MUMPS VIRAL EXANTHEMS

Exanthems Enanthem
Other names : Infectious Parotitis • External rash • En-ternal rash
- Epidemic Parotitis • Comes first

Causative Agent : Mumps Virus / Paramyxo Virus Measles & German Measles
Target : Glands Measles :
Mode of transmission : Droplet, Fomites • Rubeola, 7 day measles, English Measles, Hard Measles,
Incubation : 12 - 25 days (ave 16 - 18 days) Brown/black measles
Pathognomonic sign : Painful swelling of one / both parotid glands
• Rashes lasts for 7 days
Pathophysiology : • Palpable
• Dark type of rash
Mumps Virus
• Causative Agent : Rubeola Virus / Measles virus
Droplet
• MOT: Airborne, Indirect
Upper respi • Incubation : 10 - 20 days
> Early incubation period, but longer disease pathology
Salivary Glands Manifestations : Pathognomonic sign
> Parotid gland > Koplik Spots - whitish spots w/ red surroundings can
> Submandibular Gland be seen in buccal mucosa
> Sublingual Gland
> Rashes : Rash Cephalocaudal Outward progression
Inflammation of More : Extremities
the parotid

Non- pruritic Fine flaking Type : Maculopapular rash

Parotitis
Color Elevation <1cm
S/sx :
• Low grade fever
Reddish 7 days
• Headache
• Malaise *IMCI management gives Vit A
* Stimson's sign - sensitivity to
*Inflammation only appears on one side because you are > High grade fever light
VACCINATED > Target : Respiratory
> Severity : Life threatening
Complications : > Other s/sx : Conjunctivitis, Coryza, Cough
• Orchitis - inflammation of testicular glands German Measles :
• Oophoritis - inflammation of ovarian glands • Rubella, 3 day measles
• Mastitis - inflammation of mammary glands • Tigdas hangin
• S/sx occurs for 3 days
Dx test : Clinical presentation
Confirmatory test : PCR • Causative Agent : Rubella Virus
Vaccine : MMRV - 2005
Precaution : Droplet • MOT : Droplet
Treatment : Supportive treatment (Paracetamol for fever) • Can cross the placental barrier
> if it crosses during 1st trimester = Congenital Rubella
Syndrome
> baby will suffer from : Deafness, Learning disabilities,
Cardiac problems, Microcephaly, Cataracts.
• Incubation : 14 - 21 days

Manifestations : Pathognomonic Sign

> Forchheimer Spots - reddish spot found in palate
- Not Pathognomonic in German Measles
- Can also seen in Scarlet Fever

> Rashes : Rash Cephalocaudal Outward progression

More : Extremities

Non- pruritic Fine flaking Type : Maculopapular rash

Color Elevation <1cm

Pinkish 3 days
*IMCI management gives Vit A
> Low grade fever * Stimson's sign - sensitivity to
> Target : Lymph nodes light
> Severity : Milder
> Other s/sx : Conjunctivitis, Coryza, Cough,
Lymphadenopathy
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Dx test for Measles & German Measles :

Vaccine : Varicella Vaccine - live vaccine
> PCR, Elevated IgM & IgG
> IgM IgG - German Measles Small pox - totally eradicated by the WHO by 1980
> IgM IgG - Measles > can only be transmitted by human to human
> Vaccine : ACAM 2000 - live vaccine
Prevention : MMRV - they used Vaccinia Virus instead of live Small pox
Treatment : Symptomatic, Antiviral -Isoprinosine (Measles) - Vaccinia is milder version of pox virus
- also used in Monkey pox outbreak last 2022
ALERT!!! > DOC : FDA Approved (2018) Tecovirimat
CHICKEN POX

Other names : Varicella, Child pox, Itching pox

Mode of transmission : Airborne - highly contagious Chicken pox cont..
Fomites
Incubation : 10 - 21 days (ave 14 - 16 days) Precaution : Airborne (Negative air pressure, single room)
Manifestations : Treatment : Antiviral - Acyclovir, Paracetamol
A. Rash - Centripetal Rash - inward progression > No aspirin = can cause Reye's Syndrome
more : Trunk
Happens 1) Macule : change in color Pruritic -Calamine / Cocoa based lotion
within 6 to
2) Papule : elevation <1 cm > wear loose fitting clothes
8 hrs
3) Vesicle - fluid filled rash > cool baking soda bath
4) Pustule - pus filled rash
5) Crusting NP1 = What herbal medicine will you use for
* Considered communicable until Crusting chicken pox ? - BAYABAS

