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    1. Measles is a highly contagious viral disease spread through direct contact and airborne transmission. It causes a rash and fever and can lead to complications like pneumonia and encephalitis without treatment. The MMR vaccine prevents measles. 2. Scarlet fever is caused by Streptococcus pyogenes bacteria and causes a sandpapery rash, fever, and sore throat. It is treated with antibiotics to prevent complications like rheumatic fever. 3. Kawasaki disease is a systemic vasculitis that commonly affects young children and can cause coronary artery aneurysms. It is diagnosed based on fever and signs including rash, conjunctivitis, and mouth changes. Treatment involves

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    1. Measles is a highly contagious viral disease spread through direct contact and airborne transmission. It causes a rash and fever and can lead to complications like pneumonia and encephalitis without treatment. The MMR vaccine prevents measles. 2. Scarlet fever is caused by Streptococcus pyogenes bacteria and causes a sandpapery rash, fever, and sore throat. It is treated with antibiotics to prevent complications like rheumatic fever. 3. Kawasaki disease is a systemic vasculitis that commonly affects young children and can cause coronary artery aneurysms. It is diagnosed based on fever and signs including rash, conjunctivitis, and mouth changes. Treatment involves

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    14 views30 pages

    Measles and Scarlet Fever Kawasaki Disease: Fatin & Eileen

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    1. Measles is a highly contagious viral disease spread through direct contact and airborne transmission. It causes a rash and fever and can lead to complications like pneumonia and encephalitis without treatment. The MMR vaccine prevents measles. 2. Scarlet fever is caused by Streptococcus pyogenes bacteria and causes a sandpapery rash, fever, and sore throat. It is treated with antibiotics to prevent complications like rheumatic fever. 3. Kawasaki disease is a systemic vasculitis that commonly affects young children and can cause coronary artery aneurysms. It is diagnosed based on fever and signs including rash, conjunctivitis, and mouth changes. Treatment involves

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    of 30

    MEASLES AND SCARLET

    FEVER FATIN & EILEEN

    KAWASAKI DISEASE
    MEASLES Measles is a highly contagious,
    serious disease caused by a
    virus. (in the paramyxovirus
    family)
    Currently rare after
    introduction of MMR vaccine
    HOW IT IS SPREAD?It is normally passed through direct
    contact and through the air.
    Measles is so contagious that if one
    person has it, up to 90% of the people
    close to that person who are not immune
    will also become infected.
    Measles virus can live for up to two
    hours in an airspace after an infected
    person leaves an area.
    KOPLIK
    SPOTS
    - WHITE SPOT
    USUALLY
    FOUND ON
    BUCCAL
    MUCOSA
    -
    PATHOGNOMONI
    C BUT
    DIFFICULT TO
    SEE
    Rash
    Discrete maculopapular rash
    Initially become blotchy and
    confluent
    It spreads downward from
    behind of the ears to the face
    and neck and spread to the
    whole of the body
    May desquamate in the second
    week
    TREATMENT OF MEASLES
    No specific antiviral treatment for measles virus.
    Severe complications from measles can be reduced through supportive care.
     that ensures good nutrition, adequate fluid intake and treatment of dehydration

    Antibiotics should be prescribed to treat eye and ear infections, and pneumonia.
    Vitamin A supplements can be given in 2 doses 24 hours apart. This treatment
    restores low vitamin A levels during measles that occur even in well-nourished
    children and can help prevent eye damage and blindness.
    COMPLICATIONS OF MEASLES
    Complications are more likely in children with a poor immune system, those who
    are malnourished or children age under 5 years old.
    Common complications
     Ear infections occur in about one out of every 10 children with measles.
     Diarrhea is reported in less than one out of 10 people with measles.

    Severe complications
     Pneumonia : 1 out of every 20 children, the most common cause of death from measles in young
    children
     Encephalitis : 1 out of every 1000 children, can lead to convulsion and can leave the child deaf or
    mentally retarded.
    Long-term Complications
     Subacute sclerosing panencephalitis (SSPE) is a very rare, but fatal
    disease of the central nervous system that results from a measles virus
    infection acquired earlier in life.
     SSPE generally develops 7 to 10 years after a person has measles, even
    though the person seems to have fully recovered from the illness.
     Since measles was eliminated in 2000, SSPE is rarely reported.
    SCARLET Scarlet fever (sometimes called scarlatina)
    is an infectious disease caused by bacteria
    FEVER called Streptococcus pyogenes, or group
    A streptococcus (GAS)

