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ROSEOLA INFANTUM
ROSEOLA INFANTUM
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ETIOLOGY
HHV-6 and HHV-7
CD46 & CD4 T cells !"#$a"%
a"'e cells #n (#()
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E*IDEMIOLOGY
Ea"l% #n l#+e
*ea, 6-./$)s
0 %1)2 7-.3 %131
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*ATHOLOGY#nc5a#)n !e"#)d
Saliva, enters the
hostoral, nasal,conjunctival mucosa
HHV-6 & HHV-7attach to cellular
receptors
Viral replication,High level of viremia
develops in PB!s
Viruses evade immune
s"stem trudo#nregulation of H! $response
- %nhancement of ' (-cell activit"
- $nduction of proin)ammator" c"to*ineresponse
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CLINICAL MANIFESTATIONS
H#'8 e$!1 971:-43c a(e1 )+ 9:c;9-/Da%s
R)se)la "as8 +)" .-9 da%s
Na'a%a$a s!)s
M#ld c)n
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R)se)la "as8?
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Na'a%a$a s!)s?
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RU@EOLA
ETIOLOGY
Measles (#"5s Re$a#n (#ale +)" aleas
948" a "))$ e$!1
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ROSEOLA INFANTUM
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+B.(.$%S
T)al @C B:33L
L%$!8)c%e 9433L
Ne5")!8#l 4/33LT8")$)c%)!en#a
se"5$ "ansa$#nase
A%!#cal l%$!8)c%e
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/$0S$S
H#'8 +e(e" 9 da%s
lanc8#n' $ac5l)!a!5la"
"as8 "5n,
!"esence )+ ac#(el%
"e!l#ca#n' (#"5s
0+/ S(/./
V#"al c5l5"e
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V#"al DNA *CR
Re(e"se "ansc"#!ase *CR
Se")l)'#c $e8)ds
Asence )+ I'G an#)d% "e!l#ca#n' (#"5s
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!P+$!($S
C)n(5ls#)ns
Se#5"e !ea, a'e .0-./ $)n8s
!)s-#cal !a"al%s#s93 - !")l)n'ed se#5"es
0: - +)cal se#5"es
9B - "e!eaed se#5"essa5s e!#le!#c5s
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Ence!8al##s Ac5e d#sse$#naed de$%el#na#)n
Ac5e ce"eell##s
He!a##s M%)ca"d##s
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De(el)!$enal d#sa#l##es
A5#s#c l#,e +ea5"es
*ALE !)s"ans!lan ac5e l#$#cence!8al##s
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(.%(%(
inimum of 1 #ee*s
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P.0S$S
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P.%V%($
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INFECTIOUS
MONONUCLEOSI
S
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ETIOLOGY
%pstein 2 Barr Virus d)5le-s"anded DNA (#"5s
%-8e"!es(#"5s E@V . & 0
%BV 3 $)"e !"e(alen )"ld#de
Ind5ces '")8 "ans+)"$a#)n )+ @ cells %BV 4 5 frica
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E*IDEMIOLOGY
(
)"al sec"e#)ns
6 $) a+e" ac5e #n+ec#)n
#ne"$#enl% +)" l#+e
seJ5al #ne"c)5"se
P.$. $%!($ during childhood
Us5all% as%$!)$a#c
M#ld )" #nd#s#n'5#s8ale
P.$. $%!($ in adolescents & adults
93 ) /3
!+SS$! (.$/8
+a#'5e2 !8a"%n'##s2 'ene"al#ed l%$!8aden)!a8%
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CLINICAL MANIFESTATION
$!9B($ P%.$/ 93 ) /3 da%s ad)lescens
P./.+ P%.$/ . ) 0 ee,s
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CLINICAL MANIFESTATION
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CLINICALMANIFESTATION
>P$!$++$ .SH?
