MMR

Question 1

Examples of paramyxovirus?

Answer 1

Measles & Mumps

Question 2

Characteristics of paramyxoviruses?

Answer 2

Enveloped, Spikes, ss RNA

Question 3

Incubation period of measles virus?

Answer 3

10-14d

Question 4

When do patients get measles?

Answer 4

By 5 years old.

Question 5

How is measles spread?

Answer 5

Aerosol spread – very contagious

Question 6

Where can the measles virus exist?

Answer 6

Viraemia, Respiratory Epithelium & Skin

Question 7

Progression of the measles virus?

Answer 7

D1-D7: Fever, Conjunctivitis, Rhinorrhoae, Cough

D2-D6: Koplik’s Spots around Parotid Duct orifices (herald onset)

D4-D9: Maculopapular Rash from face to whole body (flat & palpable, geographic pattern)

Question 8

Complications of Measles?

Answer 8

1. Mucosal Infections
   - Conjunctivitis
   - Otitis Media
2. Respiratory
   - Bronchopneumonia
3. GI
   - diarrhoae
   - secondary bacterial infection
4. Encephalitis
5. Sub-Acute Sclerosing Panencephaltis
   - persistent latent infection of neurons
   - myoclonic seizures, intellectual deteroriation
   - “suppresion-burst” EEG pattern (low voltage interuptted by periodic high voltage complexes)
   - cytoplasmic inclusions in neuronal cells

Question 9

3 ways measles can be diagnosed?

Answer 9

1. Tissue Culture
   - isolated from pharynx, conjuctiva
   - infected monkey kidney cells show multinucleated giant cells
2. RT-PCR
3. Serology - IgM for recent infection; TgG for retrospective

Question 10

Prevention of measles?

Answer 10

MMR vaccine at age 12m and 12-18m (earlier in poorer communities)

Question 11

Who should NOT receive the measles vaccine? What should they receive?

Answer 11

Malnourished, Immunocompromised, pregnant. Give passive immunisation with IVIG

Question 12

When do people get infected by mumps?

Answer 12

5-15 yo

Question 13

What is the incubation period for mumps?

Answer 13

2-3wks

Question 14

Clinical presentation of mumps?

Answer 14

Fever
Malaise
Salivary Gland Enlargement (parotid)

Question 15

Complications of mumps?

Answer 15

1. Aseptic Meningitis
2. Orchitis (pain and swelling)
   - usually unilateral; if bilateral can lead to subfertility
3. Pancreatitis
4. Myocarditis, Nephritis, Oophritis, Thyroiditis, Demyelinating encephalitis, arthrtis

Question 16

methods for diagnosing mumps?

Answer 16

Samples from saliva, throat, urine, CSF

RT-PCR
Tissue culture using cell lines on hen’s eggs – cytopathic effect (rounding of cells, multinucleated syncytial formation, eosinophilic inclusions
Serology - IgM + IgG

Question 17

Prevention of mumps?

Answer 17

Live attenuated vaccine

Question 18

What virus is a togavirus?

Answer 18

Rubella

Question 19

What are characteristics of togaviruses?

Answer 19

1. Icosahedral symmetry
2. Enveloped
3. RNA
4. 1 serotype

Question 20

What is the incubation for rubella?

Answer 20

2-3weeks

Question 21

Clinical presentation of rubella?

Answer 21

Malaise, Headache, Fever

Conjuctivitis, Cough, Lymphadenopathy (Suboccipital, Posterior Auricular, Cervical)

Rose spots (Forscheimer’s spots) herald onset of skin rash

Rubella Rash (small maculopapular lesions from face to trunk & extremities (3d) - can coagulase to form erythemous sheet (geographic pattern)
- d1: upper body and heart
- d3: UL + LL

Question 22

Complications of Rubella?

Answer 22

1. Arthralgia, Arthritis
2. Encephalitis
3. Purpura
4. Teratogenic (esp in first trimester)
   - still born
   - ocular, ear, CNS defects
   - CVS/Respi malformations
5. T1DM
6. Hepatosplenomegaly
7. Thrombocytopenia
8. Bone (metaphyseal osteitis)
9. Hemorhagic Rash

Question 23

How to diagnose rubella?

Answer 23

Tissue culture
RT-PCR
Serology - IgM, Antibody Titre, TORCHES

Question 24

Management and Prevention of Rubella?

Answer 24

Live attenuated vaccine (no conveiving within 3m; other side effects are fever, rash, arthralgia, arthritis, lymphadenopathy)

Quarentine, Specific Ig, screen close contacts, screen pregnant mothers for rubella antibodies

Question 25

Rubella RO?

Answer 25

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