NANCY F. DANILA, RN,US RN, MAN

ERUPTIVE FEVER DISEASE

ERUPTIVE FEVER DISEASECHICKEN POXEXANTHEM SUBITICUMGERMAN MEASLESHERPES ZOSTERMEASLES

CHICKEN POX

VARICELLA-OTHER NAMEAn acute and highly contagious disease of

viral etiologyCharacterized- vesicular eruptions on the

skin and mucous membrane and mild constitutional symptoms

INFECTIOUS AGENT- HERPESVIRUS VARICELLAE

Man is the only source of infectionClosely related or identical to herpes zoster

virus

Incubation Period10-21 days or maybe prolonged after

passive immunization against chicken pox

MODE OF TRANSMISSIONDirect contact with patients who sheds the

virus from the vesiclesIndirect contact, through linen or fomitesAirborne or spread by droplet infection

PERIOD OF COMMUNICABILITYThe patient is capable of transmitting the

disease about a day before the eruption of the first lesion up to about 5 days after the appearance of the last crop

CLINICAL MANIFESTATIONPRE-ERUPTIVE MANIFESTATION- mild’:

fever and malaiseERUPTIVE STAGE-

Rash start from the trunk then spread to th other parts of the body

Initial lesions are distinctively red papules where contents become milky and pus-like within 4 days

In adult and bigger children, the lesions are more wide spread and more severe

CLINICAL MANIFESTATIONERUPTIVE STAGE-

There is rapid progression so that transition is completed in 6-8 hours

Vesicular lesion are very pruriticAll 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 following stages: macule, papule, vesicles, pustule, crust

Macule- a lesion that is not elevated above the skin surface

Papule- a lesion that ie elevated above the skin surface with a diameter of about 3 mm

Vesicle – a pop-like eruption filled with fluid; the thin-walled vesicle early burst and dry up in 3-5 days

Pustule- a vesicle that is infected or filled with pus. If lesion become infected the scar may be big and wide

Crust- a scab or eschar. This is a secondary lesion caused by the secretion of visicle drying on the skin

The scar are superficial, depigmented and take time to fade out

DIAGNOSTIC TESTDetermination of V-Z through complement

fixation testDetermination of V-Z virus through electron

microscopic examination of vesicular fluid

Complications Secondary infection of the lesions;

furuncles, cellulites, skin abscess, erysipelas

MeningoencephalitisPneumoniaSepsisHemorrhagic varicella

TreatmentZoveraz 500mg/tablet 1 tab 2x aday for 7

daysOral acyclovir 800 mg 3x a day for 5 daysOral anti-histamine for symptomatic

pruritusCalamine lotionDo not give salicylatesAntipyretic for fever

Nursing ManagementRespiratory isolation until all vesicles have

crustedPrevention of secondary infectionDisinfection of contaminated articlesCut nail shortFor a child, apply mittensProvide activities to keep child occupied to

lessen pruritus

PREVENTIVE MEASURESActive immunization with live attenuated

varicella vaccineAvoid exposure as much as possible to

infected persons

ROSEOLA INFANTUM, ROSE RASH OF INFANT

EXANTHEM SUBITUM

DEFINITIONA benign disease that occur almost

exclusively in infants and young children

ETIOLOGIC AGENTThe agent causing the disease still unknown

but believed to be virus

INCUBATION PERIOD:8-14 DAYS with an average of 10 days

CLINICAL MANIFESTATIONHigh grade fever ranging from 38.3-39.8

degree celcius or may have febrile convulsions

Fever, irritability and anorexia may last for 2-5 days after which the fever suddenly drops to normal and infants appear well

Morbilliform eruption spread all over the body that start on the trunk, spread to the neck, the abdomen, the upper and lower extremities

CLINICAL MANIFESTATIONSThe rash disappear within a few hours or

may persist for 2 days with no mark leftThe region above the nose and cheeks are

free from rashThe pharynx slightly inflamed, tonsils are

slightly reddened or covered with follicular exudates

Treatment/ManagementSymptomatic with some antipyreticNo isolation needed

RUBELLA; 3- DAY MEASLES

GERMAN MEASLES

DEFINITIONA mild viral illness caused by rubella virusIt causes mild feverish illness associated

with a rash, and aches in jointsIt has teratogenic effect on the fetus

INFECTIOUS AGENT: RUBELLA VIRUS ( FAMILY- TOGAVIRIDAE; GENUS RUBIVIRUS)

