Rubella

Rubella is a contagious infection that can be determined by a rash on the skin. It previously observed in schoolchildren with occasional epidemic fluctuation but now rare in immunized population. Rubella is caused by a virus that is spread through the airborne droplet transmission or by close contact.

When invasion to the upper respiratory tract, it is followed by dissemination to skin, conjunctiva and mucous membranes, and proliferative hyperplasia in lymp node. The incubation period is 2.5 – 3 weeks and within 24-48 hours will followed by a discrete maculopapular generalized rash. The rash may last 5 days but is often fleeting and fades without straining or desquamation.

How to Diagnose
Rubella is diagnosed y the haemagglutination-inhibition and IgM test.

Complication
The complication of rubella are:

• Immune complex arthritis mainly in women
• Allergic encephalomyelitis that commonly 10-14 days after rubella
• Purpura that is caused by thrombocytopenia and vascular defect
• Congenital rubella syndrome

Treatment and Prevention
Most of rubella treatment is asymptomatic and non steroid anti-inflammatory agent may be given for rubella arthritis. On the other hand, the prevention can be done by giving vaccine measles-mumps-rubella (MMR) between 12 and 18 month of age

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Infectious Diseases: Measles

Measles is an acute exanthematous disease. It is caused by meales virus, a member of Paramyxoviridae. The desease is common in preschool and junior school children but recently it is rare due to widespread of effective immunization. The explosive outbreaks may occur if measles is introduced to unexposed and non-immune communities.

Pathogenesis:

• Measles spread follow airborne droplet transmission from the respiratory tract of patient with active measles
• No other reservoir of infection
• The invasion of upper respiratory tract is followed by lymphoid tissues multiplication and viraemia.

Signs and Symptoms:

1. Koplik's spot as white spots on buccal mucosa (3 days after a high fever)
2. Maculopapular rash, spreads from the head downward
3. Low-grade fever with cough, coryza, and conjunctivitis
4. Erythematous

Complication of Measles:

• Obstructive laryngitis and dysentery
• Secondary bacterial otitis media
• Appendicitis
• Giant cell pneumonitis
• subacute slerosing panencephalitis
• Allergic encephalomyelitis

Management of Measles:

• Commonly the management is symptomatic
• No effective antiviral therapy for acute complications
• Erythrocin, clarithromycin or azithromycin, or co-amoxiclave for bacterial complication
• Steroids are used in allergic encephalitis

How to prevent measles:

1. Active immunization: using combined meales, mumps, rubella (MMR) vaccine is geven between 12-18 months of age. Mild febrile reactions are expected in 3% of vaccines
2. Passive Immunization: It is given within 72 hours of exposure and especially useful in immunocompromised non-immune children

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