<div id="pf1" class="pf w0 h0" data-page-no="1"><div class="pc pc1 w0 h0"><img class="bi x0 y0 w1 h1" alt="" src="https://files.passeidireto.com/cb6739bf-1d15-4a05-9b9e-791388b639c2/bg1.png"><div class="t m0 x1 h2 y1 ff1 fs0 fc0 sc0 ls0">81</div><div class="t m0 x2 h3 y2 ff2 fs0 fc1 sc0 ls1 ws6">Capítulo <span class="ls2 ws7"> </span></div><div class="t m0 x3 h4 y3 ff2 fs1 fc1 sc0 ls2">4</div><div class="t m0 x4 h5 y4 ff3 fs2 fc1 sc0 ls3 ws8">DOENÇAS E<span class="blank _0"> </span>X<span class="blank _1"> </span>ANT<span class="blank _2"></span>EM<span class="blank _0"> </span>Á<span class="blank _3"></span>TICAS</div><div class="t m0 x5 h6 y5 ff4 fs3 fc1 sc0 ls4 ws7">O QUE VOCÊ PRECIS<span class="blank _0"> </span>A SABER?</div><div class="t m0 x6 h7 y6 ff5 fs4 fc0 sc0 ls2 ws7"> <span class="blank _4"></span>u<span class="blank _5"> </span><span class="ff6 fs5 fc2 ws9 v1">Diag<span class="blank _0"> </span>nóstic<span class="blank _0"> </span>o difere<span class="blank _0"> </span>ncial d<span class="blank _0"> </span>os exantem<span class="blank _0"> </span>as: avaliar a idade d<span class="blank _0"> </span>o pacie<span class="blank _0"> </span>nte, as ca<span class="blank _0"> </span>rac<span class="blank _0"> </span>terís<span class="blank _0"> </span>ticas do exan<span class="blank _0"> </span>tema e os </span></div><div class="t m0 x7 h8 y7 ff6 fs5 fc2 sc0 ls5 wsa">sint<span class="blank _2"></span>omas q<span class="blank _2"></span>ue o acompa<span class="blank _2"></span>nham.</div><div class="t m0 x6 h7 y8 ff5 fs4 fc0 sc0 ls2 ws7"> <span class="blank _4"></span>u<span class="blank _5"> </span><span class="ff6 fs5 fc2 v1">Lem<span class="blank _0"> </span>bre<span class="blank _0"> </span>-<span class="blank _0"> </span>se do exante<span class="blank _0"> </span>ma poli<span class="blank _0"> </span>mór<span class="blank _0"> </span>\ue61f<span class="blank _0"> </span>co da vari<span class="blank _0"> </span>cela e da<span class="blank _0"> </span>s manc<span class="blank _0"> </span>has de Kopli<span class="blank _0"> </span>k, p<span class="blank _0"> </span>atogno<span class="blank _0"> </span>môni<span class="blank _0"> </span>cas do sar<span class="blank _0"> </span>amp<span class="blank _0"> </span>o.</span></div><div class="t m0 x6 h7 y9 ff5 fs4 fc0 sc0 ls2 ws7"> <span class="blank _4"></span>u<span class="blank _5"> </span><span class="ff6 fs5 fc2 v1">Co<span class="blank _0"> </span>nhe<span class="blank _0"> </span>cer os a<span class="blank _0"> </span>gen<span class="blank _0"> </span>tes etiol<span class="blank _0"> </span>ógic<span class="blank _0"> </span>os, o tr<span class="blank _0"> </span>atame<span class="blank _0"> </span>nto e as me<span class="blank _0"> </span>didas de p<span class="blank _0"> </span>revenç<span class="blank _0"> </span>ão.</span></div><div class="t m0 x6 h7 ya ff5 fs4 fc0 sc0 ls2 ws7"> <span class="blank _4"></span>u<span class="blank _5"> </span><span class="ff6 fs5 fc2 ls5 wsb v1">Noti\ue61fcaçã<span class="blank _2"></span>o compulsóri<span class="blank _2"></span>a: sa<span class="blank _2"></span>rampo, rubéola, sí<span class="blank _2"></span>ndrome da<span class="blank _2"></span> rubéola congênita<span class="blank _2"></span> e caso<span class="blank _2"></span>s gra<span class="blank _2"></span>ves i<span class="blank _2"></span>nternados<span class="blank _2"></span> ou </span></div><div class="t m0 x7 h8 yb ff6 fs5 fc2 sc0 ls5 wsa">óbito<span class="blank _2"></span>s por v<span class="blank _2"></span>aricela.</div><div class="t m0 x8 h9 yc ff3 fs0 fc0 sc0 ls6 wsc">1. <span class="blank _0"> </span><span class="ls7 wsd"> INTROD<span class="blank _0"> </span>UÇÃO</span></div><div class="t m1 x9 ha yd ff6 fs6 fc2 sc0 ls8 wse">Na infância<span class="blank _0"> </span>, é comu<span class="blank _0"> </span>m a ocor<span class="blank _0"> </span>rência de do<span class="blank _0"> </span>enças qu<span class="blank _0"> </span>e </div><div class="t m2 x9 ha ye ff6 fs6 fc2 sc0 ls9 wsf">se carac<span class="blank _0"> </span>terizam pelo apa<span class="blank _0"> </span>recime<span class="blank _0"> </span>nto de erup<span class="blank _0"> </span>ções </div><div class="t m3 x9 ha yf ff6 fs6 fc2 sc0 lsa ws10">cutân<span class="blank _0"> </span>eas eritematosas di<span class="blank _2"></span>sseminadas, tam<span class="blank _0"> </span>bém </div><div class="t m4 x9 ha y10 ff6 fs6 fc2 sc0 ls2 ws11">con<span class="blank _0"> </span>hecidas c<span class="blank _0"> </span>omo exantema ou <span class="ff7 lsb ws0">ras<span class="blank"> </span>h</span> c<span class="blank _0"> </span>utâne<span class="blank _0"> </span>o. Os </div><div class="t m5 x9 ha y11 ff6 fs6 fc2 sc0 lsc wsf">exantemas gera<span class="blank _0"> </span>lmente são causad<span class="blank _0"> </span>os por vír<span class="blank _0"> </span>us, </div><div class="t m6 x9 ha y12 ff6 fs6 fc2 sc0 lsd ws11">emb<span class="blank _0"> </span>ora bac<span class="blank _0"> </span>térias, doe<span class="blank _0"> </span>nças reum<span class="blank _0"> </span>atológicas e até </div><div class="t m3 x9 ha y13 ff6 fs6 fc2 sc0 lse ws12">alguns m<span class="blank _0"> </span>edicame<span class="blank _0"> </span>ntos també<span class="blank _0"> </span>m possam esta<span class="blank _0"> </span>r<span class="blank _2"></span> </div><div class="t m0 x9 ha y14 ff6 fs6 fc2 sc0 lsd ws13">implicados<span class="blank _0"> </span>. <span class="blank _2"></span><span class="ff8 ls2 ws14">A\ue61d<span class="blank _2"></span>análise das c<span class="blank _0"> </span>arac<span class="blank _0"> </span>terístic<span class="blank _0"> </span>as da lesão </span></div><div class="t m7 x9 hb y15 ff8 fs6 fc2 sc0 lsf wsf">exantemátic<span class="blank _0"> </span>a (<span class="blank _2"></span>tipo d<span class="blank _0"> </span>e exantema<span class="blank _0"> </span>, localização e </div><div class="t m0 x9 hb y16 ff8 fs6 fc2 sc0 ls2 ws15">prog<span class="blank _0"> </span>ressão<span class="blank _2"></span>), dos sinais e si<span class="blank _0"> </span>ntomas assoc<span class="blank _0"> </span>iados e </div><div class="t m0 x9 hb y17 ff8 fs6 fc2 sc0 ls10 ws16">de dados epide<span class="blank _0"> </span>miológicos (idade, sexo e saz<span class="blank _2"></span>ona<span class="ls2">-</span></div><div class="t m8 x9 ha y18 ff8 fs6 fc2 sc0 ls11 ws11">lidade) permi<span class="blank _0"> </span>tem inferir o d<span class="blank _0"> </span>iagnós<span class="blank _0"> </span>tico etioló<span class="blank _0"> </span>gico<span class="ff6 ls2 ws7"> </span></div><div class="t m0 x9 ha y19 ff6 fs6 fc2 sc0 ls12 ws17">sem a necessidade de ex<span class="blank _2"></span>ames comple<span class="blank _0"> </span>mentares.</div><div class="t m9 x9 ha y1a ff6 fs6 fc2 sc0 lsb wse">Pode<span class="blank _0"> </span>mos dividir os exantemas da infânc<span class="blank _0"> </span>ia em dois </div><div class="t m0 x9 ha y1b ff6 fs6 fc2 sc0 ls10 ws18">tipos principais:</div><div class="t m0 x8 hc y1c ff5 fs7 fc3 sc0 ls2 ws7"> <span class="blank _6"></span>u<span class="blank _7"> </span><span class="ff6 fs6 fc2 ls11 ws19 v2">E<span class="blank _0"> </span>xant<span class="blank _2"></span>ema macul<span class="blank _0"> </span>opapular: co<span class="blank _0"> </span>mposto por mácu<span class="blank _0"> </span><span class="ls2">-</span></span></div><div class="t ma xa ha y1d ff6 fs6 fc2 sc0 ls12 wsf">las e pápulas (Figura\ue60f<span class="blank _8"> </span>1<span class="blank _9"></span>). É\ue60f<span class="blank _0"> </span>o tip<span class="blank _0"> </span>o de exantema </div><div class="t m0 xa ha y1e ff6 fs6 fc2 sc0 ls2 ws1a">mais comu<span class="blank _0"> </span>m, e<span class="blank _0"> </span>ncontra<span class="blank _0"> </span>do no saramp<span class="blank _0"> </span>o, rubé<span class="blank _0"> </span>ola, </div><div class="t mb xa ha y1f ff6 fs6 fc2 sc0 lsd ws1b">eritema infeccioso, ex<span class="blank _2"></span>antema súbito, escarlat<span class="blank _2"></span>ina </div><div class="t m0 xa ha y20 ff6 fs6 fc2 sc0 ls2 ws7">e na doe<span class="blank _0"> </span>nça de Kawasaki.</div><div class="t m0 xb hd y21 ff8 fs8 fc0 sc0 ls2 ws7">Fig<span class="blank _0"> </span>ura 1. <span class="ff6 fc2 ls13 ws1c">Exantema maculopapular<span class="blank _9"></span>.</span></div><div class="t m0 xc he y22 ff8 fs9 fc0 sc0 ls2 ws7">Fon<span class="blank _0"> </span>te: <span class="ff9 fc2 ls14 ws1">ht<span class="blank"> </span>tps:<span class="blank"> </span>/<span class="blank _2"></span>/ww<span class="blank"> </span>w.por<span class="blank"> </span>talp<span class="blank"> </span>ed.co<span class="blank"> </span>m.<span class="blank"> </span>br<span class="blank _2"></span>/especialidades-</span></div><div class="t m0 xc hf y23 ff9 fs9 fc2 sc0 ls15 ws2">da-p<span class="blank"> </span>e<span class="blank"> </span>diatria<span class="blank"> </span>/<span class="blank"> </span>infectologia/zika<span class="blank"> </span>-vir<span class="blank"> </span>us<span class="blank"> </span>-<span class="blank _0"> </span>quando<span class="blank _0"> </span>-suspe<span class="blank"> </span>itar/</div><div class="t m0 xd hf y24 ff9 fs9 fc2 sc0 ls3 ws3">attachment/<span class="blank _9"></span>erupcao<span class="blank"> </span>-papular<span class="blank _9"></span>-<span class="blank _2"></span>2<span class="blank"> </span>/<span class="blank _9"></span>.</div><div class="t m0 xe hc y25 ff5 fs7 fc3 sc0 ls2 ws7"> <span class="blank _6"></span>u<span class="blank _7"> </span><span class="ff6 fs6 fc2 ws1d v2">E<span class="blank _0"> </span>xantema papulovesicular<span class="blank _0"> </span>: comp<span class="blank _0"> </span>osto por pápu<span class="blank _0"> </span>-</span></div><div class="t mc xf ha y26 ff6 fs6 fc2 sc0 ls16 ws1e">las e vesículas (Figur<span class="blank _0"> </span>a\ue60f<span class="blank _9"></span>2<span class="blank _2"></span>), que po<span class="blank _0"> </span>dem evoluir para<span class="blank _0"> </span> </div><div class="t md xf ha y27 ff6 fs6 fc2 sc0 ls11 wsf">pústulas e c<span class="blank _0"> </span>rostas. Enc<span class="blank _0"> </span>ontrado na varic<span class="blank _0"> </span>ela, no </div><div class="t m0 xf ha y28 ff6 fs6 fc2 sc0 ls2 ws7">her<span class="blank _0"> </span>pes-zóster e na doenç<span class="blank _0"> </span>a mão<span class="blank _0"> </span>-p<span class="blank _0"> </span>é<span class="blank _0"> </span>-bo<span class="blank _0"> </span>ca.</div><div class="t m0 x10 hd y29 ff6 fs8 fc0 sc0 ls17 ws4">\ue61d\ue61c\ue61b\ue61a\ue619\ue618<span class="blank _9"></span>\ue617\ue616\ue615\ue61d\ue614/\ue61b\ue619\ue613\ue612<span class="blank _2"></span>\ue614\ue611\ue610\ue616\ue615\ue61d\ue614</div><div class="t m0 x11 h10 y2a ffa fsa fc4 sc1 ls2 ws7">Ano_1_Pediatria-2.indb 81<span class="blank _a"></span><span class="fc5 sc0">Ano_1_Pediatria-2.indb 81<span class="blank _b"> </span><span class="fc4 sc1">03/11/2021 12:45:45<span class="blank _c"></span><span class="fc5 sc0">03/11/2021 12:45:45</span></span></span></div></div><div class="pi" data-data="{"ctm":[1.000000,0.000000,0.000000,1.000000,0.000000,0.000000]}"></div></div> <div id="pf2" class="pf w0 h0" data-page-no="2"><div class="pc pc2 w0 h0"><img class="bi x0 y0 w1 h1" alt="" src="https://files.passeidireto.com/cb6739bf-1d15-4a05-9b9e-791388b639c2/bg2.png"><div class="t m0 x12 h11 y2b ff4 fs9 fc1 sc0 ls18 ws7">Doenças ex<span class="blank _2"></span>antemáticas<span class="blank _d"> </span><span class="ff2 fs8 fc0 ls19 v0">Urgências pediátricas</span></div><div class="t m0 x13 h2 y1 ff1 fs0 fc0 sc0 ls1a">82</div><div class="t m0 x14 hd y2c ff8 fs8 fc0 sc0 ls2 ws7">Fig<span class="blank _0"> </span>ura 2<span class="blank _0"> </span>. <span class="ff6 fc2 ls13 ws1c">E<span class="blank _0"> </span>xant<span class="blank _2"></span>ema papulovesicular<span class="blank _9"></span>.</span></div><div class="t m0 x15 he y2d ff8 fs9 fc0 sc0 ls2 ws7">Fon<span class="blank _0"> </span>te: <span class="ff9 fc2 ls14 ws1">ht<span class="blank"> </span>tps:<span class="blank"> </span>/<span class="blank _2"></span>/ww<span class="blank"> </span>w.maeme<span class="blank"> </span>quer.pt/desenvolvimento-<span class="blank"> </span>infantil/</span></div><div class="t m0 x16 hf y2e ff9 fs9 fc2 sc0 ls1b ws1f">saude-inf<span class="blank _2"></span>antil/<span class="blank _9"></span>diciona<span class="blank _2"></span>rio-<span class="blank"> </span>da-saude-<span class="blank"> </span>do<span class="blank"> </span>-bebe/herpes-z<span class="blank _2"></span>ost<span class="blank _2"></span>er<span class="blank _2"></span>/<span class="blank _9"></span>.