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Endemic desease
Varicella
Etiology
: Transmitted via respiratory droplets and / or contact with lessions Infectious peroide begins 2 days before skin lession and ends when the lessions crust , usually 5 days later An episode of varicella confers immunocity , second episode are exceedingly rare
Epidemiology
Before varicella vaccine became widespread, 4 million cases of chickenpox were reported annually in the US , with 11.000 hospitalization and 50 100 deaths annualy Maximum incidence of varicella in children aged 1 6 years Maximum transmission occurs during late winter and spring Highly contagius : secondary attack rate is 80 100 % for contacts
Rash ussually start on the head and trunks and spreads to the rest of the body Varicellas hallmark is the simultaneous presence of rash in different stages Each lesion starts as ared macula and pass through stages of papula , vesicle ( pear or dewdrop on rose petal ), pustule, and then crusts Other accompanying manifestasion include headache , malaise , anorexia , cough and coryza , sore throat , and low grade fever
Diagnosis
Clinical
diagnosis based on the characteristic appearance of the rash Tzanck smear of scrapping from the base of veisicles will show multinucleated giant cells Serologic test can be done to assess pior exposure to varicella but have little diagnostic value during acut infection
Differential diagnosis
Contact
dermatitis Drug reaction Enterovirus Insect bites Impetigo Smallpox Urticaris Herpes simplex virus ( HSV )
Treatment
Symptomatic relief of fever and itching Do not use aspirin ( associated with Reye syndrome ) Antiviral ( acyclovir ) are used in some cases
Progressive or severe varicella Life threatening complications ( e.g. Encephalitis , pneumonia ) Neonate or asolescent / adult patient ( because high risk of severe desease ) Patient with cancer or on steroid or other immunosuppresive therapies
Universal
vaccination with live virus has significantly reduced morbidity and mortality ; confers protection to 75 100% of those immunizied ( children with immunodeficiencies ( HIV , cancer , steroid or other immunosuppressive regimen ) should not recive the varicella vaccine or any other live vaccine product
An other wise helthy child usually has 250 500 lessions ( but may have as few as 10 or as many as 1.500 ) New lesions continue to erupt for 3 5 days Lessions usually crust within 1 week and heal completely by 2 weeks Contagius from 2 days before skin lessions appear until the lessionss crust Nearly 1 in 50 cases of varicella may be associated with complication ( i.e. Varicella pneumonia and encephalitis ) Secondary bacterial infection may occur with invasive group A streptococcus, a serious infection thet may envolve rapidly into necrotizing fascitis or toxic shock syndrome
Measles
Primary infection occurs in the respiratory epithelium of the nasopharynx After 2 3 days , viremia ensues with infection of the reticuloendothelial system A second viremia occurs 5 7 days after initial infection Rash develops about 14 days after initial exposure Highly contagius during both viremia periods individuals are also infectious 3 5 days before and up to 4 days after the rash Transmitted via respiratory droplets
Epidemiology
Typically
occurs in prschool and young school aged children Occurs worldwide Peak incidence in late winter and spring >99% reduction of disease following childhood immunization Most cases in US occur in individuals who recently entered the country
Sign / symptoms
Prodome
Fever , coryza , hacking or brassy cough , non purulent conyungtivitis Koplik spots ( 1- mm blue with spots, characteristically opposite lower premolas and oral mucosa ) Maculopapular eruption lasting 5 7 days ; typically begins on faced/ head and progress to nhand / feet Desquamation may occur
Exanthema phase
Generalized lymphadenopathy Anorexia Diarrhea ( especially infant ) Fever may persist 7- 10 days
Diagnosis
Primarily a clinical diagnosis : Kopliks spots are pathognomonic Lekopenia / lympophenia Elevated transaminases Serologigies are the most common methode for diagnosis
