CHICKENPOX & MEASLES MANAGEMENT

 

CHICKENPOX

Chickenpox, a common childhood disease.

Those who do not develop this disease may fall prey later on in life. Red, itchy, blisters all over the body are common signs of chickenpox.

DEFINITION

Chickenpox is a viral skin infection caused by varicella zoster virus (VZV) characterized by an itchy rash that makes the child very uncomfortable and fever.

It is very contagious and spreads through coughing, sneezing, touching as well as breathing. This infection is however preventable with the help of chickenpox vaccine.

CAUSES

By a virus varicella zoster virus (VZV).

MODE OF SPREAD

It infects a healthy body by inhaling droplets or touching the fluids from a chickenpox blister. As it is very contagious, anyone who does not have immunity towards the virus can get infected. The infection lasts for about 5-10 days.

SIGNS AND SYMPTOMS

Chickenpox is known for some of its classic symptoms. These include: 

· Fluid-filled, itchy blisters

· Clear fluid-filled blisters become cloudy in 24-48 hours

· Cloudy blisters then turn dry and form crusty scabs that drop off in a week or so

· Rash appearing on the face, chest, back

· Rash that spreads to all other parts of the body that includes eyelids, mouth as well as genitals.

Apart from the blisters and rash, a child may develop other symptoms of chickenpox like:

· High fever

· Fatigue

· Appetite loss

· Headache

· General malaise

· Stomach ache

These blisters generally do not leave scars. However, scars appear after the child scratches on the itchy blisters. Many times, excessive scratching may lead to secondary bacterial skin infection.

COMPLICATIONS

Chickenpox is a mild disease that usually does not lead to complications. However, some people are prone to develop complications after an infection.

These people include:

· Very young children, that is, infants

· Adults who never developed an infection in childhood

· Pregnant women

· People with weak immune system like those with HIV/AIDS or on chemotherapy, steroids and other immunosuppressive drugs 

Chickenpox infection in such cases can lead to severe complications. These include: 

· Inflammation of the brain

· Secondary bacterial infection

· Sepsis

· Joint infection

· Bone infection

· Death, in rare and extreme cases 

TREATMENT

There is no specific treatment for chickenpox. However, there are several things that one should do to get relief from the irritation.

These measures include the following: 

· Apply calamine lotion on the rash to help relieve itching

· Make the child wear loose, cotton clothes that does not cause itching

· Give the child an oatmeal or cornstarch bath using lukewarm water

· Apply moisturizers to prevent skin drying that increases the itchiness

· Under the guidance of the doctor give the child non-aspirin medication like acetaminophen/Paracetamol to help reduce the fever

· Make sure the nails are cut short to prevent the child from scratching the itchy skin

Until and unless the symptoms are very severe, doctors do not suggest any medications. However, in severe infections, antiviral medications may be suggested. The child should be given plenty of fluids to help ease the stomach pain and keep the body hydrated.

 

 

PREVENTION

Prevention of the disease includes getting two vaccine shots for chickenpox. The majority of the people who opt in vaccination never develop the infection. However, a few may show extremely mild symptoms of the disease. Remember, once a person develops chickenpox, he/she becomes immune to the infection for life. However, the virus remains dormant in the body. Low immunity, fever, stress, emotional distress, malnutrition may trigger the virus to become active and cause a shingles infection. Shingles develops much later in life and many people never develop it. It is also very contagious and can lead to chickenpox in those who never had been infected. 

 

MEASLES

Measles is best known for causing a fever and rash in childhood, but measles can affect other parts of the body and sometimes occurs in adults. Although isolated outbreaks continue to occur, measles has been occurring more frequently due to an increased number of vaccine refusals.

There are two types of measles, each caused by a different virus. Although both produce a rash and fever, they are really different diseases. When most people use the term measles, they are referring to the first condition below.

· The rubeola virus causes "red measles," also known as "hard measles" or just "measles." Although most people recover without problems, rubeola can lead to pneumonia or inflammation of the brain (encephalitis).

· The rubella virus causes "German measles," also known as "three-day measles." This is usually a milder disease than red measles. However, this virus can cause significant birth defects if an infected pregnant woman passes the virus to her unborn child.

 

 

DEFINITION

Measles (also known as English measles), also known as morbilli, is an infection of the respiratory system caused by a virus, specifically a paramyxovirus of the genus Morbillivirus. Symptoms include fever, cough, runny nose, red eyes and a generalized, maculopapular, erythematous rash.

MODE OF TRANSMISSION

Measles is spread through respiration (contact with fluids from an infected person's nose and mouth, either directly or through aerosol transmission), and is highly contagious—90% of people without immunity sharing living space with an infected person will catch it.