$)"#ll#+)"$2 (asc5l##c "as8
>0$(($- !.S($ S/.% > s%$$e"#c "as8 )n c8ee,s $5l#!le
e"%8e$a)5s !a!5les
c)alesce #n) !laK5es !e"s#s ./ ) /3 da%s
a!!ea"s l#,e a)!#c de"$a##s
a!!ea" )n eJ"e$##es & 5)c,s
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DIAGNOSIS In+ec#)5s$)n)n5cle)s#s
!"es5$!#(e !"esence )+ %!#cal cl#n#cal s%$!)$s #8
a%!#cal l%$!8)c%)s#s c)n"$a)"%
se")l)'#c es#n' 8ee")!8#le As2 )" s!ec#c E@V As
c5l5"e "ans+)"$a#)n assa% "eK5#"es 4-6 ee,s
)")!8a"%n'eal )" 'en#al sec"e#)ns2!e"#!8e"al l))d .3-93 $L2 )" 5$)" #885$an 5$#l#cal c)"d l%$!8)c%es
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La)"a)"% Tess
:3 )+ cases
le5,)c%)s#s )+.32333-032333
cellsL 09s a"el%$!8)c%es
a%!#call%$!8)c%es 03-
43 )+ 8e )aln5$e"
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La)"a)"% Tess
Hee")!8#le An#)d% Tes "ans#en 8ee")!8#le an#)d#es *a5l-
@5nnell an#)d#es I'M As deeced % 8e *a5l-@5nnell-
Da(#ds)8n es +)" "ed s8ee! a''l5#na#)n
'"eae" sens##(#% a''l5#nae #n s8ee! "c
#n 7/ cases .s ee,
#n :3-:/ cases 0nd ee,
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La)"a)"% Tess
S*ECIFIC E*STEIN-@ARR VIRUSANTI@ODIES es#n' #s 5se+5l ) c)n"$
ac5e E@V #n+ec#)n2 #n 8ee")!8#le-ne'a#(e cases
) c)n"$ !as #n+ec#)n
dee"$#ne s5sce!##l#% ) +55"e #n+ec#)n
An#'ens E@NA2 EA and VCA
Ac5e IM VCA I'G and I'M2 EA I'G
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T"ea$en
NO s!ec#c "ea$en Ma#nsa% Mana'e$en
rest2 enc)5"a'#n' adeK5ae =5#d andn5"##)n #na,e
s%$!)$a#c "ea$en #8 acea$#n)!8en)" NSAIDS +e(e"2 8")a d#sc)$+)"2$ala#se
S8)" c)5"ses )+ c)"#c)se")#ds 0 , !"edn#s)ne . $','da% $aJ#$5$ 63
$'da% a#"a% )s"5c#)n2 8")$)c%)!en#a #8
8e$)""8a'#n'2 a5)#$$5ne2 8e$)l%#cane$#a2 se#5"es2 and $en#n'##s
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T"ea$en
An#(#"al 8e"a!% #s n)"ec)$$ended ac%cl)(#"2 #8 )" #8)5 c)"#c)se")#ds
dec"eases (#"al "e!l#ca#)n and)")!8a"%n'eal s8edd#n' d5"#n'
# d)es NOT "ed5ce 8e se(e"#% )" d5"a#)n)+ s%$!)$s )" ale" 8e e(en5al )5c)$e
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C)$!l#ca#)ns
s5ca!s5la" s!len#c 8e$)""8a'e )"s!len#c "5!5"e )cc5"s d5"#n' 0nd ee,2 "ae )+ 31/
)+ cases #n ad5ls
Sell#n' )+ 8e )ns#ls and)")!8a"%n'eal l%$!8)#d #ss5e
ca5se a#"a% )s"5c#)n $an#+es d"))l#n'2 s"#d)"2 and #ne"+e"ence
#8 "ea8#n'
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C)$!l#ca#)n
A#"a% c)$!")$#se #8 !")'"ess#(e s%$!)$s)cc5"s
/ )+ cases
c)$$)n #nd#ca#)n +)" 8)s!#al#a#)n
ele(a#n' 8e 8ead ed2 #n"a(en)5s8%d"a#)n2 85$#d#ed a#"2 and s%se$#cc)"#c)se")#ds
Res!#"a)"% d#s"ess #8 #nc#!#en )" ac5ala#"a% )ccl5s#)n $ana'ed %
)ns#ll)aden)#dec)$%
end)"ac8eal #n5a#)n +)" .0-04 8"
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C)$!l#ca#)n