Differences :
Complications :
1. Bacterial wound infection
Chicken Pox vs Measles / German Measles 2. Pneumonia
3. Encephalitis
• Centripetal - inward • Cephalocaudal- outward
• Highly pruritic • Non-pruritic / mild Erythema Infectiosum
• Crusting • Fine flaking > 5th disease
> Parvovirus B19
> Slap cheek syndrome
Chicken Pox vs Herpes Zoster (Shingles)
6 most common rash disease in children in the whole world :
• onset : childhood • onset : adulthood
• M-P-V-P-C • M-P-V 1st disease - Measles
• More : trunk • confined in a certain 2nd disease - Scarlet fever
• If dormant : will area 3rd disease - Rubella
stay in 4th disease - Dulce's disease
• rash : Painful
Peripheral > not used since this is also Scarlet fever
vesicular rash
Nerves 5th disease - Erythema Infectiosum
6th disease - Roseala Infantum (Baby measles)
Varicella infection Enanthem > Exanthum Sibitum
Painful rash > Causative agent : Human Herpes Virus 6
in Peripheral activates
nerves > infects 2 yr
> just like small pox but non pruritic rash
follow the nerve
pathway
Erythema Marginatum - reddish margin
> it is a symptom of RHEUMATIC FEVER
Chicken Pox Small Pox
> it has a pinkish center and red border "ring like"
• Fever @ the time • Fever 2 - 4 days > not common to the face
of rash > spreading of rash = > site : trunk inner limbs
• Rapid fever > non-pruritic
progression > formation of
• Pruritic Erythema Migrans - from Lyme's disease
pustules = fever - tick born disease
• Superficial rash
development - dart like rash
• Centripetal rash • Slow progression - -
12 inches
appearance (3 weeks)
"inward" • Non-pruritic rash
• More : trunk • Deep rash
• Less : development
extremities • Centrifugal
"outward"
• More :

Matan
extremities
• Less : trunk
• Precaution :
Airborne
e
 VIRAL HEPATITIS - confirm immunity HB vaccine
- HBSAg -
Hepar - Liver 2. HBeAq - hepatitis B.E Antigen
Itis - Inflammation - Viral replication
- HBeAg. Viral replication
Causes :
A. Drugs & Medicines - detectable 6 - 14 weeks
B. Alcoholism - Viral load - can pass through placental barrier
C. Viral Infection
> kills hepatocytes 3. HBcAB - Hepa B. Core Antibody
> first antibody to be detected
Fxns of liver : > HBaB = Vaccine immunity
I. Responsible for bile production
> essential for breakdown and absorption of fats,
4. HBeAB - Hepathysis Envelpalophaty
cholesterol, protein
II. Bilirubin > HBeAg = HBeAb
> absorption & metabolization of bilirubin > HBeAb = VL
> brownish - yellowish color
III. Blood clot - Vit K. + Bile = risk for bleeding > HheAbt = HBeAq
IV. Metabolization of carbohydrates > Convalescence stage
> stores carbs in liver in form of glycogen
> patient with liver problem has extreme fatigue 4. Fiibroscan If result is 1,

⑪
V. Vitamins / Mineral storage - ADEK, B12 minor level in
VI. Breakdown of proteins --> Bile --> Ammonia --> Urea the iiver
VII. Filters the blood

river cirrhosis

at the re * Glutathione - used for treatment regimen for alcoholism

t
set
Treatment for Chronic Infection :
DOC : Pegasys (Pegylated Interferon)
> Nucleoside - Lamivudine, Tenofovir, Adefovir, Entacavir
snow
·or Vaccine : Hepa B Vaccine
Precaution : Blood borne prec (Contact)
Health teaching : Practice safe sex

Types of Hepatitis :
Hepatitis A
> Other names : Infectious Hepatitis, Catarrhal Jaundice
> Infection : Acute infection ( <6mos)
> Causative Agent : Hepa A Virus - SS-RNA
> MOT : Fecal-oral
> Incubation : 15 - 50 days (ave 28 days)
Hepatitis C
> Other names : Non-A, Non-B Hepatitis, Inoculation Hepatitis
> Infection : Acute -> Chronic Infection
> Causative Agent : Hepa C Virus - SS-RNA
> MOT : Sex, Blood, Perinatal
> Incubation : 14 - 180 days (ave 45 days)
Dx : Can reveal Normal Liver Enzyme
> it's best to rely on Hepa C Antibody test and PCR
Treatment : Pegasys + Ribavirin
> Direct Acting Antivirals - Elbasvir / Grazoprevir