</div><div class="t m0 x9 h12 y2f ff4 fs9 fc1 sc0 ls1c ws7"> <span class="blank _e"> </span> <span class="blank _e"> </span>BA<span class="blank _0"> </span>SES DA ME<span class="blank _0"> </span>DIC<span class="blank _0"> </span>INA</div><div class="t m0 x15 hd y30 ff6 fs8 fc2 sc0 ls2 ws25">Vale a pen<span class="blank _0"> </span>a revisa<span class="blank _0"> </span>r algu<span class="blank _0"> </span>ns co<span class="blank _0"> </span>nce<span class="blank _0"> </span>itos bás<span class="blank _0"> </span>icos da d<span class="blank _0"> </span>er<span class="blank _0"> </span>ma-</div><div class="t m0 x15 hd y31 ff6 fs8 fc2 sc0 ls1d ws20">tologia:</div><div class="t m0 x17 h13 y32 ff5 fs4 fc0 sc0 ls2 ws7"> <span class="blank _4"></span>W</div><div class="t me x18 hd y33 ff6 fs8 fc2 sc0 ls1e ws26">Eri<span class="blank _0"> </span>tema: l<span class="blank _0"> </span>esão d<span class="blank _0"> </span>e pel<span class="blank _0"> </span>e com c<span class="blank _0"> </span>olor<span class="blank _0"> </span>ação ave<span class="blank _0"> </span>rme<span class="blank _0"> </span>lhada o<span class="blank _0"> </span>u </div><div class="t mf x18 hd y34 ff6 fs8 fc2 sc0 ls2 ws27">róse<span class="blank _0"> </span>a dec<span class="blank _0"> </span>orr<span class="blank _0"> </span>ente d<span class="blank _0"> </span>e alte<span class="blank _0"> </span>raçã<span class="blank _0"> </span>o vascul<span class="blank _0"> </span>ar<span class="blank _2"></span>, ge<span class="blank _0"> </span>ral<span class="blank _0"> </span>men<span class="blank _0"> </span>te </div><div class="t m0 x18 hd y35 ff6 fs8 fc2 sc0 ls1f ws21">transitória.</div><div class="t m0 x17 h13 y36 ff5 fs4 fc0 sc0 ls2 ws7"> <span class="blank _4"></span>W</div><div class="t m10 x18 hd y37 ff6 fs8 fc2 sc0 ls13 ws28">Enantema: alt<span class="blank _2"></span>eração vascular<span class="blank _2"></span> transitória<span class="blank _2"></span> com colora<span class="blank _0"> </span><span class="ls2">-</span></div><div class="t m0 x18 hd y38 ff6 fs8 fc2 sc0 ls2 ws7">ção ave<span class="blank _0"> </span>rme<span class="blank _0"> </span>lhada d<span class="blank _0"> </span>e muc<span class="blank _0"> </span>osas.</div><div class="t m0 x17 h14 y39 ff5 fs4 fc0 sc0 ls2 ws7"> <span class="blank _4"></span>W<span class="blank _f"> </span><span class="ff6 fs8 fc2 ws29 v1">Mác<span class="blank _0"> </span>ula: tod<span class="blank _0"> </span>a e qualq<span class="blank _0"> </span>uer a<span class="blank _0"> </span>lter<span class="blank _0"> </span>ação d<span class="blank _0"> </span>a cor d<span class="blank _0"> </span>a pele q<span class="blank _0"> </span>ue </span></div><div class="t m0 x18 hd y3a ff6 fs8 fc2 sc0 ls20 ws2a">não a<span class="blank _0"> </span>pre<span class="blank _0"> </span>se<span class="blank _0"> </span>nte re<span class="blank _0"> </span>levo.</div><div class="t m0 x17 h14 y3b ff5 fs4 fc0 sc0 ls2 ws7"> <span class="blank _4"></span>W<span class="blank _f"> </span><span class="ff6 fs8 fc2 ws2b v1">Páp<span class="blank _0"> </span>ula: le<span class="blank _0"> </span>são sól<span class="blank _0"> </span>ida<span class="blank _0"> </span>, elevad<span class="blank _0"> </span>a e com m<span class="blank _0"> </span>eno<span class="blank _0"> </span>s de 1\ue60f<span class="blank _0"> </span>cm </span></div><div class="t m11 x18 hd y3c ff6 fs8 fc2 sc0 ls21 ws2c">de diâ<span class="blank _0"> </span>met<span class="blank _0"> </span>ro. A\ue60f<span class="blank _1"> </span>con<span class="blank _0"> </span>\ue61euê<span class="blank _0"> </span>ncia d<span class="blank _0"> </span>essa<span class="blank _0"> </span>s lesõe<span class="blank _0"> </span>s ori<span class="blank _0"> </span>gina </div><div class="t m0 x18 hd y3d ff6 fs8 fc2 sc0 ls22 ws2d">uma pla<span class="blank _2"></span>ca.</div><div class="t m0 x17 h14 y3e ff5 fs4 fc0 sc0 ls2 ws7"> <span class="blank _4"></span>W<span class="blank _f"> </span><span class="ff6 fs8 fc2 ws2e v1">V<span class="blank _2"></span>es<span class="blank _0"> </span>ícula<span class="blank _0"> </span>: lesão e<span class="blank _0"> </span>levada q<span class="blank _0"> </span>ue co<span class="blank _0"> </span>ntém e<span class="blank _0"> </span>m seu i<span class="blank _0"> </span>nter<span class="blank _0"> </span>ior </span></div><div class="t m0 x18 hd y3f ff6 fs8 fc2 sc0 ls2 ws7">um líq<span class="blank _0"> </span>uido c<span class="blank _0"> </span>laro.</div><div class="t m0 x17 h13 y40 ff5 fs4 fc0 sc0 ls2 ws7"> <span class="blank _4"></span>W</div><div class="t m12 x18 hd y41 ff6 fs8 fc2 sc0 ls19 ws26">Pús<span class="blank _0"> </span>tula: l<span class="blank _0"> </span>esão e<span class="blank _0"> </span>levada qu<span class="blank _0"> </span>e co<span class="blank _0"> </span>ntém p<span class="blank _0"> </span>us em se<span class="blank _0"> </span>u inte<span class="blank _0"> </span>rio<span class="blank _0"> </span>r<span class="blank _9"></span>.</div><div class="t m0 x17 h13 y42 ff5 fs4 fc0 sc0 ls2 ws7"> <span class="blank _4"></span>W</div><div class="t m13 x18 hd y43 ff6 fs8 fc2 sc0 ls23 ws2c">Cro<span class="blank _0"> </span>stas: c<span class="blank _0"> </span>onc<span class="blank _0"> </span>reç<span class="blank _0"> </span>ões q<span class="blank _0"> </span>ue se for<span class="blank _0"> </span>mam e<span class="blank _0"> </span>m áreas d<span class="blank _0"> </span>e </div><div class="t m14 x18 hd y44 ff6 fs8 fc2 sc0 ls24 ws1d">pe<span class="blank _0"> </span>rda tec<span class="blank _0"> </span>idua<span class="blank _0"> </span>l, c<span class="blank _0"> </span>omo ap<span class="blank _0"> </span>ós a ru<span class="blank _0"> </span>ptu<span class="blank _0"> </span>ra de u<span class="blank _0"> </span>ma vesíc<span class="blank _0"> </span>ula.</div><div class="t m0 x19 ha y45 ff6 fs6 fc2 sc0 ls2 ws2f">No passado, alg<span class="blank _0"> </span>umas das doenç<span class="blank _0"> </span>as ex<span class="blank _2"></span>antem<span class="blank _0"> </span>áticas </div><div class="t m15 x19 ha y46 ff6 fs6 fc2 sc0 ls10 wsf">mais comu<span class="blank _0"> </span>ns da infância foram classi\ue61f<span class="blank _0"> </span>cadas de </div><div class="t m16 x19 ha y47 ff6 fs6 fc2 sc0 ls25 wsf">acord<span class="blank _0"> </span>o com a sua or<span class="blank _0"> </span>dem de de<span class="blank _0"> </span>scobr<span class="blank _0"> </span>imento, ou </div><div class="t m0 x19 ha y48 ff6 fs6 fc2 sc0 ls2 ws7">melh<span class="blank _0"> </span>or<span class="blank _9"></span>, d<span class="blank _0"> </span>escriç<span class="blank _0"> </span>ão clínica<span class="blank _0"> </span>, em:</div><div class="t m0 x1a h15 y49 ff5 fs7 fc3 sc0 ls2 ws7"> <span class="blank _6"></span>u</div><div class="t m17 x1b ha y4a ff6 fs6 fc2 sc0 ls11 ws11">Prim<span class="blank _0"> </span>eira doe<span class="blank _0"> </span>nça: saram<span class="blank _0"> </span>po (<span class="blank _2"></span>descr<span class="blank _0"> </span>ita no sé<span class="blank _0"> </span>culo </div><div class="t m0 x1b ha y4b ff6 fs6 fc2 sc0 ls26 ws22">X<span class="blank _1"> </span>V<span class="blank"> </span>I<span class="blank"> </span>I<span class="blank"> </span>).</div><div class="t m0 x1a hc y4c ff5 fs7 fc3 sc0 ls2 ws7"> <span class="blank _6"></span>u<span class="blank _7"> </span><span class="ff6 fs6 fc2 ls1f ws30 v2">Segunda doença: escarlat<span class="blank _2"></span>ina (<span class="blank _9"></span>descrita no sécu<span class="ls2">-</span></span></div><div class="t m0 x1b ha y4d ff6 fs6 fc2 sc0 ls26 ws31">lo<span class="blank _0"> </span> X<span class="blank _1"> </span>V<span class="blank _0"> </span>II<span class="blank _0"> </span>).</div><div class="t m0 x1a hc y4e ff5 fs7 fc3 sc0 ls2 ws7"> <span class="blank _6"></span>u<span class="blank _7"> </span><span class="ff6 fs6 fc2 v2">T<span class="blank _9"></span>erceira d<span class="blank _0"> </span>oenç<span class="blank _0"> </span>a: rubéo<span class="blank _0"> </span>la (<span class="blank _9"></span>desc<span class="blank _0"> </span>rita e<span class="blank _0"> </span>m 1<span class="blank _9"></span>881<span class="blank _9"></span>).</span></div><div class="t m0 x1a h15 y4f ff5 fs7 fc3 sc0 ls2 ws7"> <span class="blank _6"></span>u</div><div class="t m18 x1b ha y50 ff6 fs6 fc2 sc0 ls27 ws1e">Quar<span class="blank _0"> </span>ta d<span class="blank _0"> </span>oenç<span class="blank _0"> </span>a: doença d<span class="blank _0"> </span>e Filatov-D<span class="blank _0"> </span>ukes (<span class="blank _9"></span>desc<span class="blank _0"> </span>rita </div><div class="t m0 x1b ha y51 ff6 fs6 fc2 sc0 ls2 ws32">em 1<span class="blank _9"></span>9<span class="blank _0"> </span>00, atu<span class="blank _0"> </span>almente cha<span class="blank _0"> </span>mada de síndrom<span class="blank _0"> </span>e da </div><div class="t m0 x1b ha y52 ff6 fs6 fc2 sc0 lsd ws13">pele esc<span class="blank _0"> </span>aldada esta\ue61flo<span class="blank _0"> </span>cócica)<span class="blank _2"></span>.</div><div class="t m0 x1a hc y53 ff5 fs7 fc3 sc0 ls2 ws7"> <span class="blank _6"></span>u<span class="blank _7"> </span><span class="ff6 fs6 fc2 ws33 v2">Quinta d<span class="blank _0"> </span>oenç<span class="blank _0"> </span>a: eritema infec<span class="blank _0"> </span>cioso (<span class="blank _9"></span>d<span class="blank _0"> </span>escrit<span class="blank _0"> </span>a em </span></div><div class="t m0 x1b ha y54 ff6 fs6 fc2 sc0 ls28 ws23">19<span class="blank _1"> </span>0<span class="blank"> </span>5<span class="blank _1"> </span>)<span class="blank"> </span>.</div><div class="t m0 x1a h15 y55 ff5 fs7 fc3 sc0 ls2 ws7"> <span class="blank _6"></span>u</div><div class="t m19 x1b ha y56 ff6 fs6 fc2 sc0 ls26 ws34">Sex<span class="blank _0"> </span>ta do<span class="blank _0"> </span>ença: exantema súb<span class="blank _0"> </span>ito (<span class="blank _9"></span>desc<span class="blank _0"> </span>rito em 1<span class="blank _9"></span>91<span class="blank _2"></span>0<span class="blank _2"></span>).</div><div class="t m1a x1c ha y57 ff6 fs6 fc2 sc0 ls29 wsf">Embo<span class="blank _0"> </span>ra essa classi<span class="blank _0"> </span>\ue61fcação se<span class="blank _0"> </span>ja pouco u<span class="blank _0"> </span>tilizada </div><div class="t m1b x1c ha y58 ff6 fs6 fc2 sc0 ls2a ws35">atualme<span class="blank _0"> </span>nte, algu<span class="blank _0"> </span>mas vez<span class="blank _2"></span>es vemos o exantema s<span class="blank _0"> </span>úbito </div><div class="t m1c x1c ha y59 ff6 fs6 fc2 sc0 ls27 ws36">send<span class="blank _0"> </span>o ref<span class="blank _2"></span>eri<span class="blank _0"> </span>do como sex<span class="blank _0"> </span>ta do<span class="blank _0"> </span>ença; p<span class="blank _0"> </span>or isso, é impo<span class="blank _0"> </span>r<span class="blank _9"></span><span class="ls2">-</span></div><div class="t m0 x1c ha y5a ff6 fs6 fc2 sc0 ls2 ws2f">tante enten<span class="blank _0"> </span>der de on<span class="blank _0"> </span>de surgiu essa n<span class="blank _0"> </span>omen<span class="blank _0"> </span>clatura.