INCUBATION PERIOD: FROM EXPOSURE TO THE APPEARANCE OF RASH IS USUALLY 14-21 DAYS

PERIOD OF COMMUNICABILITYApproximately one week before and four

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 birth

Mode of TransmissionDirect contact with nasopharyngeal

secretionsAir dropletsTransplacental in placental in congenital

rubellaInfants with congenital rubella shed large

quantities or virus in their pharyngeal secretions and urine which serve as source of infection to other contacts

CLINICAL MANIFESTATIONPRODROMAL PERIOD-Low grade fever-headache-malaiseMild coryzaConjunctivitisPost-auricular, sub-occipital and posterior

cervical lymphadenopathy with occur on the 3rd to the 5th day after onset

ERUPTIVE PERIODA pinkish rash on the soft palate

(Forchheimer’s spot)An exanthematous rash that appear first on

the face, spreading to the neck, the arms, trunk and legs

Eruption appears after onset of adenopathyThe rash may last for 1-5 days and leaves no

pigmentation, no desquamationTonsillar pain in young adultsTransient poly arthralgia and poly arthritis

may oocur

Treatment

Very little treatment is necessary; it is essentially symptomatic

Risk of congenital malformation100% - when maternal infection occurs on

the first trimester of pregnancy or first month of gestation

4% in the second trimester90% -of congenital rubella cases will

excrete the virus at birth and are therefore infectious

10% remain contagious until one year of age

Nursing ManagementIsolation Bedrest until fever subsidesDarken room to avoid photophobiaMild liquid diet but nourishingIrrigate eyes with warm saline to relieve

irritationCare of the ears-do not apply heat or cold unless

so orderedGood ventilationPrevent spread of infectionPrevent complications

PREVENTIONAdministration of live attenuated vaccine

(MMR)Pregnant women should avoid exposure to

patient with rubella administration of Immune Serum Globulin one week after exposure to Rubella

SHINGLES:ACUTE POSTERIOR GANGLIONITIS

1 HERPES ZOSTER

DEFINITIONAn acute viral infection of the sensory

nerve caused by variety of chicken pox virus

ETIOLOGIC AGENTVARICELLA-ZOSTER VIRUZ

INCUBATION PERIOD:13-17 DAYS

PERIOD OF COMMUNICABILITYA day before the appearance of the first rash

to 5-6 days after the last crust

MODE OF TRANSMISSIONDirect contact-through droplet infection;

airborne spreadIndirect contact

Clinical ManifestationAny part of the trunk maybe affected but

the thoracic segment is commonly involvedOther areas that maybe affected are the

extremities and branches of he 5th and 7th cranial nerves

Erythematous base of the skin lesion appears first is followed within 24 hours by the appearance of the vesicles

Clinical ManifestationCluster of vesicles appear to form patchesEruption are unilateral and never cross the

midline of the bodyThe vesicles become pustular, break down

and form crusts. Lesions may last for 1-2 weeks

Pain of varying intensity Pain occurs from one to five days prior to

the development of rash, described as burning or stabbing

Clinical ManifestationPatient may complain of pruritus, pain

usually worse at night and is intensified by movement

Regional lymph nodesWhen opthalmic or the 5th cranial nerve is

affected, corneal anesthesia may occur, it is known as Gasserian ganglionitis

Paralysis of the facial nerve and vesicles in the external auditory canal affecting the 7th cranial nerve. The condition is called Ramsay Hunt syndrome

DIAGNOSTIC EXAMCharactistic skin rash may be diagnosticTissue culture techniqueSmear of vesicle fluidMicroscopy

Complication EncephalitisParalytic ileus, bladder paralysisOpthalmic herpes which may lead to

blindness

Modalities of TreatmentSymptomaticAntiviral drugsAnalgesic to control painAnti- inflammatory

