NANCY F.

DANILA, RN,US RN, MAN

ERUPTIVE FEVER DISEASE
ERUPTIVE FEVER DISEASE
CHICKEN POX
EXANTHEM SUBITICUM
GERMAN MEASLES
HERPES ZOSTER
MEASLES
CHICKEN POX
VARICELLA-OTHER NAME
An acute and highly contagious disease of
viral etiology
Characterized- vesicular eruptions on the
skin and mucous membrane and mild
constitutional symptoms
INFECTIOUS AGENT- HERPESVIRUS
VARICELLAE
Man is the only source of infection
Closely related or identical to herpes zoster
virus
Incubation Period
10-21 days or maybe prolonged after
passive immunization against chicken pox

MODE OF TRANSMISSION
Direct contact with patients who sheds the
virus from the vesicles
Indirect contact, through linen or fomites
Airborne or spread by droplet infection
PERIOD OF
COMMUNICABILITY
The patient is capable of transmitting the
disease about a day before the eruption of
the first lesion up to about 5 days after the
appearance of the last crop
CLINICAL MANIFESTATION
PRE-ERUPTIVE MANIFESTATION- mild:
fever and malaise
ERUPTIVE STAGE-
Rash start from the trunk then spread to th
other parts of the body
Initial lesions are distinctively red papules
where contents become milky and pus-like
within 4 days
In adult and bigger children, the lesions are
more wide spread and more severe
CLINICAL MANIFESTATION
ERUPTIVE STAGE-
There is rapid progression so that transition
is completed in 6-8 hours
Vesicular lesion are very pruritic
All stages are present simultaneously before
all are covered with scabs known as celestial
map
All lesions appear in different stages at one
time or it will pass through the following
stages: macule, papule, vesicles, pustule,
crust
Macule- a lesion that is not elevated above
the skin surface
Papule- a lesion that ie elevated above the
skin surface with a diameter of about 3 mm
Vesicle a pop-like eruption filled with
fluid; the thin-walled vesicle early burst
and dry up in 3-5 days
Pustule- a vesicle that is infected or filled
with pus. If lesion become infected the scar
may be big and wide
Crust- a scab or eschar. This is a
secondary lesion caused by the secretion of
visicle drying on the skin
The scar are superficial, depigmented and
take time to fade out
DIAGNOSTIC TEST
Determination of V-Z through complement
fixation test
Determination of V-Z virus through electron
microscopic examination of vesicular fluid
Complications
Secondary infection of the lesions;
furuncles, cellulites, skin abscess,
erysipelas
Meningoencephalitis
Pneumonia
Sepsis
Hemorrhagic varicella
Treatment
Zoveraz 500mg/tablet 1 tab 2x aday for 7
days
Oral acyclovir 800 mg 3x a day for 5 days
Oral anti-histamine for symptomatic
pruritus
Calamine lotion
Do not give salicylates
Antipyretic for fever
Nursing Management
Respiratory isolation until all vesicles have
crusted
Prevention of secondary infection
Disinfection of contaminated articles
Cut nail short
For a child, apply mittens
Provide activities to keep child occupied to
lessen pruritus

PREVENTIVE MEASURES
Active immunization with live attenuated
varicella vaccine
Avoid exposure as much as possible to
infected persons
ROSEOLA INFANTUM, ROSE RASH
OF INFANT
EXANTHEM SUBITUM
DEFINITION
A benign disease that occur almost
exclusively in infants and young children

ETIOLOGIC AGENT
The agent causing the disease still unknown
but believed to be virus

INCUBATION PERIOD:
8-14 DAYS with an average of 10 days
CLINICAL MANIFESTATION
High grade fever ranging from 38.3-39.8
degree celcius or may have febrile
convulsions

Fever, irritability and anorexia may last for
2-5 days after which the fever suddenly
drops to normal and infants appear well
Morbilliform eruption spread all over the
body that start on the trunk, spread to the
neck, the abdomen, the upper and lower
extremities
CLINICAL MANIFESTATIONS
The rash disappear within a few hours or
may persist for 2 days with no mark left
The region above the nose and cheeks are
free from rash
The pharynx slightly inflamed, tonsils are
slightly reddened or covered with follicular
exudates
Treatment/Management
Symptomatic with some antipyretic
No isolation needed
RUBELLA; 3- DAY MEASLES
GERMAN MEASLES
DEFINITION
A mild viral illness caused by rubella virus
It causes mild feverish illness associated
with a rash, and aches in joints
It has teratogenic effect on the fetus
INFECTIOUS AGENT: RUBELLA VIRUS
( FAMILY- TOGAVIRIDAE; GENUS
RUBIVIRUS)