</div><div class="t m0 x1d h12 y5b ff4 fs9 fc1 sc0 ls1c ws7"> <span class="blank _e"> </span> <span class="blank _e"> </span>DI<span class="blank _0"> </span>A A DI<span class="blank _0"> </span>A MÉD<span class="blank _0"> </span>ICO</div><div class="t m1d x1e hd y5c ff6 fs8 fc2 sc0 ls1d ws37">Mo<span class="blank _0"> </span>men<span class="blank _0"> </span>to cur<span class="blank _0"> </span>iosid<span class="blank _0"> </span>ade da tia N<span class="blank _0"> </span>ath: a do<span class="blank _0"> </span>enç<span class="blank _0"> </span>a de Fi<span class="blank _0"> </span>lato<span class="blank _0"> </span><span class="ls2">-</span></div><div class="t m1e x1e hd y5d ff6 fs8 fc2 sc0 ls2b ws37">v-<span class="blank _0"> </span>Du<span class="blank _0"> </span>kes foi desc<span class="blank _0"> </span>rit<span class="blank _0"> </span>a em 1<span class="blank _2"></span>90<span class="blank _0"> </span>0 co<span class="blank _0"> </span>mo o que p<span class="blank _0"> </span>arec<span class="blank _0"> </span>ia ser </div><div class="t m0 x1e hd y5e ff6 fs8 fc2 sc0 ls2 ws37">uma fo<span class="blank _0"> </span>rma es<span class="blank _0"> </span>car<span class="blank _0"> </span>latini<span class="blank _0"> </span>forme d<span class="blank _0"> </span>a rub<span class="blank _0"> </span>éol<span class="blank _0"> </span>a, já qu<span class="blank _0"> </span>e, e<span class="blank _0"> </span>m vez </div><div class="t m1f x1e hd y5f ff6 fs8 fc2 sc0 ls2c ws37">de in<span class="blank _0"> </span>iciar c<span class="blank _0"> </span>omo u<span class="blank _0"> </span>m exante<span class="blank _0"> </span>ma mac<span class="blank _0"> </span>ulopa<span class="blank _0"> </span>pula<span class="blank _0"> </span>r na face </div><div class="t m0 x1e hd y60 ff6 fs8 fc2 sc0 ls2 ws38">co<span class="blank _0"> </span>m prog<span class="blank _0"> </span>ressã<span class="blank _0"> </span>o cra<span class="blank _0"> </span>nioc<span class="blank _0"> </span>auda<span class="blank _0"> </span>l (<span class="blank _2"></span>co<span class="blank _0"> </span>mo é car<span class="blank _0"> </span>ac<span class="blank _0"> </span>terís<span class="blank _0"> </span>tico da </div><div class="t m0 x1e hd y61 ff6 fs8 fc2 sc0 ls2 ws39">ru<span class="blank _0"> </span>béo<span class="blank _0"> </span>la<span class="blank _2"></span>), c<span class="blank _0"> </span>ome<span class="blank _0"> </span>çava co<span class="blank _0"> </span>mo um e<span class="blank _0"> </span>rite<span class="blank _0"> </span>ma he<span class="blank _0"> </span>tero<span class="blank _0"> </span>gên<span class="blank _0"> </span>eo em </div><div class="t m20 x1e hd y62 ff6 fs8 fc2 sc0 ls2d ws37">todo o c<span class="blank _0"> </span>orp<span class="blank _0"> </span>o, co<span class="blank _0"> </span>mo se foss<span class="blank _0"> </span>e uma es<span class="blank _0"> </span>carl<span class="blank _0"> </span>atina<span class="blank _0"> </span>. Dur<span class="blank _0"> </span>ante </div><div class="t m0 x1e hd y63 ff6 fs8 fc2 sc0 ls2 ws3a">mui<span class="blank _0"> </span>to temp<span class="blank _0"> </span>o apó<span class="blank _0"> </span>s sua de<span class="blank _0"> </span>scri<span class="blank _0"> </span>ção, n<span class="blank _0"> </span>ada mais foi m<span class="blank _0"> </span>en<span class="blank _0"> </span>cio<span class="blank _0"> </span>-</div><div class="t m0 x1e hd y64 ff6 fs8 fc2 sc0 ls2 ws3b">nado s<span class="blank _0"> </span>obre e<span class="blank _0"> </span>ssa do<span class="blank _0"> </span>enç<span class="blank _0"> </span>a, q<span class="blank _0"> </span>ue li<span class="blank _0"> </span>teral<span class="blank _0"> </span>men<span class="blank _0"> </span>te desa<span class="blank _0"> </span>pare<span class="blank _0"> </span>ceu </div><div class="t m0 x1e hd y65 ff6 fs8 fc2 sc0 ls2 ws3c">dos li<span class="blank _0"> </span>vros d<span class="blank _0"> </span>e med<span class="blank _0"> </span>icin<span class="blank _0"> </span>a da ép<span class="blank _0"> </span>oca<span class="blank _0"> </span>. Ap<span class="blank _0"> </span>enas e<span class="blank _0"> </span>m 1<span class="blank _9"></span>979 Kei<span class="blank _0"> </span>th </div><div class="t m21 x1e hd y66 ff6 fs8 fc2 sc0 ls2e ws3d">Powell descreveu uma doença exantemática causada </div><div class="t m0 x1e hd y67 ff6 fs8 fc2 sc0 ls2 ws3e">po<span class="blank _0"> </span>r exotoxinas ep<span class="blank _0"> </span>ide<span class="blank _0"> </span>rmo<span class="blank _0"> </span>lític<span class="blank _0"> </span>as do <span class="ff7">S<span class="blank _0"> </span>. aur<span class="blank _0"> </span>eus</span>, à q<span class="blank _0"> </span>ual de<span class="blank _0"> </span>u </div><div class="t m22 x1e hd y68 ff6 fs8 fc2 sc0 ls2 ws27">o nom<span class="blank _0"> </span>e de sí<span class="blank _0"> </span>ndro<span class="blank _0"> </span>me da p<span class="blank _0"> </span>ele es<span class="blank _0"> </span>cal<span class="blank _0"> </span>dada es<span class="blank _0"> </span>ta\ue61f<span class="blank _0"> </span>loc<span class="blank _0"> </span>óci<span class="blank _0"> </span>ca<span class="blank _0"> </span>, </div><div class="t m0 x1e hd y69 ff6 fs8 fc2 sc0 ls2 ws3f">pos<span class="blank _0"> </span>teri<span class="blank _0"> </span>orm<span class="blank _0"> </span>en<span class="blank _0"> </span>te iden<span class="blank _0"> </span>ti\ue61f<span class="blank _0"> </span>cada c<span class="blank _0"> </span>omo a q<span class="blank _0"> </span>uar<span class="blank _0"> </span>ta d<span class="blank _0"> </span>oen<span class="blank _0"> </span>ça<span class="blank _0"> </span>, des<span class="blank _0"> </span>-</div><div class="t m0 x1e hd y6a ff6 fs8 fc2 sc0 ls2 ws7">cr<span class="blank _0"> </span>ita e<span class="blank _0"> </span>m 1<span class="blank _9"></span>9<span class="blank _0"> </span>00 p<span class="blank _0"> </span>or Du<span class="blank _0"> </span>kes.</div><div class="t m0 x1a h9 y6b ff3 fs0 fc0 sc0 ls6 wsc">2<span class="blank _0"> </span>. <span class="ws40"> SA<span class="blank _0"> </span>R<span class="blank _0"> </span>A<span class="blank _0"> </span>MP<span class="blank _0"> </span>O</span></div><div class="t m0 x1c h6 y6c ff2 fs3 fc0 sc0 ls2f ws41">2<span class="blank _1"> </span>.1<span class="blank _1"> </span>.<span class="blank _0"> </span> <span class="ls30 ws42"> EPIDEMIOLOGIA</span></div><div class="t m23 x1c ha y6d ff6 fs6 fc2 sc0 ls10 ws36">O saramp<span class="blank _0"> </span>o é uma doen<span class="blank _0"> </span>ça infecciosa exantemática </div><div class="t m24 x1c ha y6e ff6 fs6 fc2 sc0 ls31 wse">aguda<span class="blank _0"> </span>, transmissível e ex<span class="blank _0"> </span>trem<span class="blank _0"> </span>amente co<span class="blank _0"> </span>ntagiosa<span class="blank _0"> </span>, </div><div class="t m25 x1c ha y6f ff6 fs6 fc2 sc0 ls25 ws36">pode<span class="blank _0"> </span>ndo evoluir com c<span class="blank _0"> </span>omplicaç<span class="blank _0"> </span>ões e óbi<span class="blank _0"> </span>tos, prin<span class="blank _0"> </span><span class="ls2">-</span></div><div class="t m0 x1c ha y70 ff6 fs6 fc2 sc0 ls25 ws43">cipalme<span class="blank _0"> </span>nte em desn<span class="blank _0"> </span>utridos e me<span class="blank _0"> </span>nores de 1 an<span class="blank _0"> </span>o.<span class="blank _2"></span> </div><div class="t m0 x11 h10 y2a ffa fsa fc4 sc1 ls2 ws7">Ano_1_Pediatria-2.indb 82<span class="blank _a"></span><span class="fc5 sc0">Ano_1_Pediatria-2.indb 82<span class="blank _b"> </span><span class="fc4 sc1">03/11/2021 12:45:45<span class="blank _c"></span><span class="fc5 sc0">03/11/2021 12:45:45</span></span></span></div></div><div class="pi" data-data="{"ctm":[1.000000,0.000000,0.000000,1.000000,0.000000,0.000000]}"></div></div> <div id="pf3" class="pf w0 h0" data-page-no="3"><div class="pc pc3 w0 h0"><img fetchpriority="low" loading="lazy" class="bi x0 y0 w1 h1" alt="" src="https://files.passeidireto.com/cb6739bf-1d15-4a05-9b9e-791388b639c2/bg3.png"><div class="t m0 x1f h16 y2b ff2 fs8 fc0 sc0 ls33 ws7">Doenças ex<span class="blank _2"></span>antemáticas<span class="blank _10"> </span><span class="fs9 fc1 ls18">Cap. 4</span></div><div class="t m0 x1 h2 y1 ff1 fs0 fc0 sc0 ls34">83</div><div class="t m26 x9 ha y4a ff6 fs6 fc2 sc0 ls12 ws48">Era uma doença endêmica<span class="blank _2"></span> mundial, com incidênci<span class="blank _2"></span>a </div><div class="t m27 x9 ha y4b ff6 fs6 fc2 sc0 ls29 wsf">quase universal na i<span class="blank _0"> </span>nfância, até a introdu<span class="blank _0"> </span>ção da </div><div class="t m28 x9 ha y71 ff6 fs6 fc2 sc0 ls35 wsf">vacina do saram<span class="blank _0"> </span>po. Nos Estad<span class="blank _0"> </span>os Unidos<span class="blank _0"> </span>, com a </div><div class="t m29 x9 ha y72 ff6 fs6 fc2 sc0 ls12 ws36">introdu<span class="blank _0"> </span>ção da vacina em 1<span class="blank _9"></span>96<span class="blank _0"> </span>3, a ta<span class="blank _0"> </span>xa de ataque do </div><div class="t m0 x9 ha y73 ff6 fs6 fc2 sc0 ls25 ws49">saramp<span class="blank _0"> </span>o caiu de 31<span class="blank _9"></span>3 casos/1<span class="blank _9"></span>0<span class="blank _0"> </span>0 0<span class="blank _0"> </span>00 pe<span class="blank _0"> </span>ssoas de </div><div class="t m0 x9 ha y74 ff6 fs6 fc2 sc0 ls25 ws4a">1<span class="blank _9"></span>956 a 1<span class="blank _9"></span>960 par<span class="blank _0"> </span>a 1<span class="blank _9"></span>,<span class="blank _0"> </span>3 casos/1<span class="blank _9"></span>0<span class="blank _0"> </span>0 0<span class="blank _0"> </span>00 pe<span class="blank _0"> </span>ssoas de </div><div class="t m0 x9 ha y75 ff6 fs6 fc2 sc0 ls25 ws4b">1<span class="blank _9"></span>982 a 1<span class="blank _9"></span>98<span class="blank _0"> </span>8. Em todo o mundo s<span class="blank _0"> </span>urgem su<span class="blank _0"> </span>r<span class="blank _0"> </span>tos de </div><div class="t m2a x9 ha y76 ff6 fs6 fc2 sc0 lsb ws36">saramp<span class="blank _0"> </span>o devido à falha de vacinaç<span class="blank _0"> </span>ão em pe<span class="blank _0"> </span>quenos </div><div class="t m0 x9 ha y77 ff6 fs6 fc2 sc0 ls36 ws4c">grupos de cria<span class="blank _2"></span>nças, decorrente do<span class="blank _2"></span>s movi<span class="blank _2"></span>mentos<span class="blank _2"></span> </div><div class="t m2b x9 ha y78 ff6 fs6 fc2 sc0 ls37 ws36">antivacina. N<span class="blank _0"> </span>o Brasil, de<span class="blank _0"> </span>sde 2001 não existiam mais </div><div class="t m0 x9 ha y79 ff6 fs6 fc2 sc0 ls25 ws1d">casos autóc<span class="blank _0"> </span>tones de saram<span class="blank _0"> </span>po. Entre 201<span class="blank _9"></span>3 e 201<span class="blank _9"></span>5, </div><div class="t m0 x9 ha y7a ff6 fs6 fc2 sc0 ls25 ws13">oco<span class="blank _0"> </span>rreram su<span class="blank _0"> </span>r<span class="blank _0"> </span>tos decor<span class="blank _0"> </span>rentes de pes<span class="blank _0"> </span>soas vindas </div><div class="t m2c x9 ha y7b ff6 fs6 fc2 sc0 ls12 ws36">de outros países<span class="blank _0"> </span>, sendo re<span class="blank _0"> </span>gistrados 1<span class="blank _9"></span>31<span class="blank _2"></span>0 casos de </div><div class="t m1b x9 ha y7c ff6 fs6 fc2 sc0 ls38 ws4d">doe<span class="blank _0"> </span>nça, p<span class="blank _0"> </span>rincipal<span class="blank _0"> </span>mente em Pe<span class="blank _0"> </span>rnamb<span class="blank _0"> </span>uco e no C<span class="blank _0"> </span>eará. </div><div class="t m0 x9 ha y7d ff6 fs6 fc2 sc0 ls25 ws4e">Nessa é<span class="blank _0"> </span>poca<span class="blank _0"> </span>, foram tomadas diversas açõ<span class="blank _0"> </span>es de </div><div class="t m2d x9 ha y7e ff6 fs6 fc2 sc0 ls31 ws36">bloqu<span class="blank _0"> </span>eio pelo Mi<span class="blank _0"> </span>nistério da Saú<span class="blank _0"> </span>de, inter<span class="blank _0"> </span>rompe<span class="blank _0"> </span>ndo </div><div class="t m2e x9 ha y7f ff6 fs6 fc2 sc0 ls11 wse">a transmissão da d<span class="blank _0"> </span>oença<span class="blank _0"> </span>, de forma qu<span class="blank _0"> </span>e já em 201<span class="blank _9"></span>6 </div><div class="t m0 x9 ha y80 ff6 fs6 fc2 sc0 ls25 ws4f">o Brasil foi consid<span class="blank _0"> </span>erado novamen<span class="blank _0"> </span>te um país livre </div><div class="t m0 x9 ha y81 ff6 fs6 fc2 sc0 ls25 ws50">do saram<span class="blank _0"> </span>po pela O<span class="blank _0"> </span>rganização Pan<span class="blank _0"> </span>-Am<span class="blank _0"> </span>ericana d<span class="blank _0"> </span>e </div><div class="t m2f x9 ha y82 ff6 fs6 fc2 sc0 lsf wsf">Saúda (OP<span class="blank _9"></span>A<span class="blank _0"> </span>S<span class="blank _2"></span>). <span class="ff8 ws11">Em 201<span class="blank _9"></span>7<span class="blank _11"></span>, foram c<span class="blank _0"> </span>on\ue61fr<span class="blank _0"> </span>mados os </span></div><div class="t m30 x9 hb y83 ff8 fs6 fc2 sc0 ls39 ws51">primeiros casos<span class="blank _2"></span> de sarampo em venezuelanos<span class="blank _9"></span> </div><div class="t m0 x9 ha y84 ff8 fs6 fc2 sc0 ls3a ws52">que entraram no<span class="blank _2"></span> Brasil pelo<span class="blank _2"></span> estado de Rora<span class="blank _2"></span>ima<span class="ff6 ls2 ws7">, </span></div><div class="t m0 x9 ha y85 ff6 fs6 fc2 sc0 ls25 ws53">ocasiona<span class="blank _0"> </span>ndo um sur<span class="blank _0"> </span>to de do<span class="blank _0"> </span>ença n<span class="blank _0"> </span>o estado, qu<span class="blank _0"> </span>e </div><div class="t m31 x9 ha y86 ff6 fs6 fc2 sc0 ls3a wsf">poster<span class="blank _0"> </span>iorme<span class="blank _0"> </span>nte se ampliou par<span class="blank _0"> </span>a o Amazonas e </div><div class="t m0 x9 ha y87 