Nursing ManagementPut patient on strict isolationApply cool, wet dressing with NSS to

pruritic lesionsPrevent secondary infectionHygeinic measures should be emphasizedHypoallergenic food is served

Prevention avoid exposure to persons with varicellaSelf protection by increasing resistance

RUBEOLA; MORBILLI

MEASLES

DEFINITIONAn acute, contagious exanthematous

disease usually affect children which are referable to URTI

Maybe one of the most common and most serious of a childhood diseases

Etiologic AgentFiltrable virus that belongs to genus

Morbilivirus of the family paramyxoviridae

Measles virus is rapidly inactivated by heat, ultraviolet light, and extreme degrees of acidity and alkalinity

INCUBATION PERIOD10-12 DAYS (20 DAYS THE LONGEST 8

DAYS THE SHORTEST)

SINGLE ATTACK CONVEYS A LIFELONG IMMUNITY

PERIOD OF COMMUNICABILITYMeasles usually lasts about 9-10 days,

measured from the beginning of the prodromal symptoms to the fading of the rash

The disease is communicable 4 days before and 5 days after the appearance of rashes

The disease is most communicable during the height of the rash

SOURCE OF INFECTIONThe virus has been found in the patient’s

blood, as well as in the secretions from the eyes, nose and throat

MODE OF TRANSMISSIONDirect contact, by droplets spread through

coughing or sneezingindirectly

PATHOGNOMONIC SIGNKOPLIK SPOTS – inflammatory lesions of the

buccal mucous glands with superficial necrosis

They appear on the mucosa of the inner cheek apposite to the second molars, or near the junction of the gum and the inner cheek

Usually appear 1-2 days before measles rashWhen rashes appear, normally koplik spot

will disappear

Clinical ManifestastionPRE-ERUPTIVE STAGEERUPTIVE STAGESTAGE OF CONVALESCENCE

Clinical ManifestastionPRE-ERUPTIVE STAGE

FeverCatarrhal symptoms (rhinitis, conjunctivitis,

photophobia, coryzaRespiratory symptoms- starts from common

colds to persistent coughingEnanthem sign (koplik spot, stimson’s line

Clinical ManifestastionERUPTIVE STAGE

The rash usually seen late in the 4th dayMaculo-papular rash appear first on either the

cheeks , bridge of the nose, along the hairline, at the temple

The rash is fully developed by the end of he second day and all symptoms are at their maximum at this time

High grade fever that comes on and offAnorexia and irritabilityAbdominal tymphanism, pruritus, lethargy

Clinical ManifestastionERUPTIVE STAGEThe throat is red and often extemely soreAs fever subsides, coughing may diminish,

but more often it hangs on for a week or two

Clinical ManifestationStage of ConvalescenceRashes fades away the manner as they

eruptFever subsides as eruption disappearsWhen the rash fades, desquamation beginsSymptoms subside, appetite returns

DIAGNOSTIC PROCEDURESNOSE AND THROAT SWABURINALYSISBLOOD EXAM (CBC leukopenia at the start

of the disease, leukocytosis when complication sets in)

Complement fixation or hemogglutinin Test

Modalities of treatmentAnri-viral drugsAntibiotics if with complication supportive therapy (oxygen inhalation, IV

fluids

COMPLICATIONSBRONCHOPNEUMONIAOTITIS MEDIAPNEUMONIA/BRONCHITISNEPHRITISENCEPHALITISBLINDNESS

NURSING MANAGEMENTISOLATION (quiet, well ventilated, subdued

light in patient’s room)Control high temperature with warm or

tepid spongesSkin care. Daily cleansing bed bathOral and nasal hygieneCare of the eyes. The patient is sensitive to

lightCare of the ears-be alert on signs of

mastoid infection

NURSING MANAGEMENTDaily elimination is important.During febrile stage, limit the diet to fruit

juices, milk and water. If the patient is vomiting, give iced juices in small amount and more frequently

Change position every 3-4 hoursPenicillin or other prescribed medication is

usually given in cases where there is complication

PREVENTIVE MEASURESAnti-measles at the age of 9 months, as

single doseMumps, measles, rubella (MMR) to give a

age 15 months old and 2nd dose at 11-12 years