Low grade fever with rash

A 7 years old boy was bought to your hospital after developing fever associated with rash formation. The rash started 5 days ago. According to the mother, the rash starts on the face and radiate to the trunk and hands. On examination, the rash is blanching on pressure.

1) What abnormality seen in picture A

2) Describe the rash on picture B

3) Outline the Pathophysiology of rash

4) What is your diagnosis

5) Outline the Pathophysiology of the diagnosis in (4)

6) What is mode of transmission for the disease in (4)

7) Name four complication of disease (4)

8) What investigation you would request

Answer

1) Koplik spot

2) Numerous rash on the back with Light pink, discrete maculopapules that coalesce to form blotches.

3) Infection -> disseminated through circulation -> deposit in small superficial capillary -> vasculitis of small vessel -> rash which blanch on pressure

4) Measels virus infection

5) Pathophysiology

- Primary infection -> Primary viraemia (disseminated through circulation)

- Prodromal phase (2-4 days; produce sneezing, coughing, runny nose, koplick spot, conjunctivitis, fever, fever, lymphopenia)

- Eruptive phase (5-8 days;infection of vascular endothelial cell)

6) Mode of transmission

- Large droplets (face-to-face exposure)

- Airborne transmission

- Indirect transmission (fomites)

- Transplacental transmission (prematurity/congenital measles)

7) Complication

- Vitamin A Deficiency

- Acute postinfectious measles encephalomyelitis (acute disseminated encephalomyelitis [ADEM])

- Subacute measles encephalitis (measles inclusion body encephalitis [MIBE])

- Subacute sclerosing panencepahlitis (SSPE)

8) Investigation

Serology

- Specific IgM (ELISA)

- Fourfold rise in antibody titer (HI, Nt tests)

Antigen detection (in epithelial cells)

-Respiratory secretions

- Urine

Isolation and identification of virus

-Nasopharyngeal swab

-Conjunctival swab

-Blood samples

-Respiratory secretions

-Urine