Headac8e /3 )+ cases
Headac8e #8 se(e"e ne5")l)'#c$an#+esa#)ns se#5"es and aaJ#a2 #n .-/ )+ cases
Al#ce-#n-)nde"land s%nd")$e$ea$)"!8)!s#a *e"ce!5al d#s)"#)ns )+ s#es2 s8a!es2
and s!a#al "ela#)ns8#!s
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C)$!l#ca#)n
G5#lla#n-@a"" s%nd")$e )" Re%es%nd")$e
He$)l%#c ane$#a C))$s es "es5l and #8 c)ld
a''l5#n#ns s!ec#c +)" "ed cell an#'e2)cc5"s #n 9 )+ cases
.s 0 , )+ #llness and lass +)" . $)1
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C)$!l#ca#)n
A!las#c Ane$#a 9-4 , a+e" 8e )nse "ec)(e"% #n 4-B da%s s)$e cases d) "eK5#"e )ne $a"")
"ans!lana#)n
M#ld 8")$)c%)!en#a and ne5")!en#a M%)ca"d##s )" #ne"s##al !ne5$)n#a
"es)l(#n' #n 9-4 ,
Ra"e !anc"ea##s2 !a")##s2 and )"c8##s
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*")'n)s#s
+)" c)$!lee "ec)(e"% #s EPCELLENT
$a
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*"e(en#)n
#$!"ac#cal ) !"e(en (#"5s #s 5#K5#)5s
$a
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CYTOMEGALOVIRUSINFECTION
ETIOLOGY
-la"'es )+ 8e 8e"!es (#"5s
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CYTOMEGALOVIRUS INFECTION
E*IDEMIOLOGY
AcK5#"ed #n d#Qe"en se#n's
.1 C)$$5n#% eJ!)s5"e
01 N)s)c)$#al "ans$#ss#)n91 In"a5e"#ne #n+ec#)n
T"ans$#ss#)n Sal#(a2 @"eas$#l,2 5"#ne2ce"(#cal and (a'#nal sec"e#)ns2 5"#ne2 se$en2s))ls2 l))d and #ss5e )" )"'an "ans!lan
-"eK5#"es (e"% cl)se )" #n#$ae c)nac
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C)$$5n#% eJ!)s5"e
@F #s 8e $)s c)$$)n ")5e )+ CMV#n+ec#)n #n ea"l% c8#ld8))d
In'es#)n )+ @M +")$ Se")!)s##(e$)8e"s- 63-73 )+ #n+ans #n+eced
In+ec#)n c)$$)n #n 8e .s6$)s
Ad)lescens- Inc1 #n+Jn d seJ5alc)nac
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N)s)c)$#al T"ans$#ss#)n
EJ!)s5"e ) l))d !")d5c2 all)'"a+"ans!lana#)n
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C)n'en#al CMV #n+n
Rae )+ c)n'en#al #n+ec#)n As#a &A+"#ca- 0
Rae )+ "ans$#ss#)n +")$ M)8e"s
!"#$a"% #n+ec#)n d5"#n' !"e'nanc%-93
N)n!"#$a"% #n+Jn !"e(1#n+eced
)$en- .-0ROT
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*a8)l)'%
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RU@ELLA
Ge"$an $easles )" 9 da% $easles
INFANTS AND CHILDREN
ADULTS
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ETIOLOGY
Fa$#l% T)'a(#"#dae and #s 8e )nl% s!ec#es)+ 8e 'en5s R5#(#"5s1
S#n'le s"anded RNA (#"5s
SENSITIVE ) 8ea2 UV l#'82 andeJ"e$es )+ !H
STA@LE a c)ld e$!e"a5"es
H5$ans
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E*IDEMIOLOGY
*REVACCINE ERA
INTRODUCTION OF THE VACCINE
AFTER SEVERAL YEARS 0 d)se "ec)$$enda#)n +)" "5ella
(acc#ne
0.scen5"% decl#ne