ff6 fs6 fc2 sc0 ls25 ws54">outros es<span class="blank _0"> </span>tados brasile<span class="blank _0"> </span>iros. Na maioria dos c<span class="blank _0"> </span>asos, </div><div class="t m0 x9 ha y88 ff6 fs6 fc2 sc0 ls25 ws55">o gen<span class="blank _0"> </span>ótipo identi<span class="blank _0"> </span>\ue61fcado foi o D8<span class="blank _0"> </span>, idêntico ao q<span class="blank _0"> </span>ue </div><div class="t m0 x9 ha y89 ff6 fs6 fc2 sc0 ls25 ws56">estava em circ<span class="blank _0"> </span>ulação na V<span class="blank _2"></span>ene<span class="blank _0"> </span>zuela. <span class="ff8 ws57">No in<span class="blank _0"> </span>ício de </span></div><div class="t m32 x9 hb y8a ff8 fs6 fc2 sc0 ls36 ws11">201<span class="blank _11"></span>9, após a c<span class="blank _0"> </span>hegad<span class="blank _0"> </span>a de um navio cr<span class="blank _0"> </span>uzeiro ao </div><div class="t m0 x9 hb y8b ff8 fs6 fc2 sc0 ls25 ws58">por<span class="blank _0"> </span>to de S<span class="blank _0"> </span>antos com d<span class="blank _0"> </span>iversos passa<span class="blank _0"> </span>geiros c<span class="blank _0"> </span>om </div><div class="t m33 x9 hb y8c ff8 fs6 fc2 sc0 ls2 ws59">sarampo, apesar de<span class="blank _2"></span> instaladas medidas de controle </div><div class="t m0 x9 hb y8d ff8 fs6 fc2 sc0 ls25 ws5a">pela v<span class="blank _0"> </span>igilância sa<span class="blank _0"> </span>nitária<span class="blank _0"> </span>, os casos d<span class="blank _0"> </span>e saramp<span class="blank _0"> </span>o se </div><div class="t m0 x9 ha y8e ff8 fs6 fc2 sc0 lsf ws5b">instalaram no Sudeste do paí<span class="blank _2"></span>s<span class="ff6 ls25 ws5c">. A\ue60f<span class="blank _2"></span>maior par<span class="blank _0"> </span>te dos </span></div><div class="t m0 x9 ha y8f ff6 fs6 fc2 sc0 ls25 ws2b">casos oco<span class="blank _0"> </span>rreu e<span class="blank _0"> </span>m pessoas não vacinadas, o qu<span class="blank _0"> </span>e </div><div class="t m34 x9 ha y90 ff6 fs6 fc2 sc0 ls3b wsf">se cor<span class="blank _0"> </span>relaciona co<span class="blank _0"> </span>m a cobe<span class="blank _0"> </span>r<span class="blank _0"> </span>tura vacinal abaixo </div><div class="t m0 x9 ha y91 ff6 fs6 fc2 sc0 ls25 ws5d">da desejada<span class="blank _0"> </span>, ou seja<span class="blank _0"> </span>, inferior a 95% da popu<span class="blank _0"> </span>lação, </div><div class="t m35 x9 ha y92 ff6 fs6 fc2 sc0 ls3c ws36">com de<span class="blank _0"> </span>staque par<span class="blank _0"> </span>a a falha na realização da 2ª dose </div><div class="t m0 x9 ha y93 ff6 fs6 fc2 sc0 ls25 ws57">da vacina aos 1<span class="blank _9"></span>5 meses de v<span class="blank _0"> </span>ida (<span class="blank _9"></span>sob a for<span class="blank _0"> </span>ma da </div><div class="t m36 x9 ha y94 ff6 fs6 fc2 sc0 ls11 ws36">tetraviral). Os dados de 201<span class="blank _9"></span>7 apo<span class="blank _0"> </span>ntam que a c<span class="blank _0"> </span>ober<span class="ls2">-</span></div><div class="t m0 x9 ha y95 ff6 fs6 fc2 sc0 ls25 ws5e">tura da vacina tríp<span class="blank _0"> </span>lice viral no B<span class="blank _0"> </span>rasil foi de 84<span class="blank _0"> </span>,<span class="blank _2"></span>9% </div><div class="t m0 x9 ha y96 ff6 fs6 fc2 sc0 ls25 ws54">para a 1<span class="blank _9"></span>ª dose e d<span class="blank _0"> </span>e 71<span class="blank _9"></span>,5<span class="blank _0"> </span>% para a 2ª dose. <span class="ff8 ls2 ws5a">As<span class="blank _0"> </span> du<span class="blank _0"> </span>as </span></div><div class="t m37 x9 hb y97 ff8 fs6 fc2 sc0 ls1f ws36">prin<span class="blank _0"> </span>cipais faixas etá<span class="blank _0"> </span>rias acome<span class="blank _0"> </span>tidas nesse úl<span class="blank _0"> </span>timo </div><div class="t m0 x9 hb y98 ff8 fs6 fc2 sc0 ls25 ws5f">sur<span class="blank _0"> </span>to fora<span class="blank _0"> </span>m a dos 20 aos 29 anos e das c<span class="blank _0"> </span>rianç<span class="blank _0"> </span>as </div><div class="t m0 x9 hb y99 ff8 fs6 fc2 sc0 ls25 ws7">men<span class="blank _0"> </span>ores de 1 an<span class="blank _0"> </span>o<span class="blank _2"></span>.</div><div class="t m0 x20 h12 y9a ff4 fs9 fc1 sc0 ls1c ws7"> <span class="blank _e"> </span> <span class="blank _e"> </span>DI<span class="blank _0"> </span>A A DI<span class="blank _0"> </span>A MÉD<span class="blank _0"> </span>ICO</div><div class="t m38 x21 hd y9b ff6 fs8 fc2 sc0 ls3d ws26">Várias me<span class="blank _0"> </span>didas d<span class="blank _0"> </span>e co<span class="blank _0"> </span>ntrol<span class="blank _0"> </span>e foram to<span class="blank _0"> </span>madas p<span class="blank _0"> </span>ela vi<span class="blank _0"> </span>gilân<span class="blank _0"> </span>cia </div><div class="t m39 x21 hd y9c ff6 fs8 fc2 sc0 ls3e ws1d">ep<span class="blank _0"> </span>ide<span class="blank _0"> </span>mioló<span class="blank _0"> </span>gic<span class="blank _0"> </span>a com o o<span class="blank _0"> </span>bje<span class="blank _0"> </span>tivo de co<span class="blank _0"> </span>nter o s<span class="blank _0"> </span>ur<span class="blank _0"> </span>to atu<span class="blank _0"> </span>al de </div><div class="t m3a x21 hd y9d ff6 fs8 fc2 sc0 ls3f ws26">sar<span class="blank _0"> </span>amp<span class="blank _0"> </span>o no país; d<span class="blank _0"> </span>ent<span class="blank _0"> </span>re elas<span class="blank _0"> </span>, po<span class="blank _0"> </span>dem<span class="blank _0"> </span>os ci<span class="blank _0"> </span>tar<span class="blank _0"> </span>: vacin<span class="blank _0"> </span>ação d<span class="blank _0"> </span>e </div><div class="t m3b x21 hd y9e ff6 fs8 fc2 sc0 ls3d ws26">blo<span class="blank _0"> </span>que<span class="blank _0"> </span>io em p<span class="blank _0"> </span>rédi<span class="blank _0"> </span>os resi<span class="blank _0"> </span>den<span class="blank _0"> </span>ciais e c<span class="blank _0"> </span>ome<span class="blank _0"> </span>rcia<span class="blank _0"> </span>is com c<span class="blank _0"> </span>asos </div><div class="t m3c x21 hd y9f ff6 fs8 fc2 sc0 ls20 ws26">da do<span class="blank _0"> </span>enç<span class="blank _0"> </span>a, vac<span class="blank _0"> </span>inaç<span class="blank _0"> </span>ão dos jove<span class="blank _0"> </span>ns adul<span class="blank _0"> </span>tos em e<span class="blank _0"> </span>staç<span class="blank _0"> </span>ões d<span class="blank _0"> </span>e </div><div class="t m0 x21 hd ya0 ff6 fs8 fc2 sc0 ls2 ws60">me<span class="blank _0"> </span>trô, ôn<span class="blank _0"> </span>ibus e e<span class="blank _0"> </span>sco<span class="blank _0"> </span>las e a ins<span class="blank _0"> </span>titui<span class="blank _0"> </span>ção da \u201cdos<span class="blank _0"> </span>e zero\u201d da </div><div class="t m0 x21 hd ya1 ff6 fs8 fc2 sc0 ls2 ws7">vaci<span class="blank _0"> </span>na tríp<span class="blank _0"> </span>lice v<span class="blank _0"> </span>iral<span class="blank _0"> </span>, apli<span class="blank _0"> </span>cada e<span class="blank _0"> </span>ntre 6 e 12 meses d<span class="blank _0"> </span>e vida<span class="blank _0"> </span>, </div><div class="t m0 x21 hd ya2 ff6 fs8 fc2 sc0 ls2 ws61">par<span class="blank _0"> </span>a prote<span class="blank _0"> </span>ção da fai<span class="blank _0"> </span>xa etár<span class="blank _0"> </span>ia de mai<span class="blank _0"> </span>or mo<span class="blank _0"> </span>r<span class="blank _0"> </span>tali<span class="blank _0"> </span>dade p<span class="blank _0"> </span>ela </div><div class="t m0 x21 hd ya3 ff6 fs8 fc2 sc0 ls2 ws62">doe<span class="blank _0"> </span>nç<span class="blank _0"> </span>a. Note qu<span class="blank _0"> </span>e essa d<span class="blank _0"> </span>ose ze<span class="blank _0"> </span>ro é uma do<span class="blank _0"> </span>se adic<span class="blank _0"> </span>iona<span class="blank _0"> </span>l </div><div class="t m0 x21 hd ya4 ff6 fs8 fc2 sc0 ls2 ws63">ao esq<span class="blank _0"> </span>uem<span class="blank _0"> </span>a vacin<span class="blank _0"> </span>al pro<span class="blank _0"> </span>pos<span class="blank _0"> </span>to para o sa<span class="blank _0"> </span>ramp<span class="blank _0"> </span>o, rea<span class="blank _0"> </span>lizado </div><div class="t m0 x21 hd ya5 ff6 fs8 fc2 sc0 ls2 ws7">aos 1<span class="blank _2"></span>2 e 1<span class="blank _9"></span>5 m<span class="blank _0"> </span>eses d<span class="blank _0"> </span>e vida<span class="blank _0"> </span>.</div><div class="t m0 x22 h6 ya6 ff2 fs3 fc0 sc0 ls32 ws64">2.2.<span class="blank _2"></span> <span class="ls30 ws65"> <span class="blank _12"></span>ETIOL<span class="blank _2"></span>OGIA E P<span class="blank _9"></span>A<span class="blank _11"></span>TOGÊNESE</span></div><div class="t m0 x22 ha ya7 ff6 fs6 fc2 sc0 ls2 ws66">O saramp<span class="blank _0"> </span>o é causado po<span class="blank _0"> </span>r um vírus de R<span class="blank _0"> </span>NA de \ue61f<span class="blank _0"> </span>ta </div><div class="t m3d x22 ha ya8 ff6 fs6 fc2 sc0 ls2 ws36">única<span class="blank _0"> </span>, da famí<span class="blank _0"> </span>lia <span class="ff7 ls10 ws44">Paramyxov<span class="blank _2"></span>iridae<span class="ff6 ls2 ws36"> e do gê<span class="blank _0"> </span>nero </span><span class="ls31 ws45">Mor<span class="ls2">-</span></span></span></div><div class="t m3e x22 ha ya9 ff7 fs6 fc2 sc0 ls8 ws46">billivirus<span class="ff6 ls40 ws67">, sendo os human<span class="blank _0"> </span>os os únicos hospe<span class="blank _0"> </span>deiros. </span></div><div class="t m3f x22 ha yaa ff6 fs6 fc2 sc0 ls37 ws36">É\ue60f<span class="blank _9"></span>mais co<span class="blank _0"> </span>mum no verão e na pr<span class="blank _0"> </span>imav<span class="blank _2"></span>era e é tr<span class="blank _0"> </span>ansmi<span class="ls2">-</span></div><div class="t m0 x22 ha yab ff6 fs6 fc2 sc0 ls2 ws68">tido por ae<span class="blank _0"> </span>rossóis. O\ue60f<span class="blank _2"></span>vírus po<span class="blank _0"> </span>de per<span class="blank _0"> </span>manec<span class="blank _0"> </span>er viável </div><div class="t m0 x22 ha yac ff6 fs6 fc2 sc0 ls2 ws58">suspe<span class="blank _0"> </span>nso no ar por até 1 ho<span class="blank _0"> </span>ra após o caso fonte </div><div class="t m40 x22 ha yad ff6 fs6 fc2 sc0 ls41 wse">deixar o amb<span class="blank _0"> </span>iente. <span class="ff8 ws36">Os pacie<span class="blank _0"> </span>ntes tra<span class="blank _0"> </span>nsmite<span class="blank _0"> </span>m o vírus </span></div><div class="t m0 x22 hb yae ff8 fs6 fc2 sc0 ls2 ws69">a par<span class="blank _0"> </span>tir de 7 dias a<span class="blank _0"> </span>pós a exposi<span class="blank _0"> </span>ção (<span class="blank _2"></span>3 dias an<span class="blank _0"> </span>tes </div><div class="t m0 x22 hb yaf ff8 fs6 fc2 sc0 ls2 ws6a">do sur<span class="blank _0"> </span>gimen<span class="blank _0"> </span>to do exantema) até 4 a 6 dias após o </div><div class="t m0 x22 hb yb0 ff8 fs6 fc2 sc0 ls2 ws6b">início da e<span class="blank _0"> </span>rup<span class="blank _0"> </span>ção, send<span class="blank _0"> </span>o o pico de tr<span class="blank _0"> </span>ansmiss<span class="blank _0"> </span>ão de </div><div class="t m0 x22 ha yb1 ff8 fs6 fc2 sc0 ls2 ws55">2 dias antes a 2 d<span class="blank _0"> </span>ias após o início d<span class="blank _0"> </span>o exantema<span class="ff6 ws7">. </span></div><div class="t m41 x22 ha yb2 ff6 fs6 fc2 sc0 ls8 ws36">A\ue60f<span class="blank _9"></span>ta<span class="blank _0"> </span>xa de ataque do saram<span class="blank _0"> </span>po é elevadíssima: cerca<span class="blank _0"> </span> </div><div class="t m42 x22 ha yb3 ff6 fs6 fc2 sc0 ls8 wse">de 90<span class="blank _0"> </span>% dos indivídu<span class="blank _0"> </span>os suscetíveis expo<span class="blank _0"> </span>stos desen<span class="blank _0"> </span><span class="ls2">-</span></div><div class="t m0 x22 ha yb4 ff6 fs6 fc2 sc0 ls1f ws4b">volv<span class="blank _9"></span>e<span class="blank _0"> </span>m a doença.