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Child Health: Measles, Mumps & feverish children. - Coggle Diagram
Child Health: Measles, Mumps & feverish children.
MEASLES
Highly contagious infection, caused by a morbillivirus of the paramyxovirus family.
Airborne virus, incubation period of around 10 days, persons is infectious from 4 days before rash appears till 4 days after onset of rash.
COMPLICATIONS
Increased susceptability to secondary infections, can lead to CNS complications such as convulsions, encephalitis, blindness or SSPE.
Complications more likley in adults, pregnant women and malnourished or chronically ill children.
MUMPS
Mumps is an cute infectious disease caused by the paramyxovirus, characterised by bilateral parotid swelling commonly salivary gland swelling.
Is spread by respiratory droplets, fomites or saliva and replicates in the upper respiratory mucosa.
Asymptomatic mumps infection common in children. Almost all develop life long immunity after one episode.
Incubation period 16-18 days, most infectious from 1-2 days prior to onset of symptoms.
COMPLICATIONS
Parotitis: inflammation of the parotid glands, usually resolves without complications.
Epididymo-orchitis:most common complication in men, can lead to sub-fertility.
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Aseptic meningitis:usually benign and all patients make a full recovery with no residual neirological effects.
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Myocardial complications:may present ECG changes, fatal myocarditis extremely rare.
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Spontaeous abortion: increased risk of miscarriage if infected with mumps during the first trimester.
Rarer complications may include: CNS disorders, thyroiditis, mastitis, prostatitis, hepatitis and thrombocytopenia (low levels of platelets).
Diagnosis
Consider diagnosis in those who present with fever, rash and known contact with confirmed case.
Check vaccination history-measles more likley in those who have not received the vaccination or completed full immunisation.
Assess for sign and symptoms including cough, coryzal symptoms with conjunctivits, malaise, fever over 39 without antipyretics and maculopapular rash.
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Rash is likley erythematous, maculopapular, first appears on face and behind ears before descending down the body to trunk and limbs, forming on the hands and feet and lasting for about 5-7days.
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Confirm diagnosis through virology testing and notify the local HPT as measles is a notifiable disease.
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Differentials
Parvovirus B19, mild self limiting illness also known as slap cheek and may present with similar rash.
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Herpes virus type 6 (roseola infantum)-mild illness, may be asymptomatic. Can present with fever and maculopapular rash.
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Early meningococcal disease, rash may change from maculopapular to purpuric in later stages and will not fade under glass test.
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Diagnosis
Clinically confirm with laboratory analysis of a saliva sample to detect presence of (Ig)M mumps antibody.
Consider diagnosis of mumps in those presenting with parotitis. May present with unilateral gland swelling with the second following soon after. May be tender to touch.
Assess for other non specifi symptoms whihc may include mild fever, headache, earache, malaise, muscle ache, loss of appetite and symptoms associated with complications.
Assess hisotry of mumps and liklehood, consider imunisation history (incomplete vaccinations), known contact with confirmed case, known recent/local outbreaks. Consider age-mumps unlikely in under 1 year.
Differentials
Other infectious causes, may include viral infections, such as slap cheek syndrome.
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Non infectious causes:Parotid duct obstruction, drugs, metabolic disorders, autoimmune disease.
Management of Mumps
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Advise is usually self limiting, should resolve within 1-2 weeks with no long term effects and without treatment.
Advise rest, good fluid intake and mild analgesia or ibuprofen for symptom relief.
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Consider follow up in one week to reassess and check symptoms are resolving. Signpost to online resource for further information on Mumps.
Advise to seek medical attention should symptoms worsen or concern about symptoms representing meningitis or epididymo-orchitis (swollen testicles).
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