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*ATHOLOGY
L%$!8)"e#c5la" #n=a$$a#)n and
$)n)n5clea" !e"#(asc5la" and$en#n'eal #nl"a#)n1
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*ATHOGENESIS
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CLINICAL MANIFESTATIONS
Inc5a#)n !e"#)d .4 0. da%s
S%$!)$s )+ L) '"ade +e(e"
S)"e 8")a
Red e%es #8 )" #8)5 !a#n Headac8e
Mala#se
An)"eJ#a
In )lde" '#"ls and )$en2 !)l%a"8"##s $a% )cc5" #8
a"8"al'#a2 sell#n'2 ende"ness2 and eQ5s#)n 5 L%$!8aden)!a8%
S5)cc#!#al2 !)sa5"#c5la" and ane"#)" ce"(#cal l%$!8 n)des a"e$)s !")$#nen
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RASH9 da%s
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EJa$#na#)n )+ 8e
)")!8a"%nJ #n%2 ")se-c)l)"ed les#)ns
orschheimer spots )"!eec8#al 8e$)""8a'es )n8e s)+ !alae1
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LA@ORATORY FINDINGSDIAGNOSIS
Cl#n#cal s#'ns and s%$!)$s
Le5,)!en#a Ne5")!en#a
M#ld 8")$)c%)!en#a
I'M an#)d#es a"e deecale #n 8e "s +e da%s
)+ #llness and a"e d#a'n)s#c S!leen #s )+en sl#'8l% enla"'ed
C5l5"e )+ R5ella (#"5s +")$ 8e nas)!8a"%nJ andl))d
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DIFFERENTIAL DIAGNOSES
Measles
Aden)(#"5s #n+ec#)ns
*a"()(#"5s #n+ec#)ns e"%8e$a
#n+ec#)s5$ E#!se#n-@a"" (#"5s
Ene")(#"5s
M%c)!las$a !ne5$)n#ae
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COM*LICATIONS
Postinfectious throm@oc"topenia
C8#ld"en and '#"ls
Man#+ess a)5 0 ee,s Q )nse )+
"as8
*eec8#ae2 e!#saJ#s2 GI leed#n'28e$a5"#a
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COM*LICATIONS
rthritis
Ad5ls )$en
@e'#ns #8#n . ee, )+ )nse
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COM*LICATIONS
%ncephalitis
*)s#n+ec#)5s ence!8al##s
A!!ea"s #8#n 7 da%s a+e" )nse )+
"as8 Headac8e2 se#5"es2 c)n+5s#)n2 c)$a2
+)cal ne5")l)'#c s#'ns and aaJ#a
N)n #n+ec#)5s !a8)'enes#s
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COM*LICATIONS
%ncephalitis
*")'"ess#(e "5ella !anence!8al##s *R*
In+ec#)5s !a8)'enes#s
Dea8 )cc5"s 0-/ %"s a+e" )nse
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TREATMENT
N) s!ec#c "ea$en a(a#lale
S5!!)"#(e Ca"e
An#!%"e#cs2 anal'es#cs
C8#ld"en #8 CRS #s $)"e c)$!leJ
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*ROGNOSIS
EJcellen !")'n)s#s
Re#n+ec#)n #8 #ld (#"5s
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*REVENTION
Is)la#)n +")$ s5sce!#le #nd#(#d5als+)" 7 da%s a+e" )nse )+ "as8
Sanda"d !l5s d")!le !"eca5#)ns
C8#ld"en #8 CRS $a% eJc"ee (#"5s5! ) . %" )+ a'e
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VACCINATION
.sa .0 ./ $)n8s
0nda 4 6 %"s )+ a'e
*)seJ!)s5"e !")!8%laJ#s #8#n 9da%s )+ eJ!)s5"e
S8)5ld n) e '#(en ) se(e"el%#$$5n)c)$!")$#sed !J