</div><div class="t m43 x22 ha yb5 ff6 fs6 fc2 sc0 ls38 ws36">O quadro clínic<span class="blank _0"> </span>o do sarampo é c<span class="blank _0"> </span>ompos<span class="blank _0"> </span>to por quatro </div><div class="t m0 x22 ha yb6 ff6 fs6 fc2 sc0 ls2 ws6c">fases: período d<span class="blank _0"> </span>e incubaç<span class="blank _0"> </span>ão, doenç<span class="blank _0"> </span>a prodrômi<span class="blank _0"> </span>ca, </div><div class="t m44 x22 ha yb7 ff6 fs6 fc2 sc0 ls42 ws36">fase exantemática e recu<span class="blank _0"> </span>peraç<span class="blank _0"> </span>ão. Durante o pe<span class="blank _0"> </span>ríodo </div><div class="t m45 x22 ha yb8 ff6 fs6 fc2 sc0 ls2e ws6d">de inc<span class="blank _0"> </span>ubação, o vír<span class="blank _0"> </span>us migra para os linfono<span class="blank _0"> </span>dos </div><div class="t m46 x22 ha yb9 ff6 fs6 fc2 sc0 ls10 wsf">regionais<span class="blank _0"> </span>, onde oc<span class="blank _0"> </span>orre uma vi<span class="blank _0"> </span>remia primár<span class="blank _0"> </span>ia que </div><div class="t m47 x22 ha yba ff6 fs6 fc2 sc0 ls37 ws36">dissemina o v<span class="blank _0"> </span>írus para o sistema re<span class="blank _0"> </span>ticuloen<span class="blank _0"> </span>dotelial. </div><div class="t m48 x22 ha ybb ff6 fs6 fc2 sc0 ls9 wsf">Uma se<span class="blank _0"> </span>gunda vi<span class="blank _0"> </span>remia dissemin<span class="blank _0"> </span>a o vírus para as </div><div class="t m49 x22 ha ybc ff6 fs6 fc2 sc0 ls2 ws6e">superfícies<span class="blank _2"></span> do corpo.<span class="blank _2"></span> A\ue60f<span class="blank _9"></span>doença prodr<span class="blank _2"></span>ômica começa </div><div class="t m4a x22 ha ybd ff6 fs6 fc2 sc0 ls37 ws36">após a seg<span class="blank _0"> </span>unda viremia e es<span class="blank _0"> </span>tá associada à ne<span class="blank _0"> </span>crose </div><div class="t m4b x22 ha ybe ff6 fs6 fc2 sc0 ls43 ws36">epi<span class="blank _0"> </span>telial e à f<span class="blank _2"></span>or<span class="blank _0"> </span>mação de cé<span class="blank _0"> </span>lulas gigantes nos tec<span class="blank _0"> </span>idos </div><div class="t m3f x22 ha ybf ff6 fs6 fc2 sc0 ls37 ws36">cor<span class="blank _0"> </span>porais, in<span class="blank _0"> </span>iciando a excreção vir<span class="blank _0"> </span>al. Duran<span class="blank _0"> </span>te a f<span class="blank _2"></span>ase </div><div class="t m4c x22 ha yc0 ff6 fs6 fc2 sc0 lsd wsf">do exantema, c<span class="blank _0"> </span>omeç<span class="blank _0"> </span>a a produção d<span class="blank _0"> </span>e anticorp<span class="blank _0"> </span>os, </div><div class="t m0 x22 ha yc1 ff6 fs6 fc2 sc0 ls2 ws6f">reduzindo a re<span class="blank _0"> </span>plicação vi<span class="blank _0"> </span>ral e os sintomas. O\ue60fvírus </div><div class="t m3 x22 ha yc2 ff6 fs6 fc2 sc0 ls36 ws70">do saram<span class="blank _0"> </span>po tamb<span class="blank _0"> </span>ém infecta as c<span class="blank _0"> </span>élulas T CD<span class="blank _0"> </span>4, </div><div class="t m0 x22 ha yc3 ff6 fs6 fc2 sc0 ls2 ws7">resulta<span class="blank _0"> </span>ndo na supressão da re<span class="blank _0"> </span>sposta im<span class="blank _0"> </span>une Th<span class="blank _2"></span>1<span class="blank _9"></span>.</div><div class="t m0 x11 h10 y2a ffa fsa fc4 sc1 ls2 ws7">Ano_1_Pediatria-2.indb 83<span class="blank _a"></span><span class="fc5 sc0">Ano_1_Pediatria-2.indb 83<span class="blank _b"> </span><span class="fc4 sc1">03/11/2021 12:45:45<span class="blank _c"></span><span class="fc5 sc0">03/11/2021 12:45:45</span></span></span></div></div><div class="pi" data-data="{"ctm":[1.000000,0.000000,0.000000,1.000000,0.000000,0.000000]}"></div></div> <div id="pf4" class="pf w0 h0" data-page-no="4"><div class="pc pc4 w0 h0"><img fetchpriority="low" loading="lazy" class="bi x0 y0 w1 h1" alt="" src="https://files.passeidireto.com/cb6739bf-1d15-4a05-9b9e-791388b639c2/bg4.png"><div class="t m0 x12 h11 y2b ff4 fs9 fc1 sc0 ls18 ws7">Doenças ex<span class="blank _2"></span>antemáticas<span class="blank _d"> </span><span class="ff2 fs8 fc0 ls19 v0">Urgências pediátricas</span></div><div class="t m0 x13 h2 y1 ff1 fs0 fc0 sc0 ls23">84</div><div class="t m0 x19 h6 yc4 ff2 fs3 fc0 sc0 ls2 ws7">2<span class="blank _0"> </span>.3<span class="blank _0"> </span>. <span class="ls44 ws74"> QU<span class="blank _2"></span>ADRO <span class="blank _13"> </span>CLÍNICO</span></div><div class="t m0 x9 h12 yc5 ff4 fs9 fc1 sc0 ls1c ws7"> <span class="blank _e"> </span> <span class="blank _e"> </span>BA<span class="blank _0"> </span>SES DA ME<span class="blank _0"> </span>DIC<span class="blank _0"> </span>INA</div><div class="t m0 x15 hd yc6 ff6 fs8 fc2 sc0 ls2 ws75">A febr<span class="blank _0"> </span>e é a elevaç<span class="blank _0"> </span>ão da te<span class="blank _0"> </span>mpe<span class="blank _0"> </span>ratu<span class="blank _0"> </span>ra co<span class="blank _0"> </span>rpo<span class="blank _0"> </span>ral ac<span class="blank _0"> </span>ima do<span class="blank _0"> </span>s </div><div class="t m4d x15 hd yc7 ff6 fs8 fc2 sc0 ls3d ws26">valo<span class="blank _0"> </span>res co<span class="blank _0"> </span>nsid<span class="blank _0"> </span>erad<span class="blank _0"> </span>os no<span class="blank _0"> </span>rmais<span class="blank _0"> </span>. Ela de<span class="blank _0"> </span>co<span class="blank _0"> </span>rre de u<span class="blank _0"> </span>m reaju<span class="blank _0"> </span>ste </div><div class="t m0 x15 hd yc8 ff6 fs8 fc2 sc0 ls2 ws76">no c<span class="blank _0"> </span>entr<span class="blank _0"> </span>o de co<span class="blank _0"> </span>ntrol<span class="blank _0"> </span>e térm<span class="blank _0"> </span>ico l<span class="blank _0"> </span>ocal<span class="blank _0"> </span>izado n<span class="blank _0"> </span>o hipo<span class="blank _0"> </span>tálam<span class="blank _0"> </span>o </div><div class="t m4e x15 hd yc9 ff6 fs8 fc2 sc0 ls3d ws26">em re<span class="blank _0"> </span>spos<span class="blank _0"> </span>ta a fato<span class="blank _0"> </span>res piro<span class="blank _0"> </span>gê<span class="blank _0"> </span>nicos e<span class="blank _0"> </span>xógen<span class="blank _0"> </span>os e en<span class="blank _0"> </span>dóg<span class="blank _0"> </span>enos<span class="blank _0"> </span> </div><div class="t m4f x15 hd yca ff6 fs8 fc2 sc0 ls2 ws26">que tê<span class="blank _0"> </span>m por o<span class="blank _0"> </span>bje<span class="blank _0"> </span>tivo auxi<span class="blank _0"> </span>liar na re<span class="blank _0"> </span>spos<span class="blank _0"> </span>ta im<span class="blank _0"> </span>uno<span class="blank _0"> </span>lógic<span class="blank _0"> </span>a de </div><div class="t m50 x15 hd ycb ff6 fs8 fc2 sc0 ls19 ws77">bar<span class="blank _0"> </span>rar a pr<span class="blank _0"> </span>olifer<span class="blank _0"> </span>ação d<span class="blank _0"> </span>os mic<span class="blank _0"> </span>rorga<span class="blank _0"> </span>nismo<span class="blank _0"> </span>s. Co<span class="blank _0"> </span>m relaç<span class="blank _0"> </span>ão ao </div><div class="t m51 x15 hd ycc ff6 fs8 fc2 sc0 ls41 ws1d">mod<span class="blank _0"> </span>o co<span class="blank _0"> </span>mo a febr<span class="blank _0"> </span>e term<span class="blank _0"> </span>ina<span class="blank _0"> </span>, pod<span class="blank _0"> </span>emo<span class="blank _0"> </span>s dizer qu<span class="blank _0"> </span>e aco<span class="blank _0"> </span>ntec<span class="blank _0"> </span>e </div><div class="t m0 x15 hd ycd ff6 fs8 fc2 sc0 ls2 ws78">\u201cem lis<span class="blank _0"> </span>e\u201d<span class="blank _2"></span>, quan<span class="blank _0"> </span>do o re<span class="blank _0"> </span>torno à te<span class="blank _0"> </span>mp<span class="blank _0"> </span>erat<span class="blank _0"> </span>ura n<span class="blank _0"> </span>orma<span class="blank _0"> </span>l é gra<span class="blank _0"> </span>-</div><div class="t m41 x15 hd yce ff6 fs8 fc2 sc0 ls45 ws26">dual<span class="blank _0"> </span>, co<span class="blank _0"> </span>m redu<span class="blank _0"> </span>ção di<span class="blank _0"> </span>a após d<span class="blank _0"> </span>ia até a nor<span class="blank _0"> </span>malid<span class="blank _0"> </span>ade<span class="blank _0"> </span>, ou que </div><div class="t m52 x15 hd ycf ff6 fs8 fc2 sc0 ls1e ws26">aco<span class="blank _0"> </span>ntec<span class="blank _0"> </span>e \u201cem c<span class="blank _0"> </span>rise\u201d, quand<span class="blank _0"> </span>o o tér<span class="blank _0"> </span>mino da fe<span class="blank _0"> </span>bre é a<span class="blank _0"> </span>bru<span class="blank _0"> </span>pto, </div><div class="t m0 x15 hd yd0 ff6 fs8 fc2 sc0 ls2 ws79">ge<span class="blank _0"> </span>ralm<span class="blank _0"> </span>ente as<span class="blank _0"> </span>soci<span class="blank _0"> </span>ado à su<span class="blank _0"> </span>dore<span class="blank _0"> </span>se profu<span class="blank _0"> </span>sa e pros<span class="blank _0"> </span>tra<span class="blank _0"> </span>ção.</div><div class="t m0 x19 ha yd1 ff6 fs6 fc2 sc0 ls2 ws7a">Ap<span class="blank _0"> </span>ós um <span class="ff8">perío<span class="blank _0"> </span>do de inc<span class="blank _0"> </span>ubação d<span class="blank _0"> </span>e 8 a 1<span class="blank _9"></span>2 dias<span class="ff6">, ini<span class="blank _0"> </span>-</span></span></div><div class="t m53 x19 ha yd2 ff6 fs6 fc2 sc0 ls10 wsf">cia-<span class="blank _0"> </span>se a <span class="ff8 ws11">fase prodr<span class="blank _0"> </span>ômica<span class="blank _0"> </span>, com febre g<span class="blank _0"> </span>eralm<span class="blank _0"> </span>ente </span></div><div class="t m0 x19 hb yd3 ff8 fs6 fc2 sc0 ls2 ws7b">acima de 3<span class="blank _0"> </span>8,5ºC, co<span class="blank _0"> </span>njun<span class="blank _0"> </span>tivite não pu<span class="blank _0"> </span>rulen<span class="blank _0"> </span>ta com </div><div class="t m54 x19 ha yd4 ff8 fs6 fc2 sc0 ls46 ws7c">fotofob<span class="blank _0"> </span>ia, c<span class="blank _0"> </span>or<span class="blank _0"> </span>iza e toss<span class="blank _0"> </span>e<span class="ff6 ls47 ws36">. Os sintomas aum<span class="blank _0"> </span>entam e<span class="blank _0"> </span>m </span></div><div class="t m55 x19 ha yd5 ff6 fs6 fc2 sc0 ls41 wse">intensidad<span class="blank _0"> </span>e até o primeiro dia do exantema<span class="blank _0"> </span>, quando<span class="blank _0"> </span> </div><div class="t m0 x19 ha yd6 ff6 fs6 fc2 sc0 ls2 ws30">a febre atinge o pic<span class="blank _0"> </span>o e depo<span class="blank _0"> </span>is resolve em 24 horas </div><div class="t m0 x19 ha yd7 ff6 fs6 fc2 sc0 ls2 ws7d">em lise. Na fase prod<span class="blank _0"> </span>rômica<span class="blank _0"> </span>, já é possível iden<span class="blank _0"> </span>ti\ue61f<span class="blank _0"> </span>-</div><div class="t m0 x19 ha yd8 ff6 fs6 fc2 sc0 ls2 ws54">car as <span class="ff8 ws5c">man<span class="blank _0"> </span>chas de Koplik<span class="blank _0"> </span>, br<span class="blank _0"> </span>anco<span class="blank _0"> </span>-azulad<span class="blank _0"> </span>as e de 1 </span></div><div class="t m0 x19 hb yd9 ff8 fs6 fc2 sc0 ls2 ws7e">milíme<span class="blank _0"> </span>tro, prese<span class="blank _0"> </span>ntes na face in<span class="blank _0"> </span>terna da b<span class="blank _0"> </span>oche<span class="blank _0"> </span>cha </div><div class="t m56 x19 ha yda ff8 fs6 fc2 sc0 ls40 ws36">próxima aos de<span class="blank _0"> </span>ntes molare<span class="blank _0"> </span>s (Figur<span class="blank _0"> </span>a\ue61d<span class="blank _9"></span>3<span class="blank _2"></span>),<span class="ff6 ls2 ws7"> <span class="blank _9"></span><span class="ff8 ls3c ws35">que surgem </span></span></div><div class="t m0 x19 hb ydb ff8 fs6 fc2 sc0 ls2 ws1d">1 a 4 dias antes d<span class="blank _0"> </span>o exantema e desa<span class="blank _0"> </span>parece<span class="blank _0"> </span>m 2 a 3 </div><div class="t m57 x19 ha ydc ff8 fs6 fc2 sc0 ls38 ws36">dias de<span class="blank _0"> </span>pois. Elas são patog<span class="blank _0"> </span>nomô<span class="blank _0"> </span>nicas do sar<span class="blank _0"> </span>ampo<span class="ff6 ls2">.</span></div><div class="t m0 x23 hd ydd ff8 fs8 fc0 sc0 ls2 ws7">Fig<span class="blank _0"> </span>ura 3<span class="blank _0"> </span>. <span class="ff6 fc2">Manc<span class="blank _0"> </span>has de Ko<span class="blank _0"> </span>plik<span class="blank _0"> </span>, </span></div><div class="t m0 x7 hd yde ff6 fs8 fc2 sc0 ls2e ws30">pat<span class="blank _2"></span>ognomônicas<span class="blank _2"></span> do sarampo<span class="blank _2"></span>.</div><div class="t m0 x24 he ydf ff8 fs9 fc0 sc0 ls2 ws7">Fon<span class="blank _0"> </span>te: <span class="ff9 fc2 ls15 ws71">Maraz<span class="blank"> </span>zi.