Interesting Case Viral exanthems History of birth BW
Interesting Case Viral exanthems �������� ������
• History of birth: • BW 3, 350 g. • ����� HB 1 , BCG 1 • History of development: normal • History of feeding: ������ 4 ����� +����� • History of vaccine: • 18 ����� DPT 4, OPV 4, JE 1 • แรกเกด BCG , HB 1 • • 2 ����� DPT 1, OPV 1, HB 2 4 ����� DPT 2, OPV 2 6 ����� DPT 3, OPV 3, HB 3 9 ����� Measles • 2 �� 6 ����� JE 2 • 4 �� DPT 5, OPV 5
• Physical examination: – V/S : Body temp (axillary): 36. 5 C, PR: 114/mins, RR: 24/min, BP: 116/71 mm. Hg , O 2 sat 99% – GA: a thai boy, irritable, no pallor, no jaundice. – HEENT: No angioedema.
• Physical examination: – Lung : clear – Heart: regular, no abnormal heart sound – Abdomen: normal contour, active bowel sound , liver and spleen can’t be palpable
• Physical examination: – Neurological examination within normal limit – Skin : generalized erythematous maculopapular rash on face, entire body and all extremities
• 5 �. �. 2553 Orders for one day Orders for continuation • Admit ped • Observe • Rash • Respiratory • Angioedema • Regular diet • Record V/S • MED CPM ¾ tsp oral qid Calamine losion ทา
• 6 �. �. 2553 Orders for one day Orders for continuation • ยายพเศษ 6 • CXR PA • On lock • CBC • Benadril ½ tsp X 3 pc • Ampicillin 600 mg v q 6 hr.
• Investigatons: – CBC: • Hb 13. 1 mg/d. L, Hct 41. 4 %, • WBC 6, 450 cells/cu. mm. – (Neutroplil 46. 8%, Lymphocyte 42. 8%, Monocyte 7. 0%, Eosinophil 2. 8%), • platelet count 300, 000 cells/cu. mm. • MCV 75. 1 fl • RDW 14 % – CXR : Perihilar infiltration.
• 7 �. �. 2553 Orders for one day Orders for continuation • 5% D/N/3 500 ml v drip 60 ml/hr. • 8 ก. พ. 2553 Orders for one day • ปรกษาเวชกรรม สงยนยน Orders for continuation Measles or Fever rash • เดกเคยไดรบวคซน Measles ? • 9 ก. พ. 2553 Orders for one day • CPM 2. 5 mg v q 6 hr. Orders for continuation • Off CPM เดม
• 10 �. �. 2553 Orders for one day • D/C • Augmentin [457] Orders for continuation • Ampicillin 600 mg ¼ tsp X 2 pc 1 bottle v q 6 hr. • Benadril ½ tsp X 3 pc 1 bottle • CPM ¾ tsp X 3 pc 1 bottle • F/U 1 เดอน OPD
• Problem list: 1. Fever with Generalized exanthematous maculopapular rash
• Diagnosis : Rubella
Schematic diagram of clinical course of typical cases of measles. The rash appears 3 to 4 day after onset of fever, conjunctivitis, coryza and cough. Koplik’s spots usually develop 2 day before the rash. (Krugman)
Development and distribution of rash.
Measles - injected eyes - photo phobia Koplik’s spots rash on 2 nd day
Measles severe measles
Measles Rubella 3 rd day rash on 1 st day rash on 2 nd days
Care of exposed person
The antibody response in acute measles infection (Preblud and Katz, 1987) Relative antibody levels Virus onset / prodome Nasopharynx Blood Urine ELISA HI Nt CF Ig. M Years infection Rash onset after Ig. G antibody, ELISA, HI = hemaglutination inhinition; I. P. 7 -18 days illness Ht = Days after onset (10 -14 days) neutralization assay;
Comparison of Maximum and Current Reported Morbidity, Vaccine-Preventable Diseases, Thailand. Disease Polio Diphtheria Pertussis Neonatal tetanus Measles Case rate %Change per 100, 000 pop. in 1977 in 2005 in 2007 2. 10 0 0 100911)��� ( 2)��� ( 0)��� ( 5. 21 0. 003 0. 004 99. 812, 290)��� ( 2)��� ( 5)��� ( 7. 17 0. 04 993, 150)��� ( 23)��� ( 28)��� ( 72. 08 per 100, 000 0. 66 per 0. 50 per 99 Livebirths 100, 000 778)��� ( Livebirths 6)��� ( 4)��� ( 19. 98 5. 35 5. 99 70. 028, 775)��� ( 3, 328)��� ( 3, 775)��� ( Source : Epidemiology Division, MOPH
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