INCUBATION PERIOD: FROM EXPOSURE TO
THE APPEARANCE OF RASH IS USUALLY
14-21 DAYS
PERIOD OF
COMMUNICABILITY
Approximately one week before and four
days after the onset of rashes, but is at its
worst when the rash is at its peak.
Highly communicable infants with
congenital rubella may shed virus for
months after birth
Mode of Transmission
Direct contact with nasopharyngeal
secretions
Air droplets
Transplacental in placental in congenital
rubella
Infants with congenital rubella shed large
quantities or virus in their pharyngeal
secretions and urine which serve as source
of infection to other contacts
CLINICAL MANIFESTATION
PRODROMAL PERIOD
-Low grade fever
-headache
-malaise
Mild coryza
Conjunctivitis
Post-auricular, sub-occipital and posterior
cervical lymphadenopathy with occur on
the 3
rd
to the 5
th
day after onset
ERUPTIVE PERIOD
A pinkish rash on the soft palate
(Forchheimers spot)
An exanthematous rash that appear first on
the face, spreading to the neck, the arms,
trunk and legs
Eruption appears after onset of adenopathy
The rash may last for 1-5 days and leaves
no pigmentation, no desquamation
Tonsillar pain in young adults
Transient poly arthralgia and poly arthritis
may oocur
Treatment


Very little treatment is necessary; it is
essentially symptomatic

Risk of congenital
malformation
100% - when maternal infection occurs on
the first trimester of pregnancy or first
month of gestation
4% in the second trimester
90% -of congenital rubella cases will
excrete the virus at birth and are therefore
infectious
10% remain contagious until one year of
age
Nursing Management
Isolation
Bedrest until fever subsides
Darken room to avoid photophobia
Mild liquid diet but nourishing
Irrigate eyes with warm saline to relieve
irritation
Care of the ears-do not apply heat or cold
unless so ordered
Good ventilation
Prevent spread of infection
Prevent complications
PREVENTION
Administration of live attenuated vaccine
(MMR)
Pregnant women should avoid exposure to
patient with rubella administration of
Immune Serum Globulin one week after
exposure to Rubella
SHINGLES:ACUTE POSTERIOR
GANGLIONITIS
1 HERPES ZOSTER
DEFINITION
An acute viral infection of the sensory
nerve caused by variety of chicken pox
virus

ETIOLOGIC AGENT
VARICELLA-ZOSTER VIRUZ
INCUBATION PERIOD:
13-17 DAYS

PERIOD OF COMMUNICABILITY
A day before the appearance of the first
rash to 5-6 days after the last crust

MODE OF TRANSMISSION
Direct contact-through droplet infection;
airborne spread
Indirect contact
Primary infection varicella zoster
virus may persist in a dominant
state in the dorsal nerve root
ganglia
Virus may emerge from the site in
later years either spontaneously or in
association with immunosuppression
to cause herpes zoster
Produce localized vesicular lession
confines to a dermatone and severe
neurologic pain in the peripheral
areas innervated by the nerves
arising in the inflamed root ganglia
Clinical Manifestation
Any part of the trunk maybe affected but
the thoracic segment is commonly involved
Other areas that maybe affected are the
extremities and branches of he 5
th
and 7
th

cranial nerves
Erythematous base of the skin lesion
appears first is followed within 24 hours by
the appearance of the vesicles
Clinical Manifestation
Cluster of vesicles appear to form patches
Eruption are unilateral and never cross the
midline of the body
The vesicles become pustular, break down
and form crusts. Lesions may last for 1-2
weeks
Pain of varying intensity
Pain occurs from one to five days prior to
the development of rash, described as
burning or stabbing
Clinical Manifestation
Patient may complain of pruritus, pain
usually worse at night and is intensified by
movement
Regional lymph nodes
When opthalmic or the 5
th
cranial nerve is
affected, corneal anesthesia may occur, it is
known as Gasserian ganglionitis
Paralysis of the facial nerve and vesicles in
the external auditory canal affecting the 7
th

cranial nerve. The condition is called
Ramsay Hunt syndrome
DIAGNOSTIC EXAM
Charactistic skin rash may be diagnostic
Tissue culture technique
Smear of vesicle fluid
Microscopy
Complication
Encephalitis
Paralytic ileus, bladder paralysis
Opthalmic herpes which may lead to
blindness
Modalities of Treatment
Symptomatic
Antiviral drugs
Analgesic to control pain
Anti- inflammatory
Nursing Management
Put patient on strict isolation
Apply cool, wet dressing with NSS to
pruritic lesions
Prevent secondary infection
Hygeinic measures should be emphasized
Hypoallergenic food is served
Prevention
avoid exposure to persons with varicella
Self protection by increasing resistance
RUBEOLA; MORBILLI
MEASLES
DEFINITION
An acute, contagious exanthematous
disease usually affect children which are
referable to URTI
Maybe one of the most common and most
serious of a childhood diseases

