• 85% of childhood rash diseases are maculopapular and 15% are vesicular.
• Maculopapular rash: scarlet fever, measles, rubella, infectious mononucleosis (EMN), CMV, 5th disease, 6th disease, meningococcemia, and some enteroviral rashes.
• Vesicular rash: Chickenpox, HSV infections, Coxsackie A (Hand-Foot-Mouth disease)
• Chickenpox is a common disease with papullovesicular rash. It is the most contagious rash disease.
• Itching in rash diseases; It is evident in scarlet fever, chicken pox and 5th disease.
Measles
Clinic
• The incubation period of measles infection is 9-14 days. Infectiousness is between 3 days before the rash and 4 days after the rash.
• Subsequently, a prodromal period characterized by fever, cough, conjunctivitis and coryza occurs. During this period, high fever and lethargy are evident. Sneezing, eyelid edema, watery eyes, photophobia and rough cough can also be seen.
• Pre-rash Koplik spots (appear as small white papules on the reddened buccal mucosa) in the prodromal period are as diagnostic and pathognomonic as culture growth for measles diagnosis. They appear just before the rash and disappear with the appearance of the rash. • A well-demarcated, maculopapular rash starts in the neck area and around the ears. The rash quickly descends and spreads to the face, arms and chest within 24 hours. It spreads to the lower extremities and buttocks on the 2nd day. On the 3rd day, it reaches the feet and jointed areas are seen in places.
• The rash is located centripedally. It disappears completely within 6 days and leaves a slight desquamation when disappearing.
• The fever subsides 2-3 days after the onset of the rash. It may take up to 10 days for the cough to improve.
• In severe cases, the rash may be hemorrhagic, petechiae and purpura may be seen.
Laboratory Findings
• In measles infection, the total leukocyte count can go down to 1500/ml. Lymphopenia is characteristic.
• Multinuclear giant cells (Warthin-Finkeldey cells} may be seen on cytological examination of oral mucosa swab samples and nasal secretions. Warthin-Finkeldey cells are not specific for measles.
• 1-2 days after the rash, a definitive diagnosis can be made with the detection of serum measles IgM antibody and the increase in antibody titer in the follow-ups. It can be detected in the blood for up to 1 month.
• A 4-fold increase in IgG type antibodies measured at 2-4 week intervals is diagnostic.
Complications
• The most common complication of measles is otitis media, and the most fatal complication is pneumonia. The incidence of fatal pneumonia is higher in immunocompromised patients (giant cell pneumonia, Hecht's pneumonia).
Respiratory complications
• Otitis media
• pneumonia
• Bronchiolitis
• Croup
Cerebral complications
• Encephalitis (usually seen within 1 week after the appearance of the rash. Dizziness, ataxia, vomiting, convulsions and coma) is a complication that occurs not directly by the effect of the virus, but by immunological means.
• Subacute sclerosing panencephalitis (SSPE) is a slow measles virus infection of the brain and occurs 7-10 years later in previously infected children. The first finding is typically a decrease in school achievement. It is characterized by myoclonic jerks and typical EEG findings (epileptic discharges that cannot be suppressed by diazepam. Common slow wave discharges). Measles antibodies in CSF are very high titer. The clinical efficacy of the treatment with interferon or isoprinosine alone has been demonstrated. It usually results in death in 6-12 months.
Other complications
• Hemorrhagic measles (characterized by multiorgan haemorrhage, fever and cerebral symptoms)
• Thrombocytopenia
• Appendicitis
• Keratitis
• Myocarditis
• Optic neuritis
• Gastroenteritis
• Reactivation or progression of tuberculosis
• Premature birth and stillbirth
Treatment-Prevention
• Usually no specific treatment is required. In immunocompromised cases, ribavirin can be used.
• Vitamin A treatment is indicated in all patients. Especially in malnourished patients, vitamin A supplementation accelerates the recovery of the disease.
• <6 months: 50,000 U
• 6-12 months: 100,000 U
• >12 months: 200.000 U Vit A should be given for 2 days.
• In patients with evidence of vitamin A deficiency, the third dose should be given 2-4 weeks after the second dose.
• 2 doses of measles vaccine are administered. The vaccine (live virus) provides fairly good immunity.
• Measles infection leaves permanent immunity.
• In measles, contagiousness begins 7 days after exposure and continues until 4 days after the rash appears.
• It does not pass from mother to fetus intrauterine.