A single measuremet of measles Ig M confirms the diagnosis; may be detected as earlty as the first day of rash but may be falsely negative in 20 % Measurement of meales IgG helaps to distinguish acute infection from prior vaccination
Differential Dx
Enteroviral infection Parvoviral infection Rubella Rosola Kawasaki desease Toxic shock syndrome Rocky mountain spotted fever Drug reaction ( e g. Stevens Johnsons syndrome )
Treatment
Supportiv care Appropiate antimicrobial agents should be used if bacterial superinfection is suspected Vitamin A supplementation agent has be shown to decrease morbidity and mortality in developing countries where vitamin A deficiency occurs ( consider vitamin A supplementation in children > 6 months , immunodeficiency, clinical evidence of vitamin A deficiency , malnutrition, and/ or recent emigration to US ) Ribavirin is controversial
Prevention
with MMR vaccine is routinely given at 12 15 mont and 4 - years of age ( vaccine failure after a single dose occurs in 2 5 % of children , however , most cases will respond to the second dose )
Complication are most common in children < age 5 or > age 20 ( 30% of cases have at least one complication ) Acute otitis media ( 10 % ) , diarrhea ( 10 % ) Lower respiratory tract infection, bacterial infection (5%): Bronkiolitis , bronkopneumonia, laryngotrakheobronkhitis , intersitial or lobar pneumonia Acute ensephalitis (0,1%): occurs 6 days after onset of rash , may result in seizures and / or neurologis damage Subacute slerosing panencephalitis is a rare but fatal neurologis disese with progressive intelectual deterioration , ataxia , seizures, and death : occurs an average of 7 years after meales infection
Mumps
A
viral infection that primary result in parotitis Transmision via respiratory droplet Contagius 2 days before through 5 days after the onset of parotitis Incubation period of 2 weeks , average duration of illness 7 10 days Prior MMR vaccine , mumps was the greteast cause of aseptic meningitis
Epidemiology
Seasonal
peaks in winter and spring but can occur any time Peak incidence in children ages 5 9 Fewer than 1.000 cases per year in US since MMR vaccine was introduced Despite high immunization rates , outbreaks of mumps still occur Permanent unilateral deafnes occur in 1 / 20.000 persons
Sign/ symptoms
Prodome : myalgia , anorexia , malaise headeache, low grade fever , chill Patrotitis is the most common manifestasion (30-40%)
Occurs within the first 2 days of illness , unilateral or bilateral involvement of parotid gland, salivary gland involment Manifest as ear pain Tender to palpation at angle of jaw, edema anterior to ear , overlying skin is not erythematous ( as opposed to bacterial parotitis ) Trismus may be prsent Asymptomatic in 20 %
Diagnosis
Primarly
a clinical diagnosis Serologic assay are the most common methode of diagnosis presence of mump IgM alone confirm diagnosis , may be detected within first week of desease viral culture of urine , saliva , and /or CSF Labs may show lymphocytosis and increase amylase
Differensial Dx
Cytomegalovirus
infection Entroviral infection Influenza infection Para influenza infection Parotis ductu obstruction Bacterial parotitis Tumor of salivary gland Mikulicz syndrome
Treatment
Supportive
care MMR is alive vaccine thet confers life long immunity ;given in two doses at 12 15 month and then again at 4 6 years
Most cases are symptomatic Symptomatic meningitis occurs in 15 % of cases but generrally resolves withour sequale
In the pervaccin era , mumps was the most common cause of aquired sensorineural hearing loss Orchitis is the most common complication in post pubertal males ( 50% ) , resulting in abrupt onset of testicular swelling , pain , nause , vomiting , fever , and possible atrophy Oophoritis , pancreatitis , and myocardium may occur Increased severity of disease in adults
Kepustakaan
Buku
kuliah 2 Ilmu kesehatan anak FK UI : Morbili ( campak,measles,Rubeola ) hal 624 Parotitis epidemika ( Gondong, Mumps) hal 629 Varisela ( Cacar air, Chicken Pox ) hal 637