INCUBATION PERIOD

An asymptomatic incubation period occurs 9 to 12 days from initial exposureand infectivity lasts from 2 to 4 days prior, until 2 to 5 days following the onset of the rash (i.e. 4 to 9 days infectivity in total).

SIGNS AND SYMPTOMS

This patient presented on the third pre-eruptive day with “Koplik spots” indicative of the beginning onset of measles.

The classical signs and symptoms of measles include;

Four-day fevers

Three Cs — cough, coryza (head cold), conjunctivitis (red eyes),

Anorexia,

Fever may reach up to 40 °C (104 °F).

Koplik's spots seen inside the mouth are pathognomonic (diagnostic) for measles, but are not often seen, even in real cases of measles, because they are transient and may disappear within a day of arising.

A generalized, maculopapular, erythematous rash that begins several days after the fever starts. It starts on the back of ears and, after a few hours, spreads to the head and neck before spreading to cover most of the body, often causing itching.

CAUSE

Measles is caused by the measles virus, a single-stranded, negative-sense enveloped RNA virus of the genus Morbillivirus within the family Paramyxoviridae.

Humans are the natural hosts of the virus; no animal reservoirs are known to exist. This highly contagious virus is spread by coughing and sneezing via close personal contact or direct contact with secretions.

Risk factors for measles virus infection include the following:

· Children with immunodeficiency due to HIV or AIDS, leukemia, alkylating agents, or corticosteroid therapy, regardless of immunization status

· Travel to areas where measles is endemic or contact with travelers to endemic areas

· Infants who lose passive antibody before the age of routine immunization

Risk factors for severe measles and its complications include the following:

· Malnutrition

· Underlying immunodeficiency

· Pregnancy

· Vitamin A deficiency.

DIAGNOSIS

Clinical diagnosis of measles requires a history of fever of at least three days, with at least one of the three C's (cough, coryza, conjunctivitis).

Observation of Koplik's spots is also diagnostic of measles.

Laboratory diagnosis of measles can be done with confirmation of positive measles IgM antibodies or isolation of measles virus RNA from respiratory specimens.

In patients where phlebotomy is not possible, saliva can be collected for salivary measles-specific IgA testing.

Positive contact with other patients known to have measles adds strong epidemiological evidence to the diagnosis. The contact with any infected person in any way, including semen through sex, saliva, or mucus, can cause infection.

TREATMENT

There is no specific treatment for measles. Most patients with uncomplicated measles will recover with rest and supportive treatment. It is, however, important to seek medical advice if the patient becomes more unwell, as they may be developing complications.

While there is no specific treatment for measles encephalitis, antibiotics are required for bacterialpneumonia, sinusitis, and bronchitis that can follow measles.

All other treatment addresses symptoms, with ibuprofen, or acetaminophen (paracetamol) to reduce fever and pain and, if required, a fast-acting bronchodilator for cough.

Givevitamin A

 

COMPLICATIONS

Complications with measles are relatively common, ranging from the relatively mild and less serious ones like diarrhea to more serious ones such as pneumonia, otitis media, acute encephalitis (rarely SSPE -- subacutesclerosingpanencephalitis), and corneal ulceration (leading to corneal scarring). Complications are usually more severe in adults who catch the virus.

Malnutrition and poor healthcare.

 In immunocompromised patients (e.g. people with AIDS) the fatality rate is approximately 30%.

PREVENTION

Most children are immunized against measles by the age of 18 months, generally as part of a three-part MMR vaccine (measles, mumps, and rubella). The vaccination is generally not given earlier than this because children younger than 18 months usually retain antimeaslesimmunoglobulins (antibodies) transmitted from the mother during pregnancy.

A second dose is usually given to children between the ages of four and five, to increase rates of immunity. Vaccination rates have been high enough to make measles relatively uncommon. Even a single case in a college dormitory or similar setting is often met with a local vaccination program, in case any of the people exposed are not already immune.

The vaccine should be given whether the child is HIV-infected or not. The vaccine is less effective in HIV-infected infants, but the risk of adverse reactions is low. Measles vaccination programs are often used to deliver other child health interventions, as well, such as bed nets to protect against malaria, anti-parasite medicine and vitamin A supplements, and so contribute to the reduction of child deaths from other causes.

PROGNOSIS

While the vast majority of patients survive measles, complications occur fairly frequently, and may include bronchitis, and pan encephalitis which is potentially fatal. Also, even if the patient is not concerned about death or sequela from the measles, the person may spread the disease to an immunocompromised patient, for whom the risk of death is much higher, due to complications such as giant cell pneumonia. Acute measles encephalitis is another serious risk of measles virus infection. It typically occurs two days to one week after the breakout of the measles exanthema, and begins with very high fever, severe headache, convulsions, and altered mentation. Patient may become comatose, and death or brain injury may occur.