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Exanthematous diseases (Measles I Morbilli (pathogenesis (Portal of entry…

- - - - Incubation period – 5-7 days (range: 1-12)
        In the site of inoculation:
        small, painless, but often pruritic papule→ vesicle → painless necrotic ulcer with a black, depressed eschar
        Extensive edema of the surrounding tissues
        regional lymphadenopathy and lymphangitis
        In exposed areas such as the face, neck, arms, and hands
        Systemic symptoms, including fever, malaise, and headache can accompany the cutaneous lesion
        Mortality <1% with antibiotic therapy; without appropriate therapy 20%
      - Rarely: malignant oedema
        Face, border between skin and mucous membranes
        Bluish/violet increasing oedema with small vesicles, without black eschar
        Severe ilness with bacteremia
    - - anthrax spores are aerosolized while working with contaminated animal products such as wool, hair, or hides OR bioterrorism
        
        Incubation period: 1-7 days (up to  60 days)
        
        Biphasic course of the disease
        
        Case-fatality:
        without antibiotic treatment – 85%- 97%
        with antibiotic treatment – 75%
      - Prodrome (4-5 days) of cough, myalgia, fatigue,  and fever
        Fulminant phase: Rapid deterioration with fever, dyspnea, cyanosis and shock
        hemorrhagic necrosis of the thoracic lymph nodes → hemorrhagic mediastinitis
        radiographic evidence of mediastinal widening
        Mortality 92%
    - - consumption of undercooked infected meat from animals infected with anthrax and tends to occur in family clusters or point-source outbreaks
        Mostly in medically unserved areas
        Incubation period 1-6 days
      - two clinical forms
        Oropharyngeal: necrotic ulcers surrounded by extensive edema of the infected intestinal segment and its adjacent mesentery; mesenteric lymph nodes may be enlarged and hemorrhagic
        Gastrointestinal: edematous lesions which progress over one to two weeks to necrotic ulcers covered with a pseudomembrane. Edema and painful swelling may develop in the oropharynx and neck, accompanied by cervical lymphadenopathy, pharyngitis, and fever, high mortality
    - - Complication of other forms of anthrax
        Develops in 50% of patients with infalation anthrax
        CSF: elevated protein (70%), low glucose (37%), and a positive Gram stain (77%) and culture (81%)
        grossly bloody lumbar puncture may be confused with a traumatic tap
        Delirium or coma follows quickly, and refractory seizures, cranial nerve palsies, and myoclonus
        Mortality 96%