rubella Virus. Administration of Immune Serum Globulin one week after exposure to Rubellla

Diagnostic procedures
Rubella hemagglutination inhibiting Abs present by second day of rash and incease in quantity over the next 10-21 days Others: CF (Compliment Fixation Test), ELISA (o Enyyme s Link Immunosorbent Assay, SRH (Single Radial Hemolysis), RIA ( Radioimmunoassay), IgM(Specific Ab test) Hemagglutination Inhibition(HI) antibody test is accepted as the most useful tecnique for diagnosis

DRUGS
Acetaminophen Nonsteroidal anti-inflammatory drugs: Aspirin Ibuprofen Naproxen Ketoprofen Acetaminophen Acetaminophen decreases fever and pain, but does not help inflammation. Adult dosing is 2 regular strength (325 mg) every 4 hours or 2 extrastrength (500 mg) every 6 hours. Maximum dose is 4,000 mg per day. Avoid this drug if you have alcoholism, liver disease or an allergy to the drug. See the package instructions. Common brand names include Tylenol, Panadol, and many others.

 Common medications used at home for pain and fever in children with rubella include: Acetaminophen Ibuprofen Naproxen (must be 13 or older) Aspirin and most of the other nonsteroidal anti-inflammatory drugs (NSAIDS) are not used in children except under a doctor's care.

PATHOPHYSIOLOGY

Herpes zoster
(Shingles)
also known as zona,

- an infection of sensory nerve, it is an extremely painful infection which the lesion occur only along the sensory nerve that is affected

CAUSATIVE AGENT
Varicella-zoster (V-z) virus This agent has been found to cause two diseases, varicella and herpes zoster The incubation period of herpes zoster is unknown it is believed to be 13-17 days.

INCUBATION PERIOD
The incubation period is unknown, it is believed to be 13-17 days

Period of communicability
Herpes zoster is communicable a day before the appearance of the first rash until five days after the last crust.

MODE OF TRANSMISSION
Herpes zoster can be transmitted through direct contact, through droplet infection, and airborne spread. It can also be transmitted through indirect contact, through articles freshly soiled by secretions and discharge from the infected person.

PATHOGNOMONIC SIGN -regional painful rash AND lesion follow peripheral nerve pathway of CN V and
CN VII

SIGN AND SYMPTOMS

- burning, itching, and pain, erythematous pathes appear followed by crops of vesicles which forms a band-like distribution of along the course of involved dermatomes, eruptions are unilateral and nerve crosses the midline of the body - the vesicles become umbilicated and crusting starts. Successive crops may appear. The lesion may last 12wks. Usually there are no scars unless secondary infections sets in. - fever and regional lymphadenopathy -Iridocycliitis and corneal anesthesia when the opthalmic or fist division of the 5th cranial nerve is affected, this is called Gasserian Ganglionitis -Paralysis of the facial nerve and vesicles in the external auditory canal are the results of infection of the 7th cranial nerve or the Geniculate Ganglion, the condition is called Ramsav Hunt Syndrome

COMPLICATION
Encephalitis Paralytic ileus, bladder paralysis Ophthalmic herpes which may lead to blindness

NURSING INTERVENTION
Put patient on strict isolation Apply cool, wet dressings with NSS to pruritic lesions. Efforts should be made to prevent secondary infection Prevent entrance of microorganism into the lesions especially if they break.

PREVENTION
Prevention
Avoid contact with active Shingles or Chicken Pox Consider prophylaxis if exposure in high-risk groups Varicella Vaccine May reduce risk of developing Shingles Now part of routine Primary Series Booster Varivax for age >55 years may be considered

DIAGNOSTIC PROCEDURE
Characteristic skin rash may be diagnostic Tissue culture technique the virus maybe isolated from fluid taken from newly developing vesicles. Smear of vesicle fluid Microscopy

DRUGS
People with mild to moderate pain can be treated with over the counter analgesic. Topical lotions containing calamine can be used on the rash or blisters and may be soothing. Occasionally, severe pain may require an opioid medication, such as morphine. Once the lesions have crusted over, capsaicin cream (Zostrix) can be used. Antiviral drugs inhibit VZV replication and reduce the severity and duration of herpes zoster with minimal side effects, but do not reliably prevent postherpetic neuralgia of these drugs, acyclovir has been the standard treatment, but the new drugs valaciclovir and famciclovir demonstrate similar or superior efficacy and good safety and tolerability.

PATHOPHYSIOLOGY
After the primary infection the varicella zoster may persist in a dormant state in the dorsal root ganglia the virus may later emerge from the site either spontaneously or in association with immunosuppression which causes herpes zoster it produces localized vesicular skin lesion confined to dermatoe and severe neurologic pain in the peripheral areas innervated by the nerves arising in inflamed root ganglion