Vaccine : Hepa A & B

Dx/Lab: ALT -
Precaution : Blood borne prec (Contact)
AST - Health teaching : Practice safe sex
IgM & IgG Complications :
• Cirrhosis (higher chance to lead in liver cirrhosis)
Treatment : Supportive measures • Cancer (higher chance to lead in liver cancer)
Vaccine : Hepa A Vaccine
Precaution : Enteric - Contact Prec Hepatitis D
> Proper waste disposal > Requires Hepa B
> Other names : Co - infection hepatitis
Hepatitis B > Two types :
> Other names : Serum Hepatitis A. Co-infection = "sabay" si B & D
> Infection : Acute -> Chronic Infection B. Super infection = B comes first then D
> Causative Agent : Hepa B Virus- DS-DNA
> MOT : Sex, blood, perinatal Infection : Chronic infection
> Incubation : 60 - 150 days (ave 90 days) Causative Agent : Hepa D Virus - SS-RNA
MOT : Blood & Blood products
Dx : Rapid test - screening test (Reactive) Incubation : Co - infection : 45 - 160 days (ave 90 days)
Specific Serum Markers for hepa B : Super infection : 2 - 8 weeks
1. HBSAg - Hepa B surface antigen
Undetectable - first serum marker to appear
after 6 - detectable prior to onset of symptoms
months - Peak : 12 week
 Dx/Labs : same with hepa B Stages of Hepatitis
Treatment : Pegasys - Pegylated Interferon
Vaccine : Hepa B vaccine A. Prodromal Stage
Precaution : Bloodborne (Contact) > Viremia - viruses in the blood
> Fever, Anorexia, Fatigue, Headache
Hepatitis E
> Other names : Perinatal hepatitis B. Icteric Stage
> Pregnant women @ risk > liver damage is present
> Infection : Acute <6 months > Jaundice, Dark Urine, Gray/Clay stool, Yellowish sclera,
> Causative Agent : Hepatitis E - SS-RNA Hepatomegaly
> MOT : Fecal oral
> Incubation : 15 - 60 days (ave 40 days) C. Convalescent Stage
> liver slowly returns to normal size
Dx : PCR > appetite improves
Treatment : Ribavirin > jaundice decreases
Precaution : Enteric Prec (Contact) > stool & urine goes back to normal color
> Proper waste disposal
Complications :
• Fulminant Liver Failure - too much cell death
> can be revived

Pathophysiology of Hepatitis
D-DNA
SS-RNA
A
C B
D
E
HEPATOCYTES

Release Release DS-DNA

SS-RNA
(Virus) Transcribe from DNA (Cell)
+ RNA DNA to Viral RNA
(Host cell)
-
Viral DNA
More
viral
RNA

Replication

Exit

Invade other hepatocytes

Lysis of hepatocyte

Cell death (Apoptosis)

Fibrosis

Necrosis

Deterioration of
liver function
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ZOONOTIC DISEASES Dx: ELISA - Enzyme link immunosorbent acid

> used to detect the antigen attached to the surface protein
- there is an infection from non human animals to humans
- human to animals can happen (Reverse Zoonosis) Confirmatory test : Microscopic Agglutination test (MAT)
> detects the presence of bacteria
LEPTOSPIROSIS
Treatment :
> it is an endemic disease in the Philippines Mild - Doxycycline 100 mg BID, Amoxicillin 500 mg q6
> Lepto - Thin (oral)
> Spira - Coil Severe - Pen G / Ceftriaxone IV
> Sis- Inflammation / Infection
> it is a thin spiral aerobic bacteria Prevention : Chemoprophylaxis - Oral doxycycline 200 mg a
week for @ risk for infection
Other names : Weil's disease, Canicola Fever, Hemorrhagic Management :
Jaundice, Japanese 7 days fever, Mud fever Supportive therapy - IVF, Respi support, Blood transfusion

Causative Agent : Leptospira specie - Leptospira Interrogans RABIES

(Most common)
> it is a bacterial infection Other names : Hydrophobia, Lyssa, Mad dog disease
Causative Agent : Rhabdo Virus (Lyssa Virus)
Reservoir : Rodents, Small mammals, Domestic animals > Neurotropic virus
MOT : > target : Brain cells
> Direct contact with urine / reproductive fluids from MOT : Contact with Saliva carrying the Rhabdo Virus
infected animals > Biting behavior, Scratch / lick)
> Contact with urine contaminated water (Flood, Stream, Reservoir : Dogs, Bats, Raccoons, Skunks, Foxes
Sewage, wet soil) Incubation : 1 - 3 months -> up to 15 yrs
> it depends on :
> Ingestion of food/water that is also contaminated by urine * the distance of the bite to the brain
(Rare) * the extensiveness of the bite
* depends on the animal
Incubation : 4 - 14 days * depends on nerve supply in the area of the bite
Common : Tropical countries - peak during rainy season
Phases of Rabies
S/sx : A. Prodromal Phase - Invasion Phase
• Mild disease - 90% > Fever
* High fever * Diarrhea > Anorexia
* Chills * Conjunctivitis - common > Malaise
if mahilig maligo sa baha > Sore throat
* Headache > Nausea & Vomiting
* Myalgia > Copions Salivation, Lacrimation, Perspiration
* Nausea & Vomiting > Irritability & Restlessness
>Pain at the site of the bite
• Severe disease - 10% > Sensitivity to light, sound, and temperature
* Renal failure - Urine output, fluid retention
B. Neurologic Phase - Excitement / Furious Phase
* Hepatic failure > Excitation / Apprehension (Fear)
* Jaundice > Delirium w/ nuchal rigidity & involuntary twitching
* Meningitis > Maniacal behavior, Severe & painful spasms - mouth,
* Myocarditis pharynx, larynx (ayaw lumunok)
* Pneumonia with pulmonary hemorrhage > Aerophobic
> Profuse drooling
Pathophysiology > Spasms -> Death -> Respi & Cardiac failure
Leptospira (Aerobic) > Pt can survive but will start to deteriorating