S8)5ld n) e '#(en d5"#n'!"e'nanc%
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MeaslesR5e)la
%tiolog"
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%tiolog"
Measles V#"5s Gen5s M)"#ll#(#"5s
Fa$#l%*a"a$%J)(#"#dae
*")d")$al !e"#)ds8ed #n
Nas)!8a"%n'ealsec"e#)ns
@l))d
U"#ne
Ne5"al##n'an#)d#es
L#$#!")l#+e"a#)n d5"#n'#n+ec#)n
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%pidemiolog"
Ende$#c 8")5'8)5 8e )"ld :3 )+ c8#ld"en acK5#"e 8#s e+)"e ./ %ea"s )ld
e+)"e #$$5n#a#)ns
Cases 8a(e dec"eased
#8 (acc#na#)ns
Res5"'ence )cc5""ed $)sl% a$)n'Vacc#ne +a#l5"e
L) c)(e"a'e )+ !"esc8))l a'ed c8#d"enM)"e "a!#d an#n' )+ $ae"nal A #n #n+ans
03.. 317 !e" .23332333 !)!5la#)n
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/% (.S$SS$
*)"al )+ en"% Res!#"a)"% "ac
C)n
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Pathogenesis
incu@ation
MV $#'"aes ) l%$!8 n)des *"#$a"% (#"e$#a Sec)nda"% (#"e$#a
Prodromal
Ass)c#aed #8 . e!#8el#al nec")s#s and 0 '#an cell+)"$a#)n #n )d% #ss5es
V#"5s s8edd#n'
%Aanthematous
Onse )+ "as8es . An#)d% !")d5c#)n e'#ns2 0 (#"al "e!l#ca#)n 9 s5s#d#n')+ s%$!)$s In+ecs CD4 T cells
.ecover"
DesK5a$a#)n )+ "as8es
!li i l if t ti
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!linical anifestations
*a8)'n)$)n#c S#'n )!l#, S!)s anda"8#n-F#n,elde% Cell
.1 H#'8 +e(e"
01 Enan8e$
91 C)5'8
41 C)"%a
/1 C)n
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!linical anifestations *")d")$al
Sa'eLass 9-/da%s
. 0
A!!ea"s .-4 da%s e+)"e)nse )+ "as8es
L)ca#)n #nne" c8ee,s a
C)n
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!linical anifestations
F#nal Sa'eInc"ease #n
!")d")$al s%$!)$s8en "as8es a!!ea"
Ras8es a!!ea" ands%$!)$s s5s#de
Ras8 +ade )(e" 7da%s
COUGH lass l)n'es
Gene"al#edl%$!8aden)!a8%
forehead
Behindears
9ppernec*
(orsoandeAtremit
ies
Palmsand
soles
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VELOSO
FIFTH DISEASE
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FIFTH DISEASE
ERYTHEMA
INFECTIOSUM
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ALEGAR@ES
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0
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%P$/%$+0
P.VV$.9S B3 Ras8 and "ans#en a!las#c c"#s#s
sc8))l-a'ed c8#ld"en
Seas)nal !ea,s lae #ne" and s!"#n' MOT "es!#"a)"% ")5e2 l))d and
l))d !")d5cs
T"ans$#ss#)n "ae ./-93
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H9 B!V$.9S F)5nd #n "es!#"a)"% sec"e#)ns
*"e(alen 0 %ea"s )ld
Ass)c#aed #8 8ee#n' "es!#"a)"%
#llness F)5nd as a c)#n+ec#)n
"es!#"a)"% s%nc%#al (#"5s
85$an $ea!ne5$)(#"5s
"8#n)(#"5s
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Biphasic $llness 7 ) .. da%s a+e" #n)c5la#)n
