Communicable Diseases (Integumentary Part)

Measles vs. Rubella

Measles (Rubeola)

• Also called 7-day measles
• Causative Agent: Paramyxoviridae
• Period of Communicability: 4 days before and 4 days after rash appearance
• Incubation Period: 1-2 weeks
• Diagnostic Test: Right testing
• Pathognomonic Sign: Koplik spots
• 3 Cs: Choriza, Conjunctivitis, Cough
• **Stages: **
  • Pre-eruptive Stage: Fever, cataral (3 Cs), photophobia, Stimson's line
  • Eruptive Stage: Maculopapular rash, high-grade fever, anorexia, irritability
  • Convalescent Stage: Fading rashes, fever subsides, desquamation begins
• Rash Pattern: Cephalocaudal (head to toe)
• Treatment:
  • Antiviral drug (Isoprenosine)
  • Antibiotic (Penicillin)
  • Oxygen, IV fluid
  • Antipyretics
• Nursing Management:
  • Isolation, Standard and Airborne precaution
  • Negative pressure room
  • Tepid sponge bath, skincare, eye care
  • Dimmed lights for photophobia
  • Daily elimination and ear care
• Preventive Measures:
  • Measles immunization (9 months, sub-Q)
  • MMR vaccine (Measles, Mumps, Rubella)
    • 1st dose at 9 months
    • 2nd dose at 11-12 years old
  • Avoid in pregnant women, active TB, leukemia, lymphoma, depressed immune system
• Complications: POD (Pneumonia, Otitis media, Diarrhea, Encephalitis)

Rubella (German Measles)

• Also called 3-day measles
• Causative Agent: Rubella virus
• Period of Communicability: 1 week before and 1 week after rash appearance
• Incubation Period: 2-3 weeks
• Diagnostic Test: Serologic test
• Pathognomonic Sign: Forschheimer spots
• Symptoms: Sore throat and lymphadenopathy
• Stages:
  • Prodromal Stage: Low-grade fever, headache, malaise, mild choriza, conjunctivitis
  • Eruptive Stage: Forschheimer spots (soft palate)
• Congenital Rubella:
  • Severe birth defects if infection occurs in first 12 weeks of pregnancy
  • Defects: Deafness, cataracts, heart defects, intellectual disabilities
• Nursing Management:
  • Airborne droplet and contact precaution
  • Isolation from pregnant women
  • Bed rest until fever subsides
  • Darkened room for photophobia
  • Mild and nutritious diet
• Preventive Measures:
  • MMR vaccine
    • Avoid pregnancy for 3 months after vaccination
    • 1st dose at 9 months (93% effectiveness)
    • 2nd dose at 12-15 months (97% effectiveness)

Chickenpox (Varicella)

• Causative Agent: Varicella zoster
• Incubation Period: 2-3 weeks
• Period of Communicability: 7 days before and until crusting
• Rash Pattern: Centripetal (starts at chest, scattered)
• Stages of Rash: Macule > Papule > Vesicle > Crust
• Diagnostic Test: Vesicular fluid test, Tzanck smear
• Congenital Varicella:
  • Birth defects: Limb deformities, scarring, retarded growth, CNS and ophthalmic issues
• Nursing Management:
  • Strict isolation
  • Exclusion from school for 1 week
  • Cut fingernails, provide mittens
  • Ensure rest
  • Use calamine lotion, baking soda with warm water
  • Acyclovir for supportive management
• Preventive Measures: Varicella zoster immunoglobulin
  • 1st dose at 9 months
  • 2nd dose at 12-15 months, sub-Q (0.5 ml)
• Complications: PICE (Pneumonia, Impetigo, Encephalitis, Secondary bacterial infection)

Summary

• Measles (Rubeola): Also called 7-day measles, complex spots, 3 Cs (choriza, conjunctivitis, cough), MMR vaccine.
• Rubella (German Measles): Also called 3-day measles, forshheimer spots, sore throat, lymphadenopathy, MMR vaccine.
• Chickenpox (Varicella): Centripetal rash, macule > papule > vesicle > crust, varicella zoster immunoglobulin.

Key Points

• Measles (Rubeola): 7-day, complex spots, 3 Cs, 4-4 period of communicability, cephalocaudal rash.
• Rubella: 3-day, forshheimer spots, sore throat, lymphadenopathy, 7-7 period of communicability.
• Chickenpox: Centripetal, macule > papule > vesicle > crust stages, varicella zoster immunoglobulin.
• Prevention: MMR vaccine for measles and rubella; varicella zoster immunoglobulin for chickenpox.