C. Terminal Phase - Paralytic Phase

MOT - break /
> Quiet & unconscious
abrasion in the skin /
> Loss of bowel & urinary control
mucous membrane
> Progressive paralysis
> Respiratory paralysis, Circulatory collapse, Heart
Bloodstream (more O2) failure --> DEATH
- multiply

Immune
response :
Appearance of s/
sx

Invasion of organs

Kidneys Liver Brain Heart Lungs

Renal failure Hepatic failure Meningitis Myocarditis Pneumonia with Sever disease - Weil's disease
Urine hemorrhage
output Jaundice Meningoencephalitis
Pathophysiology Aerophobic WHO treatment categories
Hydrophobic
⑯
6

Rhabdo Virus Category 1 - Feeding / touching an animal

- Licking of intact skin
MOT : Bite/Scratch - Casual contact with rabies pt

Action : 1. Wash exposed skin immediately w/ soap&water

Brain cells 2. No vaccine or Rabies Ig needed

Affect the nervous Category 2 - Nibbling (small bite)

system - Minor scratch/ abrasion w/o bleeding
"CPG" - central pattern
generators Action : 1. Wash wound w/ soap & water
> responsible for 2. Start vaccine immediately & complete 28 days
swallowing & breathing 3. Rabies Ig is not needed

Hypoglosal Nucleus Medulla oblongata Category 3 - Single / Multiple transdermal bites / scratches
- respiration - swallowing - Exposure from saliva and pt have broken skin/wound

Mimic the Action : 1. Wash the wound with soap & water
Aerophobic characteristics Hydrophobic 2. Start vaccine & rabies Ig immediately = complete 28
of the virus days

* 2018 update - All bites should be managed without delay

Avoid water & air - Wash wounds for 15 minutes continuously
- Apply alcohol, povidone iodine or any antiseptic to the
Spasms PARALYSIS wound
- Avoid suturing the wound
Cardiac / - If suturing is required, delay it for 2hrs after the
respi failure COMA Rabies Ig administration - for the Rabies Ig
infiltrate completely but suture loosely

DEATH Management :
• Isolate the pt
Dx : • Provide supportive care
Humans • Provide optimum comfort & prevent injury specially during
- Fluorescent Antibody Test (FAT) uses saliva / skin hyperactive attacks/episodes
- PCR uses saliva / skin biopsy -> NEGRI BODIES • Darken the room & provide quiet environment
(Pathognomonic in Cytoplasm) • Should not be bathed - NO RUNNING WATER / HEARING
DISTANCE / SIGHT
Confirmatory - Brain biopsy (Post-mortem) / Skin biopsy • If IV is needed - wrap the IV
(neck skin)
• Disinfection
Animals * Let the pt stink / have a bad odor
- Observe the animal for changes of behavior within 14 days
from the bite
- DO NOT KILL THE ANIMAL - if it dies, decapitate the head
and submit the specimen wrapped in a plastic / rubber and
place it in a cooler. Send to CD Institution (IRTM/San Lazaro)

Prevention : Mass dog vaccination

Dog population Management (Impounding, Surgical
Sterilization, Humane Euthanasia - last resort)

Vaccine : PrEP & PEP

> Recommended by WHO
1. PVRV - Purified Vero Rabies Vaccine
> Imovax, Verorab, Abhay rab
2. PCECV - Purified Chick Embryo Cell Vaccine
> Rabavert

Prep - given for high risk individuals

> Vet, pet owners, animal handlers
> Given in 1 month = 0, 7, 21, 28 days
> Route : ID, IM
• PVRV - ID (.1ml) , IM (.5ml)
• PCECV - ID (.1ml) , IM (1ml)
PEP - after exposure
> Standard regimen (WHO)
> via IM
> Schedule : 0,3,7,14,28 days
• PVRV - .5 ml
• PCECV - 1 ml