V#"e$#a
Dec"eased "e#c5l)c%e c)5ns Nas)!8a"%n'eal (#"al s8edd#n'
Fe(e"
Mala#se
R8#n)""8ea
Cl#n#cal Man#+esa#)n
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Cl#n#cal Man#+esa#)n*a"()(#"5s @.:
E"%8e$a In+ec#)s5$ F#+8 D#sease $)s c)$$)n en#'n2 sel+-l#$#ed eJan8e$a)5s
#llness )+ c8#ld8))d #nc5a#)n !e"#)d 4-0B da%s a(e"a'e
.6-.7 da%s !")d")$al !8ase
$#ld l)-'"ade +e(e" #n ./-93 )+ cases2
8eadac8e2 s%$!)$s )+ $#ld URTI
E"%8e$a In+ec#)s5$ F#+8 D#sease
7/25/2019 Infectious Disease Case 1
84/92
E"%8e$a In+ec#)s5$ F#+8 D#sease
Hall$a", c8a"ace"#s#c "as8
9 sa'es
#n##al sa'e +ace =5s8#n'
sla!!ed-c8ee,a!!ea"ance
E"%8e$a In+ec#)s5$ F#+8 D#sease
7/25/2019 Infectious Disease Case 1
85/92
E"%8e$a In+ec#)s5$ F#+8 D#sease
0nd sa'e "5n, and !")J#$al
eJ"e$##es
d#Q5se $ac5la" e"%8e$a
Cen"al clea"#n' lac%2 "e#c5laed a!!ea"ance
!")$#nen )n eJens)"s5"+aces2 - !al$s and s)les
a+e"#le
"as8 "es)l(es s!)nane)5sl%#8)5 desK5a$a#)n
aJ and ane )(e" .-9 ,
"ec5" s5nl#'82 8ea2 eJe"c#se2s"ess
A8 8
7/25/2019 Infectious Disease Case 1
86/92
A8")!a8%
A"8"##s and a"8"al'#a ad5ls and )lde" ad)lescens
7/25/2019 Infectious Disease Case 1
87/92
T"ans#en A!las#c C"#s#s
"ans#en a""es )+ e"%8")!)#es#s andas)l5e "e#c5l)c%)!en#a s5dden +all #n se"5$ 8e$)'l)#n
)cc5"s #n !a#ens #8 c8")n#c 8e$)l%s#s and)" "a!#d R@C 5"n)(e"
#ll #8 +e(e"2 $ala#se2 and le8a"'%
ssJ )+ !")+)5nd ane$#a !all)"2 ac8%ca"d#a2
ac8%!nea Ras8 #s "a"el% !"esen
I$$5n)c)$!")$#sed
7/25/2019 Infectious Disease Case 1
88/92
5 )c) ! ) sed*e"s)ns
C8")n#c ane$#a acc)$!an#ed % ne5")!en#a2
8")$)c%)!en#a2 )" c)$!lee $a"")
s5!!"ess#)n cance" c8e$)8e"a!% )"
#$$5n)s5!!"ess#(e 8e"a!%
C8")n#c #n+ec#)ns
F l I + #
7/25/2019 Infectious Disease Case 1
89/92
Feal In+ec#)n
/ "#s, +)" +eal l)ss a+e" #n+ec#)n *"#$a"% $ae"nal #n+ec#)n ass)c#aed
#8
n)n#$$5ne +eal 8%d")!s #n"a5e"#ne +eal de$#se
$ec8an#s$ (#"al #nd5ced R@Ca!las#a
M%)ca"d##s
7/25/2019 Infectious Disease Case 1
90/92
M%)ca"d##s dJ se")l)'#c nd#n's2
@.: DNA #n ca"d#ac#ss5e
O8e" C5ane)5sMan#+esa#)ns !a!5la"!5"!5"#c
'l)(es-and-s)c,ss%nd")$e **GSS +e(e"2
!"5"#5s2!a#n+5l
ede$a2 e"%8e$a l)cal#ed ) 8ed#sal eJ"e$##es
sel+-l#$#ed "es)l(es #8#n a +e
ee,s
D#a'n)s#s
7/25/2019 Infectious Disease Case 1
91/92
D#a'n)s#s
@ased )n 8e cl#n#cal !"esena#)n )+ 8e %!#cal "as8 Se")l)'#c ess
@.:- s!ec#c I'M
An#-@.: I'G- !as #n+Jn
An#- @.:I'M- "ecenac5e #n+JnSe")c)n(e"s#)n )+ an#-@.: I'G A@
Se")l)'#c es- n) "el#ale +) IC !Js
*CR N5cle#c ac#d 8%"#d#a#)n
I$$5ne elec")n $#c")sc)!%
!omplications
7/25/2019 Infectious Disease Case 1
92/92
!omplications
Us5all% "ec)(e" +5ll% 5 #8!")"aced s%$!)$s
.1 Se(e"e !ne5$)n##s #8 8#'8 +aal#%"ae
#+ 8%!)Je$#a de(el)!s