</span></div><div class="t m0 x25 h17 ye0 ff9 fsb fc2 sc0 ls48">10</div><div class="t m0 x1c hb y4a ff8 fs6 fc2 sc0 ls2 ws66">O exantema in<span class="blank _0"> </span>icia na regiã<span class="blank _0"> </span>o poste<span class="blank _0"> </span>rior do pavilhão </div><div class="t m0 x1c hb y4b ff8 fs6 fc2 sc0 ls31 ws80">auricular (<span class="blank _9"></span>circundando a l<span class="blank _2"></span>inha de implantação<span class="blank _2"></span> dos </div><div class="t m58 x1c hb y71 ff8 fs6 fc2 sc0 ls41 ws36">cabe<span class="blank _0"> </span>los<span class="blank _2"></span>) e na par<span class="blank _0"> </span>te su<span class="blank _0"> </span>perio<span class="blank _0"> </span>r do pesco<span class="blank _0"> </span>ço com<span class="blank _0"> </span>o uma </div><div class="t m0 x1c ha y72 ff8 fs6 fc2 sc0 ls1f ws81">erupção maculopapular morbilif<span class="blank _2"></span>orme<span class="ff6 ls10 ws82">. Dissemina<span class="ls2">-</span></span></div><div class="t m0 x1c ha y73 ff6 fs6 fc2 sc0 ls2 ws6d">-se par<span class="blank _0"> </span>a a par<span class="blank _0"> </span>te inf<span class="blank _2"></span>erio<span class="blank _0"> </span>r do tórax e ex<span class="blank _0"> </span>tremi<span class="blank _0"> </span>dades, </div><div class="t m0 x1c ha y74 ff6 fs6 fc2 sc0 ls2 ws83">atingind<span class="blank _0"> </span>o palmas e plantas em até 5<span class="blank _0"> </span>0% casos. Fre<span class="blank _0"> </span>-</div><div class="t m59 x1c ha y75 ff6 fs6 fc2 sc0 ls1f ws48">quentemente<span class="blank _2"></span> se t<span class="blank _2"></span>orna con\ue61euente<span class="blank _2"></span> na parte superior </div><div class="t m0 x1c ha y76 ff6 fs6 fc2 sc0 ls2 ws84">do tronc<span class="blank _0"> </span>o (Figura\ue60f4<span class="blank _2"></span>). Com o início d<span class="blank _0"> </span>o ex<span class="blank _2"></span>antem<span class="blank _0"> </span>a, os </div><div class="t m0 x1c ha y77 ff6 fs6 fc2 sc0 ls2 ws1d">outros sin<span class="blank _0"> </span>tomas come<span class="blank _0"> </span>çam a diminuir<span class="blank _2"></span>. <span class="ff8 ws7">O\ue61d<span class="blank _2"></span>exantema </span></div><div class="t m0 x1c hb y78 ff8 fs6 fc2 sc0 ls2 ws85">desapa<span class="blank _0"> </span>rece e<span class="blank _0"> </span>m cerc<span class="blank _0"> </span>a de 7 dias no sen<span class="blank _0"> </span>tido cr<span class="blank _0"> </span>anio<span class="blank _0"> </span>-</div><div class="t m0 x1c hb y79 ff8 fs6 fc2 sc0 ls31 ws4a">caudal, frequentemente dei<span class="blank _2"></span>xando uma de<span class="blank _2"></span>scama<span class="ls2">-</span></div><div class="t m0 x1c ha y7a ff8 fs6 fc2 sc0 ls35 ws5b">ção \ue61fna<span class="blank _2"></span> (<span class="blank _2"></span>furfurácea<span class="blank _9"></span>)<span class="ff6 ls2 ws5d">. Dos sintomas do sara<span class="blank _0"> </span>mpo, a </span></div><div class="t m0 x1c ha y7b ff6 fs6 fc2 sc0 ls2 ws86">tosse é o que dura m<span class="blank _0"> </span>ais t<span class="blank _2"></span>em<span class="blank _0"> </span>po (<span class="blank _2"></span>cerc<span class="blank _0"> </span>a de 1<span class="blank _9"></span>0 dias<span class="blank _2"></span>). </div><div class="t m0 x1c ha y7c ff6 fs6 fc2 sc0 ls2 ws87">Em casos mais graves, p<span class="blank _0"> </span>ode haver linfadenopatia </div><div class="t m0 x1c ha y7d ff6 fs6 fc2 sc0 lsd ws13">associada (<span class="blank _2"></span>cer<span class="blank _0"> </span>vic<span class="blank _0"> </span>ais e occipitais<span class="blank _2"></span>).</div><div class="t m0 x26 hd ye1 ff8 fs8 fc0 sc0 ls2 ws7">Fig<span class="blank _0"> </span>ura 4<span class="blank _0"> </span>. <span class="ff6 fc2">Fase exante<span class="blank _0"> </span>máti<span class="blank _0"> </span>ca do sa<span class="blank _0"> </span>ramp<span class="blank _0"> </span>o, co<span class="blank _0"> </span>m exante<span class="blank _0"> </span>ma </span></div><div class="t m0 x1b hd ye2 ff6 fs8 fc2 sc0 ls2 ws7">mor<span class="blank _0"> </span>bili<span class="blank _0"> </span>forme e<span class="blank _0"> </span>m face e t<span class="blank _0"> </span>ronc<span class="blank _0"> </span>o, in<span class="blank _0"> </span>clus<span class="blank _0"> </span>ive con<span class="blank _0"> </span>\ue61eue<span class="blank _0"> </span>nte </div><div class="t m0 x1b hd ye3 ff6 fs8 fc2 sc0 ls2 ws7">no tro<span class="blank _0"> </span>nco s<span class="blank _0"> </span>upe<span class="blank _0"> </span>rio<span class="blank _0"> </span>r<span class="blank _9"></span>. P<span class="blank _0"> </span>acie<span class="blank _0"> </span>nte ap<span class="blank _0"> </span>rese<span class="blank _0"> </span>nta ai<span class="blank _0"> </span>nda co<span class="blank _0"> </span>m a </div><div class="t m0 x1e hd ye4 ff6 fs8 fc2 sc0 ls2 ws7">car<span class="blank _0"> </span>acte<span class="blank _0"> </span>rís<span class="blank _0"> </span>tica \u201c<span class="blank _0"> </span>fac<span class="blank _0"> </span>ies sa<span class="blank _0"> </span>ramp<span class="blank _0"> </span>en<span class="blank _0"> </span>ta\u201d com p<span class="blank _0"> </span>roem<span class="blank _0"> </span>inê<span class="blank _0"> </span>ncia </div><div class="t m0 x27 hd ye5 ff6 fs8 fc2 sc0 ls2 ws7">dos si<span class="blank _0"> </span>ntoma<span class="blank _0"> </span>s de vias aé<span class="blank _0"> </span>reas s<span class="blank _0"> </span>upe<span class="blank _0"> </span>rio<span class="blank _0"> </span>res ca<span class="blank _0"> </span>rac<span class="blank _0"> </span>teriza<span class="blank _0"> </span>dos </div><div class="t m0 x22 hd ye6 ff6 fs8 fc2 sc0 ls2e ws30">pela obst<span class="blank _2"></span>rução nas<span class="blank _2"></span>al, coriza<span class="blank _2"></span> e conjunt<span class="blank _2"></span>ivite.</div><div class="t m0 x28 he ye7 ff8 fs9 fc0 sc0 ls2 ws7">Fon<span class="blank _0"> </span>te: <span class="ff9 fc2 ls1b ws72">Georgia.</span></div><div class="t m0 x29 h17 ye8 ff9 fsb fc2 sc0 ls49">11</div><div class="t m0 x11 h10 y2a ffa fsa fc4 sc1 ls2 ws7">Ano_1_Pediatria-2.indb 84<span class="blank _a"></span><span class="fc5 sc0">Ano_1_Pediatria-2.indb 84<span class="blank _b"> </span><span class="fc4 sc1">03/11/2021 12:45:46<span class="blank _c"></span><span class="fc5 sc0">03/11/2021 12:45:46</span></span></span></div></div><div class="pi" data-data="{"ctm":[1.000000,0.000000,0.000000,1.000000,0.000000,0.000000]}"></div></div> <div id="pf5" class="pf w0 h0" data-page-no="5"><div class="pc pc5 w0 h0"><img fetchpriority="low" loading="lazy" class="bi x0 y0 w1 h1" alt="" src="https://files.passeidireto.com/cb6739bf-1d15-4a05-9b9e-791388b639c2/bg5.png"><div class="t m0 x1f h16 y2b ff2 fs8 fc0 sc0 ls33 ws7">Doenças ex<span class="blank _2"></span>antemáticas<span class="blank _10"> </span><span class="fs9 fc1 ls18">Cap. 4</span></div><div class="t m0 x1 h2 y1 ff1 fs0 fc0 sc0 ls4a">85</div><div class="t m5a x2a h12 ye9 ff2 fs9 fc1 sc0 ls4b ws8e"> DIC<span class="blank _0"> </span>A </div><div class="t m0 x2b h8 yea ff6 fs5 fc2 sc0 ls4c ws8f">\ue60bNa prova deve<span class="blank _0"> </span>mos pe<span class="blank _0"> </span>nsar e<span class="blank _0"> </span>m sa<span class="blank _0"> </span><span class="ls2">-</span></div><div class="t m0 x2a h8 yeb ff6 fs5 fc2 sc0 ls2 ws90">ram<span class="blank _0"> </span>po na pre<span class="blank _0"> </span>senç<span class="blank _0"> </span>a de exante<span class="blank _0"> </span>ma macu<span class="blank _0"> </span>lo<span class="blank _0"> </span>-</div><div class="t m0 x2a h8 yec ff6 fs5 fc2 sc0 ls4d ws8f">papu<span class="blank _0"> </span>lar em t<span class="blank _0"> </span>ronc<span class="blank _0"> </span>o associ<span class="blank _0"> </span>ado a sin<span class="blank _0"> </span>tomas </div><div class="t m0 x2a h8 yed ff6 fs5 fc2 sc0 ls4e ws91">imp<span class="blank _0"> </span>or<span class="blank _0"> </span>ta<span class="blank _0"> </span>ntes de via a<span class="blank _0"> </span>érea su<span class="blank _0"> </span>per<span class="blank _0"> </span>ior (coriza e </div><div class="t m0 x2a h8 yee ff6 fs5 fc2 sc0 ls4f ws92">con<span class="blank _0"> </span>junti<span class="blank _0"> </span>vite) ou na prese<span class="blank _0"> </span>nça d<span class="blank _0"> </span>as machas d<span class="blank _0"> </span>e </div><div class="t m0 x2a h8 yef ff6 fs5 fc2 sc0 ls5 wsa">Kopl<span class="blank _2"></span>ik, patognomôn<span class="blank _2"></span>icas d<span class="blank _2"></span>a doença.</div><div class="t m3 x9 ha yf0 ff6 fs6 fc2 sc0 lsa ws93">Ou<span class="blank _0"> </span>tros sintomas que pod<span class="blank _0"> </span>em esta<span class="blank _0"> </span>r associados </div><div class="t m0 x9 ha yf1 ff6 fs6 fc2 sc0 ls2 ws94">ao saramp<span class="blank _0"> </span>o são diarreia e vômitos, se<span class="blank _0"> </span>ndo que os </div><div class="t m5b x9 ha yf2 ff6 fs6 fc2 sc0 ls2 ws11">lacten<span class="blank _0"> </span>tes apresenta<span class="blank _0"> </span>m maior risco de evoluir c<span class="blank _0"> </span>om </div><div class="t m5c x9 ha yf3 ff6 fs6 fc2 sc0 lsc ws6d">desidrat<span class="blank _0"> </span>ação. T<span class="blank _11"></span>ambé<span class="blank _0"> </span>m pode o<span class="blank _0"> </span>corre<span class="blank _0"> </span>r apendic<span class="blank _0"> </span>ite </div><div class="t m0 x9 ha yf4 ff6 fs6 fc2 sc0 ls2 ws50">por ob<span class="blank _0"> </span>struç<span class="blank _0"> </span>ão da luz do apên<span class="blank _0"> </span>dice pela hip<span class="blank _0"> </span>erplasia </div><div class="t m0 x9 ha yf5 ff6 fs6 fc2 sc0 ls11 ws89">linfoide.</div><div class="t m0 x2c h12 yf6 ff4 fs9 fc1 sc0 ls1c ws7"> <span class="blank _e"> </span> <span class="blank _e"> </span>DI<span class="blank _0"> </span>A A DI<span class="blank _0"> </span>A MÉD<span class="blank _0"> </span>ICO</div><div class="t m5d x2d hd yf7 ff6 fs8 fc2 sc0 ls50 ws2c">Em pa<span class="blank _0"> </span>cien<span class="blank _0"> </span>tes me<span class="blank _0"> </span>nore<span class="blank _0"> </span>s de 1 an<span class="blank _0"> </span>o, que ai<span class="blank _0"> </span>nda p<span class="blank _0"> </span>ossu<span class="blank _0"> </span>em </div><div class="t m5e x2d hd yf8 ff6 fs8 fc2 sc0 ls2c ws95">anti<span class="blank _2"></span>corpos ma<span class="blank _2"></span>ternos<span class="blank _2"></span> circul<span class="blank _2"></span>antes,<span class="blank _2"></span> pode ocorr<span class="blank _2"></span>er uma<span class="blank _2"></span> forma<span class="blank _2"></span> </div><div class="t m5f x2d hd yf9 ff6 fs8 fc2 sc0 ls21 ws2c">sub<span class="blank _0"> </span>clín<span class="blank _0"> </span>ica de s<span class="blank _0"> </span>aram<span class="blank _0"> </span>po co<span class="blank _0"> </span>m exante<span class="blank _0"> </span>ma ine<span class="blank _0"> </span>spe<span class="blank _0"> </span>cí\ue61f<span class="blank _0"> </span>co e </div><div class="t m60 x2d hd yfa ff6 fs8 fc2 sc0 ls1f ws2c">breve as<span class="blank _0"> </span>socia<span class="blank _0"> </span>do a po<span class="blank _0"> </span>ucos s<span class="blank _0"> </span>intom<span class="blank _0"> </span>as. Ess<span class="blank _0"> </span>es paci<span class="blank _0"> </span>ente<span class="blank _0"> </span>s </div><div class="t m0 x2d hd yfb ff6 fs8 fc2 sc0 ls2c ws96">geralme<span class="blank _0"> </span>nte não t<span class="blank _2"></span>ransmi<span class="blank _0"> </span>tem o vírus.