    SCARLE Scarlet fever is mainly a childhood


    disease and is most commonly seen
    T FEVER between the ages of 2 and 8 years.
    Scarlet fever, is highly contagious and is
    spread by close contact with someone
    carrying the bacteria
    SIGNS AND SYMPTOMS
    It takes around 2 to 5 days to develop
    symptoms after exposure to these
    bacteria.
    Characteristics of the rash typically
    include:
     Erythematous rash that blanches on pressure
     Sandpaper quality
     Begins on the trunk, then quickly spreads
    outward, usually sparing the palms, soles, and
    face
    TREATMENT OF SCARLET
    FEVER
    The use of a recommended antibiotic regimen to treat
    scarlet fever:
    Shortens the duration of symptoms
    Reduces the likelihood of transmission to family members,
    classmates, and other close contacts
    Prevents the development of complications, including acute
    rheumatic fever
    Penicillin V or amoxicillin is the antibiotic of choice to treat scarlet fever
    KAWASAKI DISEASE
     systemic vasculitis
     Also called as mucocutaneous lymph node
    syndrome
    most important manifestation/complication
    = coronary vasculitis  aneurysm of coronary
    arteries
    EPIDEMIOLOGY
    Usually affect 6m to 4 y/o children
    Peak: end of first year of life
    boys>girls

    Young infants
    -more sevely affected
    -Have incomplete sx
    ETIOLOGY
    Remains unknown
    Possible bacterial toxin or viral agents with genetic predisposition
    DIAGNOSTIC CRITERIA :
    #WARMCREAM
     Warm : fever >5day

     Conjunctivitis : bilateral, non purulent


     Rash : erythematous, maculopapular,
     Erythema palm and sole : with swelling
     Adenopathy : cervical, unilateral
     Mucous membrane : dry, red, strawberry tongue
    DIAGNOSTIC CRITERIA
    Fever (at least 5d) + 4 out of 5 of the following:

    EYE BILATERAL NON PURULENT


    CONJUCTIVTIS
    MUCOSAL CHANGES IN INJECTED PHARYNX
    OROPHARYNX RED LIPS
    DRY FISSURED LIPS
    STRAWBERRY TONGUE
    NECK CERVICAL
    LYMPHADENOPATHY
    BODY (TRUNCAL) RASH (POLYMORPHOUS BUT
    NON VESICULAR)
    CHANGES IN EXTREMITIES EDEMA HAND, FEET
    ERYTHEMA
    DESQUAMATION (BEGINNING
    PERIUNGUALLY)
    OTHER FEATURES
    CNS IRRITABILITY
    ALTERED MENTAL
    STATE
    ASEPTIC MENINGITIS
    CVS CORONARY
    ABNORMALITIES
    GIT DIARRHEA
    VOMITING
    ABD PAIN
    HEPATOSPLENOMEGALY
    HYDROPS OF GALL
    BLADDER
    GU STERILE PYURIA
    MUSCULOSKELETAL TRANSIENT ARTHRITIS
    OTHERS INDURATED BCG SCAR
    C A Adenopathy – cervical,
    unilateral

    R
    M

    E
    INCOMPLETE KAWASAKI
    DISEASE
    Tend to occur in young infant
    Have incomplete symptoms in which not fulfill diagnostic criteria
    Must be high suspicious-can develop coronary artery dilatation or
    aneurysm
    INVESTIGATION
    No diagnostic test
    FULL BLOOD COUNT NORMOCYTIC ANEMIA
    LEUCOCYTOSIS
    THROMBOCYTOSIS
    - AFTER 10TH DAY OF ILLNESS
    - LAST FOR FEW WEEKS
    LIVER FUNCTION TEST ELEVATED ALANINE
    TRANSAMINASE
    HYPOALBUMINEMIA
    (ALBUMIN <3G/DL)
    ACUTE PHASE REACTANTS ESR HIGH
    CRP HIGH
    URINE >10 WBC/HPF
    ECHOCARDIOGRAPHY TO LOOK FOR/MONITOR
    CORONARY ARTERY
    ANEURYSM DEVELOPMENT
    INDICATION OF ECHO
    Prolong fever
    With other 2 criteria
     Periungual desquamation
     2 criteria + thrombosis
     Rash without any other explaination
    MANAGEMENT
    Primary Tx
    1. IV Immunoglobulin 2gm/kg infusion over 10-12h
    - If start <10d of onsetprevent coronary vascular damage
    2. Oral aspirin 30mg/kg/d (anti-inflammatory dose) for 2w or until afebrile for 2-3d

    Maintainance
    1. Oral Aspirin 3-5mg/kg/d (anti-platelet dose) for 6-8w or until ESR and platelet
    normalize
    2. If coronary artery aneurysm presentcont Aspirin until resolves
    3. If develop giant coronary artery aneurysmlong term warfarin therapy

    If not respond to primary tx,


    -persistent or recrudescent fever 36 hrs and more after completion initial dose IV
    Immunoglobulins

    TX repeat IV Immunglobulins 2gm/kg infusion over 10-12h


    VACCINATION
    IV Ig impair efficacy live attenuated virus vaccine

    So, need to delay these vaccination for at least 11 months


    PROGNOSIS
    1. Complete recovery in children without coronary artery involvement
    2. 80% of 3-5mm aneurysm resolve
    3. 30% of 5-8mm aneurysm resolve
    4. Aneurysm>8mm (prognosis worst)
    5. Mortality=1-2% (from cardiac complication within 1-2 months onset)
    REFERENCES
    ILLUSTRATED TEXT BOOK OF PAEDIATRIC, 5TH EDITION ,TOM LISEAUR
    PAEDIATRIC PROTOCOL 4TH EDITION
    DRUG DOSES FRANK SHAN

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