Etiologic Agent
Filtrable virus that belongs to genus
Morbilivirus of the family paramyxoviridae

Measles virus is rapidly inactivated by heat,
ultraviolet light, and extreme degrees of
acidity and alkalinity
INCUBATION PERIOD
10-12 DAYS (20 DAYS THE LONGEST 8
DAYS THE SHORTEST)

SINGLE ATTACK CONVEYS A LIFELONG
IMMUNITY
PERIOD OF
COMMUNICABILITY
Measles usually lasts about 9-10 days,
measured from the beginning of the
prodromal symptoms to the fading of the
rash

The disease is communicable 4 days before
and 5 days after the appearance of rashes

The disease is most communicable during
the height of the rash
SOURCE OF INFECTION
The virus has been found in the patients
blood, as well as in the secretions from the
eyes, nose and throat

MODE OF TRANSMISSION
Direct contact, by droplets spread through
coughing or sneezing
indirectly
PATHOGNOMONIC SIGN
KOPLIK SPOTS inflammatory lesions of
the buccal mucous glands with superficial
necrosis
They appear on the mucosa of the inner
cheek apposite to the second molars, or
near the junction of the gum and the inner
cheek
Usually appear 1-2 days before measles
rash
When rashes appear, normally koplik spot
will disappear
Clinical Manifestastion
PRE-ERUPTIVE STAGE
ERUPTIVE STAGE
STAGE OF CONVALESCENCE
Clinical Manifestastion
PRE-ERUPTIVE STAGE
Fever
Catarrhal symptoms (rhinitis, conjunctivitis,
photophobia, coryza
Respiratory symptoms- starts from common
colds to persistent coughing
Enanthem sign (koplik spot, stimsons line

Clinical Manifestastion
ERUPTIVE STAGE
The rash usually seen late in the 4
th
day
Maculo-papular rash appear first on either the
cheeks , bridge of the nose, along the hairline, at
the temple
The rash is fully developed by the end of he second
day and all symptoms are at their maximum at this
time
High grade fever that comes on and off
Anorexia and irritability
Abdominal tymphanism, pruritus, lethargy
Clinical Manifestastion
ERUPTIVE STAGE
The throat is red and often extemely sore
As fever subsides, coughing may diminish,
but more often it hangs on for a week or two
Clinical Manifestation
Stage of Convalescence
Rashes fades away the manner as they
erupt
Fever subsides as eruption disappears
When the rash fades, desquamation begins
Symptoms subside, appetite returns
DIAGNOSTIC PROCEDURES
NOSE AND THROAT SWAB
URINALYSIS
BLOOD EXAM (CBC leukopenia at the start
of the disease, leukocytosis when
complication sets in)
Complement fixation or hemogglutinin Test
Modalities of treatment
Anri-viral drugs
Antibiotics if with complication
supportive therapy (oxygen inhalation, IV
fluids
COMPLICATIONS
BRONCHOPNEUMONIA
OTITIS MEDIA
PNEUMONIA/BRONCHITIS
NEPHRITIS
ENCEPHALITIS
BLINDNESS
NURSING MANAGEMENT
ISOLATION (quiet, well ventilated, subdued
light in patients room)
Control high temperature with warm or
tepid sponges
Skin care. Daily cleansing bed bath
Oral and nasal hygiene
Care of the eyes. The patient is sensitive to
light
Care of the ears-be alert on signs of
mastoid infection
NURSING MANAGEMENT
Daily elimination is important.
During febrile stage, limit the diet to fruit
juices, milk and water. If the patient is
vomiting, give iced juices in small amount
and more frequently
Change position every 3-4 hours
Penicillin or other prescribed medication is
usually given in cases where there is
complication
PREVENTIVE MEASURES
Anti-measles at the age of 9 months, as
single dose
Mumps, measles, rubella (MMR) to give a
age 15 months old and 2
nd
dose at 11-12
years