</div><div class="t m0 x9 h6 yfc ff2 fs3 fc0 sc0 ls2 ws7">2<span class="blank _0"> </span>.4<span class="blank _0"> </span>. <span class="ls51 ws97"> DIA<span class="blank _2"></span>GNÓSTICO</span></div><div class="t m0 x9 ha yfd ff6 fs6 fc2 sc0 ls2 ws15">O diagnós<span class="blank _0"> </span>tico é feito pelo quadro c<span class="blank _0"> </span>línico e epid<span class="blank _0"> </span>e<span class="blank _0"> </span>-</div><div class="t m61 x9 ha yfe ff6 fs6 fc2 sc0 ls52 ws36">miológic<span class="blank _0"> </span>o. Além disso, po<span class="blank _0"> </span>demos e<span class="blank _0"> </span>ncontr<span class="blank _0"> </span>ar achados </div><div class="t m0 x9 ha yff ff6 fs6 fc2 sc0 ls2 ws98">labora<span class="blank _0"> </span>toriais inespe<span class="blank _0"> </span>cí\ue61fc<span class="blank _0"> </span>os na fase aguda, c<span class="blank _0"> </span>omo a </div><div class="t m62 x9 ha y100 ff6 fs6 fc2 sc0 ls1f ws59">leucopenia com<span class="blank _2"></span> redução propor<span class="blank _2"></span>cionalm<span class="blank _2"></span>ente ma<span class="blank _2"></span>ior </div><div class="t m63 x9 ha y101 ff6 fs6 fc2 sc0 lsb wse">dos linfócitos, e<span class="blank _0"> </span>mbora t<span class="blank _0"> </span>ambém p<span class="blank _0"> </span>ossa oco<span class="blank _0"> </span>rrer uma </div><div class="t m64 x9 ha y102 ff6 fs6 fc2 sc0 ls16 ws36">neu<span class="blank _0"> </span>tropen<span class="blank _0"> </span>ia absoluta. N<span class="blank _0"> </span>a ausência de c<span class="blank _0"> </span>omplic<span class="blank _0"> </span>ação </div><div class="t m65 x9 ha y103 ff6 fs6 fc2 sc0 ls3b ws6d">bacteriana se<span class="blank _0"> </span>cundá<span class="blank _0"> </span>ria, a velocidad<span class="blank _0"> </span>e de hemos<span class="blank _0"> </span><span class="ls2">-</span></div><div class="t m0 x9 ha y104 ff6 fs6 fc2 sc0 ls2 ws99">sedim<span class="blank _0"> </span>entação (<span class="blank _0"> </span>V<span class="blank _0"> </span>HS) e a proteína C reativa (PCR) </div><div class="t m0 x9 ha y105 ff6 fs6 fc2 sc0 ls2 ws7">també<span class="blank _0"> </span>m são norma<span class="blank _0"> </span>is.</div><div class="t m0 x9 hb y106 ff8 fs6 fc2 sc0 ls2 ws86">A con<span class="blank _0"> </span>\ue61frmaçã<span class="blank _0"> </span>o do diagnós<span class="blank _0"> </span>tico po<span class="blank _0"> </span>de ser feit<span class="blank _0"> </span>a pela </div><div class="t m66 x9 ha y107 ff8 fs6 fc2 sc0 lsc ws8a">sorolog<span class="blank"> </span>ia<span class="blank"> </span><span class="ff6 ls29 wsf">, pr<span class="blank _0"> </span>incipalm<span class="blank _0"> </span>ente pelo e<span class="blank _0"> </span>ncon<span class="blank _0"> </span>tro de IgM </span></div><div class="t m67 x9 ha y108 ff6 fs6 fc2 sc0 ls2 ws36">positivo, que su<span class="blank _0"> </span>rge 1 a 2 dias após o início do exan<span class="blank _0"> </span>-</div><div class="t m0 x9 ha y109 ff6 fs6 fc2 sc0 ls2 ws86">tema e con<span class="blank _0"> </span>tinua detec<span class="blank _0"> </span>táv<span class="blank _2"></span>el p<span class="blank _0"> </span>or até 1 mês, ou p<span class="blank _0"> </span>ela </div><div class="t m68 x9 ha y10a ff6 fs6 fc2 sc0 ls8 ws36">iden<span class="blank _0"> </span>ti\ue61fcação d<span class="blank _0"> </span>o aumen<span class="blank _0"> </span>t<span class="blank _2"></span>o em 4 vezes dos títulos d<span class="blank _0"> </span>e </div><div class="t m69 x9 ha y10b ff6 fs6 fc2 sc0 ls8 ws36">IgG e<span class="blank _0"> </span>m amostras pareadas<span class="blank _0"> </span>, colhidas na fase aguda<span class="blank _0"> </span> </div><div class="t m6a x9 ha y10c ff6 fs6 fc2 sc0 ls52 ws36">e na fase de convalescê<span class="blank _0"> </span>ncia (2 a 4 semanas dep<span class="blank _0"> </span>ois<span class="blank _9"></span>). </div><div class="t m6b x9 ha y10d ff6 fs6 fc2 sc0 ls40 ws36">T<span class="blank _11"></span>am<span class="blank _0"> </span>bém é possível o\ue60f<span class="blank _2"></span>isolamen<span class="blank _0"> </span>to viral por cul<span class="blank _0"> </span>tura ou </div><div class="t m0 x9 ha y10e ff6 fs6 fc2 sc0 ls2 ws82">a detec<span class="blank _0"> </span>ção do RN<span class="blank _0"> </span>A viral pe<span class="blank _0"> </span>la reação em c<span class="blank _0"> </span>adeia de </div><div class="t m0 x9 ha y10f ff6 fs6 fc2 sc0 ls2 ws9a">polime<span class="blank _0"> </span>rase em temp<span class="blank _0"> </span>o real (RT<span class="blank _9"></span>-<span class="blank _0"> </span>PC<span class="blank _0"> </span>R) em amostras </div><div class="t m0 x9 ha y110 ff6 fs6 fc2 sc0 ls2 ws9b">de sang<span class="blank _0"> </span>ue, urin<span class="blank _0"> </span>a e secre<span class="blank _0"> </span>ções respir<span class="blank _0"> </span>atórias, desde </div><div class="t m0 x22 ha y4a ff6 fs6 fc2 sc0 ls2 ws9c">que as amos<span class="blank _0"> </span>tras sejam col<span class="blank _0"> </span>hidas até o 7º dia após </div><div class="t m6c x22 ha y4b ff6 fs6 fc2 sc0 ls2 wse">o início do exantema. A\ue60f<span class="blank _2"></span>análise mole<span class="blank _0"> </span>cular po<span class="blank _0"> </span>de ser </div><div class="t m0 x22 ha y71 ff6 fs6 fc2 sc0 ls2 ws9d">utilizada para de<span class="blank _0"> </span>terminar o ge<span class="blank _0"> </span>nótipo circ<span class="blank _0"> </span>ulante do </div><div class="t m0 x22 ha y72 ff6 fs6 fc2 sc0 ls2 ws9e">vírus<span class="blank _0"> </span>, além de difere<span class="blank _0"> </span>nciar a infecção c<span class="blank _0"> </span>ausada pelo </div><div class="t m6d x22 ha y73 ff6 fs6 fc2 sc0 ls11 wsf">vírus se<span class="blank _0"> </span>lvagem daquela de<span class="blank _0"> </span>cor<span class="blank _0"> </span>rente de vacinação </div><div class="t m0 x22 ha y74 ff6 fs6 fc2 sc0 ls2 ws7">rece<span class="blank _0"> </span>nte do saramp<span class="blank _0"> </span>o.</div><div class="t m0 x22 hb y111 ff8 fs6 fc2 sc0 ls35 ws9f">O sarampo<span class="blank _2"></span> é uma d<span class="blank _2"></span>oença de not<span class="blank _2"></span>i\ue61fcação compul<span class="ls2">-</span></div><div class="t m0 x22 hb y112 ff8 fs6 fc2 sc0 ls2 ws7">sória<span class="blank _0"> </span>, realizada log<span class="blank _0"> </span>o após a sus<span class="blank _0"> </span>peita c<span class="blank _0"> </span>línica.</div><div class="t m0 x22 h6 y113 ff2 fs3 fc0 sc0 ls2 ws7">2<span class="blank _0"> </span>.<span class="blank _0"> </span>5. <span class="ls53 wsa0"> <span class="blank _12"></span>TR<span class="blank _0"> </span>A<span class="blank _9"></span>T<span class="blank _9"></span>AM<span class="blank _0"> </span>ENTO E COMPLIC<span class="blank _0"> </span>A<span class="blank _2"></span>ÇÕES</span></div><div class="t m6e x22 hb y114 ff8 fs6 fc2 sc0 ls31 ws11">O trat<span class="blank _0"> </span>amen<span class="blank _0"> </span>to é apena<span class="blank _0"> </span>s de supo<span class="blank _0"> </span>r<span class="blank _0"> </span>te, com uso d<span class="blank _0"> </span>e </div><div class="t m6f x22 hb y115 ff8 fs6 fc2 sc0 ls42 ws48">antipiréticos, hidratação, supor<span class="blank _0"> </span>te nutricional e o<span class="blank _9"></span>xige<span class="blank _0"> </span><span class="ls2">-</span></div><div class="t m70 x22 ha y116 ff8 fs6 fc2 sc0 ls41 ws8b">niotera<span class="blank"> </span>pia<span class="blank"> </span><span class="ff6 ls40 wse">, se n<span class="blank _0"> </span>eces<span class="blank _0"> </span>sário. </span><span class="ls3c ws35">Pacientes hospitali<span class="blank _2"></span>zados </span></div><div class="t m4 x22 hb y117 ff8 fs6 fc2 sc0 ls2 wsa1">devem pe<span class="blank _0"> </span>rmane<span class="blank _0"> </span>cer e<span class="blank _0"> </span>m prec<span class="blank _0"> </span>auçõe<span class="blank _0"> </span>s de cont<span class="blank _0"> </span>ato e </div><div class="t m71 x22 hb y118 ff8 fs6 fc2 sc0 ls25 wsf">de aero<span class="blank _0"> </span>ssóis dura<span class="blank _0"> </span>nte o períod<span class="blank _0"> </span>o de trans<span class="blank _0"> </span>missão </div><div class="t m72 x22 ha y119 ff8 fs6 fc2 sc0 ls25 wsf">do víru<span class="blank _0"> </span>s (<span class="blank _9"></span>até 4 a 6 dias d<span class="blank _0"> </span>o início do exantem<span class="blank _0"> </span>a<span class="blank _9"></span>).<span class="ff6 ls2 ws7"> </span></div><div class="t m0 x22 ha y11a ff6 fs6 fc2 sc0 ls2 ws4b">A\ue60fde\ue61fc<span class="blank _0"> </span>iência de v<span class="blank _0"> </span>itamina A e<span class="blank _0"> </span>m crianças d<span class="blank _0"> </span>e países </div><div class="t m73 x22 ha y11b ff6 fs6 fc2 sc0 ls2 ws11">em des<span class="blank _0"> </span>envolvimen<span class="blank _0"> </span>to está associada ao aum<span class="blank _0"> </span>ento </div><div class="t m0 x22 ha y11c ff6 fs6 fc2 sc0 ls2 ws4f">da mor<span class="blank _0"> </span>talida<span class="blank _0"> </span>de do saramp<span class="blank _0"> </span>o, com uma c<span class="blank _0"> </span>orrelaç<span class="blank _0"> </span>ão </div><div class="t m3 x22 ha y11d ff6 fs6 fc2 sc0 ls36 ws6d">inversa entre os níveis de retino<span class="blank _0"> </span>l e a gravidade </div><div class="t m74 x22 ha y11e ff6 fs6 fc2 sc0 ls11 wsf">do saram<span class="blank _0"> </span>po; por isso, <span class="ff8 ws11">a Org<span class="blank _0"> </span>anização Mu<span class="blank _0"> </span>ndial de </span></div><div class="t m75 x22 hb y11f ff8 fs6 fc2 sc0 ls9 wsf">Saú<span class="blank _0"> </span>de (<span class="blank _2"></span>OMS) reco<span class="blank _0"> </span>menda a s<span class="blank _0"> </span>uplem<span class="blank _0"> </span>entaç<span class="blank _0"> </span>ão com </div><div class="t m0 x22 ha y120 ff8 fs6 fc2 sc0 ls2 ws6c">vita<span class="blank _0"> </span>mina A em m<span class="blank _0"> </span>enore<span class="blank _0"> </span>s de 2 anos co<span class="blank _0"> </span>m saram<span class="blank _0"> </span>po<span class="ff6 ws7"> </span></div><div class="t m0 x22 ha y121 ff6 fs6 fc2 sc0 ls2 ws32">em duas dos<span class="blank _0"> </span>es via oral de 5<span class="blank _0"> </span>0.<span class="blank _2"></span>0<span class="blank _0"> </span>00\ue60f<span class="blank _0"> </span>U<span class="blank _0"> </span>I em men<span class="blank _0"> </span>ores </div><div class="t m0 x22 ha y122 ff6 fs6 fc2 sc0 ls2 ws84">de 6 meses<span class="blank _0"> </span>, 1<span class="blank _9"></span>0<span class="blank _0"> </span>0.00<span class="blank _0"> </span>0\ue60f<span class="blank _2"></span>UI e<span class="blank _0"> </span>ntre 6 e 1<span class="blank _9"></span>2 mese<span class="blank _0"> </span>s de vida </div><div class="t m0 x22 ha y123 ff6 fs6 fc2 sc0 ls2 ws7">e de 20<span class="blank _0"> </span>0.<span class="blank _2"></span>0<span class="blank _0"> </span>00\ue60fU<span class="blank _0"> </span>I nos maiores de 1 a<span class="blank _0"> </span>no.</div><div class="t m0 x2e h12 y124 ff4 fs9 fc1 sc0 ls1c ws7"> <span class="blank _e"> </span> <span class="blank _e"> </span>BA<span class="blank _0"> </span>SES DA ME<span class="blank _0"> </span>DIC<span class="blank _0"> </span>INA</div><div class="t m76 x21 hd y125 ff6 fs8 fc2 sc0 ls54 ws27">Vale a pe<span class="blank _0"> </span>na rele<span class="blank _0"> </span>mb<span class="blank _0"> </span>rar as m<span class="blank _0"> </span>edi<span class="blank _0"> </span>das de iso<span class="blank _0"> </span>lame<span class="blank _0"> </span>nto ho<span class="blank _0"> </span>s<span class="ls2">-</span></div><div class="t m0 x21 hd y126 ff6 fs8 fc2 sc0 ls2b ws8c">pitalar<span class="blank"> </span>:</div><div class="t m0 x2f h13 y127 ff5 fs4 fc0 sc0 ls2 ws7"> <span class="blank _4"></span>W</div><div class="t m77 xc hd y128 ff6 fs8 fc2 sc0 ls55 ws27">Pre<span class="blank _0"> </span>cau<span class="blank _0"> </span>çõe<span class="blank _0"> </span>s de co<span class="blank _0"> </span>ntato: uso d<span class="blank _0"> </span>e luvas e ave<span class="blank _0"> </span>ntais a<span class="blank _0"> </span>o </div><div class="t m78 xc hd y129 ff6 fs8 fc2 sc0 ls56 wsa2">co<span class="blank _0"> </span>ntato c<span class="blank _0"> </span>om o pac<span class="blank _0"> </span>ien<span class="blank _0"> </span>te, asso<span class="blank _0"> </span>ciad<span class="blank _0"> </span>o à lavagem f<span class="blank _0"> </span>requ<span class="blank _0"> </span>en<span class="blank _0"> </span>te </div><div class="t m0 xc hd y12a ff6 fs8 fc2 sc0 ls2 ws7">das mão<span class="blank _0"> </span>s ou uso d<span class="blank _0"> </span>e álco<span class="blank _0"> </span>ol ge<span class="blank _0"> </span>l.</div><div class="t m0 x2f h13 y12b ff5 fs4 fc0 sc0 ls2 ws7"> <span class="blank _4"></span>W</div><div class="t m79 xc hd y12c ff6 fs8 fc2 sc0 ls2d ws37">Pre<span class="blank _0"> </span>cau<span class="blank _0"> </span>ções d<span class="blank _0"> </span>e gotíc<span class="blank _0"> </span>ulas: uso d<span class="blank _0"> </span>e másc<span class="blank _0"> </span>ara ci<span class="blank _0"> </span>rúrg<span class="blank _0"> </span>ica </div><div class="t m7a xc hd y12d ff6 fs8 fc2 sc0 ls3e ws26">qua<span class="blank _0"> </span>ndo no m<span class="blank _0"> </span>esm<span class="blank _0"> </span>o ambi<span class="blank _0"> </span>ente fec<span class="blank _0"> </span>had<span class="blank _0"> </span>o que o pac<span class="blank _0"> </span>ien<span class="blank _0"> </span>te.</div><div class="t m0 x2f h13 y12e ff5 fs4 fc0 sc0 ls2 ws7"> <span class="blank _4"></span>W</div><div class="t m7b xc hd y12f ff6 fs8 fc2 sc0 ls3f ws26">Pre<span class="blank _0"> </span>cau<span class="blank _0"> </span>ções d<span class="blank _0"> </span>e aer<span class="blank _0"> </span>ossóis: u<span class="blank _0"> </span>so de más<span class="blank _0"> </span>cara N<span class="blank _0"> </span>95 quand<span class="blank _0"> </span>o </div><div class="t m0 xc hd y130 ff6 fs8 fc2 sc0 ls2 ws7">no me<span class="blank _0"> </span>smo a<span class="blank _0"> </span>mbie<span class="blank _0"> </span>nte fec<span class="blank _0"> </span>hado q<span class="blank _0"> </span>ue o pac<span class="blank _0"> </span>ien<span class="blank _0"> </span>te.</div><div class="t m0 x22 ha y131 ff6 fs6 fc2 sc0 ls2 wsa3">As co<span class="blank _0"> </span>mplicaçõ<span class="blank _0"> </span>es são atribuídas aos efeitos pato<span class="blank _0"> </span>-</div><div class="t m0 x22 ha y132 ff6 fs6 fc2 sc0 ls2 ws9f">gênic<span class="blank _0"> </span>os do saram<span class="blank _0"> </span>po no trato respiratório e n<span class="blank _0"> </span>o sis-</div><div class="t m0 x22 ha y133 ff6 fs6 fc2 sc0 ls2 wsa4">tema imun<span class="blank _0"> </span>e. <span class="ff8 ls25 wsa5">A\ue61d<span class="blank _9"></span>maior<span class="blank _2"></span> morbimortalidade ocorre<span class="blank _2"></span> em </span></div><div class="t m7c x22 hb y134 ff8 fs6 fc2 sc0 ls16 ws36">men<span class="blank _0"> </span>ores de 5 ano<span class="blank _0"> </span>s (<span class="blank _9"></span>em e<span class="blank _0"> </span>specia<span class="blank _0"> </span>l, nos me<span class="blank _0"> </span>nores de 1 </div><div class="t m0 x22 hb y135 ff8 fs6 fc2 sc0 ls2 ws81">ano<span class="blank _2"></span>) e nos maio<span class="blank _0"> </span>res de 20 anos<span class="blank _0"> </span>, princ<span class="blank _0"> </span>ipalme<span class="blank _0"> </span>nte na </div><div class="t m0 x11 h10 y2a ffa fsa fc4 sc1 ls2 ws7">Ano_1_Pediatria-2.indb 85<span class="blank _a"></span><span class="fc5 sc0">Ano_1_Pediatria-2.indb 85<span class="blank _b"> </span><span class="fc4 sc1">03/11/2021 12:45:46<span class="blank _c"></span><span class="fc5 sc0">03/11/2021 12:45:46</span></span></span></div></div><div class="pi" data-data="{"ctm":[1.000000,0.000000,0.000000,1.000000,0.000000,0.000000]}"></div></div> <div id="pf6" class="pf w0 h0" data-page-no="6"><div class="pc pc6 w0 h0"><img fetchpriority="low" loading="lazy" class="bi x0 y0 w1 h1" alt="" src="https://files.passeidireto.com/cb6739bf-1d15-4a05-9b9e-791388b639c2/bg6.png"><div class="t m0 x12 h11 y2b ff4 fs9 fc1 sc0 ls18 ws7">Doenças ex<span class="blank _2"></span>antemáticas<span class="blank _d"> </span><span class="ff2 fs8 fc0 ls19 v0">Urgências pediátricas</span></div><div class="t m0 x13 h2 y1 ff1 fs0 fc0 sc0 ls4a">86</div><div class="t m1b x19 hb y4a ff8 fs6 fc2 sc0 ls57 ws35">vigê<span class="blank _0"> </span>ncia de des<span class="blank _0"> </span>nutri<span class="blank _0"> </span>ção, de\ue61f<span class="blank _0"> </span>ciência d<span class="blank _0"> </span>e vitami<span class="blank _0"> </span>na A ou </div><div class="t m0 x19 ha y4b ff8 fs6 fc2 sc0 ls2 wse">imun<span class="blank _0"> </span>ode\ue61f<span class="blank _0"> </span>ciênc<span class="blank _0"> </span>ia associada<span class="blank _0"> </span><span class="ff6">. Deve-<span class="blank _0"> </span>se suspei<span class="blank _0"> </span>tar de </span></div><div class="t m7d x19 ha y71 ff6 fs6 fc2 sc0 ls3c ws36">com<span class="blank _0"> </span>plicação na pe<span class="blank _0"> </span>rsistência o<span class="blank _0"> </span>u recru<span class="blank _0"> </span>descê<span class="blank _0"> </span>ncia da </div><div class="t m7e x19 ha y72 ff6 fs6 fc2 sc0 ls3c ws36">febre por mais d<span class="blank _0"> </span>e 3 dias após o início do exantema.</div><div class="t m7f x19 hb y136 ff8 fs6 fc2 sc0 ls12 ws11">A causa m<span class="blank _0"> </span>ais comu<span class="blank _0"> </span>m de mor<span class="blank _0"> </span>te no sar<span class="blank _0"> </span>ampo é a </div><div class="t m80 x19 ha y137 ff8 fs6 fc2 sc0 ls37 wsa6">pneumonia<span class="ff6 ls42 ws36">, c<span class="blank _0"> </span>ausada diretam<span class="blank _0"> </span>ente pela infecç<span class="blank _0"> </span>ão viral </span></div><div class="t m81 x19 ha y138 ff6 fs6 fc2 sc0 lsd wsf">(pn<span class="blank _0"> </span>eumon<span class="blank _0"> </span>ia de células gigantes<span class="blank _2"></span>) ou po<span class="blank _0"> </span>r inf<span class="blank _2"></span>ec<span class="blank _0"> </span>ção </div><div class="t m82 x19 ha y139 ff6 fs6 fc2 sc0 ls38 ws36">bacter<span class="blank _0"> </span>iana sobrep<span class="blank _0"> </span>osta po<span class="blank _0"> </span>r <span class="ff7 wse">S. p<span class="blank _0"> </span>neu<span class="blank _0"> </span>moniae<span class="blank _0"> </span>, S. a<span class="blank _0"> </span>ureus<span class="blank _0"> </span></span><span class="ls2 ws7"> </span></div><div class="t m0 x19 ha y13a ff6 fs6 fc2 sc0 ls2 ws7">ou <span class="blank _1"> </span><span class="ff7 ls11 wsaa">H. in\ue61f<span class="blank _0"> </span>uenzae</span><span class="wsab">. É\ue60f<span class="blank _0"> </span>co<span class="blank _0"> </span>mum a evolução para b<span class="blank _0"> </span>ron<span class="blank _0"> </span>-</span></div><div class="t m0 x19 ha y13b ff6 fs6 fc2 sc0 ls12 ws68">quiolite oblit<span class="blank _2"></span>erante em crianças que apresentaram </div><div class="t m1b x19 ha y13c ff6 fs6 fc2 sc0 ls38 ws6e">pneumonia gra<span class="blank _9"></span>ve por sara<span class="blank _2"></span>mpo. Embora a<span class="blank _2"></span> pneumonia </div><div class="t m83 x19 ha y13d ff6 fs6 fc2 sc0 ls37 ws36">seja a causa mais c<span class="blank _0"> </span>omum de mo<span class="blank _0"> </span>r<span class="blank _0"> </span>te, <span class="ff8 ls9 wsac">a compli<span class="blank _2"></span>cação </span></div><div class="t m0 x19 ha y13e ff8 fs6 fc2 sc0 ls2 wsad">mais co<span class="blank _0"> </span>mum do sar<span class="blank _0"> </span>ampo é a oti<span class="blank _0"> </span>te média ag<span class="blank _0"> </span>uda<span class="ff6 ws7">, </span></div><div class="t m84 x19 ha y13f ff6 fs6 fc2 sc0 ls31 wsf">em de<span class="blank _0"> </span>corrê<span class="blank _0"> </span>ncia do excesso de se<span class="blank _0"> </span>creç<span class="blank _0"> </span>ão em via </div><div class="t m0 x19 ha y140 ff6 fs6 fc2 sc0 ls2 wsae">aérea sup<span class="blank _0"> </span>erior, que pode c<span class="blank _0"> </span>omplicar i<span class="blank _0"> </span>nclusive com </div><div class="t m0 x19 ha y141 ff6 fs6 fc2 sc0 ls11 ws9e">sinusite e mastoidite.</div><div class="t m85 x19 ha y142 ff6 fs6 fc2 sc0 ls1f wsf">Ou<span class="blank _0"> </span>tras complic<span class="blank _0"> </span>ações mais g<span class="blank _0"> </span>rav<span class="blank _2"></span>es são desc<span class="blank _0"> </span>ritas </div><div class="t m0 x19 ha y143 ff6 fs6 fc2 sc0 ls2 ws7">associadas ao saram<span class="blank _0"> </span>po, com<span class="blank _0"> </span>o<span class="blank _2"></span>:</div><div class="t m0 x30 hc y144 ff5 fs7 fc3 sc0 ls2 ws7"> <span class="blank _6"></span>u<span class="blank _7"> </span><span class="ff6 fs6 fc2 wsaf v2">Encefali<span class="blank _0"> </span>te após sarampo: mais com<span class="blank _0"> </span>um em <span class="ff8 ls12 wsa7">ado<span class="blank"> </span><span class="ls2">-</span></span></span></div><div class="t m86 x16 ha y145 ff8 fs6 fc2 sc0 ls12 wsb0">lescentes e adultos<span class="ff6 ls2 ws1e">, dec<span class="blank _0"> </span>orren<span class="blank _0"> </span>te de um </span><span class="ls1f ws4b">processo </span></div><div class="t m87 x16 ha y146 ff8 fs6 fc2 sc0 ls2e ws51">pós-inf<span class="blank _2"></span>eccioso imunologicamente<span class="blank _2"></span> mediado, <span class="ff6 ls2 ws7">e </span></div><div class="t m88 x16 ha y147 ff6 fs6 fc2 sc0 ls10 wsf">não do efeito direto do vírus. C<span class="blank _0"> </span>ome<span class="blank _0"> </span>ça duran<span class="blank _0"> </span>te<span class="blank _2"></span> </div><div class="t m89 x16 ha y148 ff6 fs6 fc2 sc0 ls9 wsf">o exantema com co<span class="blank _0"> </span>nvulsões, let<span class="blank _0"> </span>argia, co<span class="blank _0"> </span>ma e </div><div class="t m0 x16 ha y149 ff6 fs6 fc2 sc0 ls1f ws5f">irritabilid<span class="blank _2"></span>ade. Identi\ue61fca-se pleocitose li<span class="blank _2"></span>nfocít<span class="blank _2"></span>ica </div><div class="t m0 x16 ha y14a ff6 fs6 fc2 sc0 ls2 ws5d">e conc<span class="blank _0"> </span>entraç<span class="blank _0"> </span>ões elevadas de proteína no líqu<span class="blank _0"> </span>or<span class="blank _9"></span>. </div><div class="t m0 x16 ha y14b ff6 fs6 fc2 sc0 ls2 wsb1">Ce<span class="blank _0"> </span>rca de 1<span class="blank _9"></span>5% dos pacie<span class="blank _0"> </span>ntes morre<span class="blank _0"> </span>m e 20 a 40% </div><div class="t m0 x16 ha y14c ff6 fs6 fc2 sc0 ls2 wsb2">mantêm se<span class="blank _0"> </span>quelas a lon<span class="blank _0"> </span>go prazo, com<span class="blank _0"> </span>o retardo </div><div class="t m0 x16 ha y14d ff6 fs6 fc2 sc0 ls31 ws7e">mental, sequela<span class="blank _2"></span>s mot<span class="blank _2"></span>oras e sur<span class="blank _2"></span>dez.</div><div class="t m0 x30 hc y14e ff5 fs7 fc3 sc0 ls2 ws7"> <span class="blank _6"></span>u<span class="blank _7"> </span><span class="ff6 fs6 fc2 ws6c v2">Encefali<span class="blank _0"> </span>te por saramp<span class="blank _0"> </span>o<span class="blank _2"></span>: oco<span class="blank _0"> </span>rre em <span class="ff8 ls1f wsa8">imunocom<span class="blank"> </span><span class="ls2">-</span></span></span></div><div class="t m0 x16 ha y14f ff8 fs6 fc2 sc0 ls10 ws45">prome<span class="blank _0"> </span>tidos<span class="ff6 ls8 ws5b"> (<span class="blank _9"></span>S<span class="blank _0"> </span>IDA<span class="blank _0"> </span>, ne<span class="blank _0"> </span>oplasias<span class="blank _0"> </span> malignas l<span class="blank _0"> </span>inforre<span class="blank _0"> </span><span class="ls2">-</span></span></div><div class="t m0 x16 ha y150 ff6 fs6 fc2 sc0 ls2 ws2f">ticulares e imu<span class="blank _0"> </span>nossupres<span class="blank _0"> </span>são<span class="blank _9"></span>) e resul<span class="blank _0"> </span>ta da <span class="ff8 ls11 ws9e">lesão </span></div><div class="t m0 x16 ha y151 ff8 fs6 fc2 sc0 ls2 ws9c">diret<span class="blank _0"> </span>a do cé<span class="blank _0"> </span>rebro p<span class="blank _0"> </span>elo víru<span class="blank _0"> </span>s<span class="ff6">, aparece<span class="blank _0"> </span>ndo de 1 a </span></div><div class="t m0 x16 ha y152 ff6 fs6 fc2 sc0 ls2 wsab">1<span class="blank _9"></span>0 m<span class="blank _0"> </span>eses após o sara<span class="blank _0"> </span>mpo. Cursa c<span class="blank _0"> </span>om convul<span class="blank _0"> </span>-</div><div class="t m0 x16 ha y153 ff6 fs6 fc2 sc0 ls2 wsb3">sões, m<span class="blank _0"> </span>ioclono<span class="blank _0"> </span>, estupo<span class="blank _0"> </span>r e coma. Q<span class="blank _0"> </span>uase sempre </div><div class="t m0 x16 ha y154 ff6 fs6 fc2 sc0 ls2 ws7">evolui com doe<span class="blank _0"> </span>nça pro<span class="blank _0"> </span>gressiva e mor<span class="blank _0"> </span>te.</div><div class="t m0 x30 h15 y155 ff5 fs7 fc3 sc0 ls2 ws7"> <span class="blank _6"></span>u</div><div class="t m8a x16 ha y156 ff6 fs6 fc2 sc0 ls35 wsf">Pane<span class="blank _0"> </span>ncefalite escle<span class="blank _0"> </span>rosante subaguda (P<span class="blank _0"> </span>EES)<span class="blank _2"></span>: </div><div class="t m0 x16 hb y157 ff8 fs6 fc2 sc0 ls2 ws9e">com<span class="blank _0"> </span>plicaçã<span class="blank _0"> </span>o crônic<span class="blank _0"> </span>a rara do s<span class="blank _0"> </span>aramp<span class="blank _0"> </span>o de início </div><div class="t m8b x16 ha y158 ff8 fs6 fc2 sc0 ls25 wsa9">tardio<span class="ff6 ls11 wsf"> e desfecho quase se<span class="blank _0"> </span>mpre fatal. Resul<span class="blank _0"> </span>ta </span></div><div class="t m8c x16 ha y159 ff6 fs6 fc2 sc0 ls12 wsf">da infecção pe<span class="blank _0"> </span>rsistente com v<span class="blank _0"> </span>írus alterad<span class="blank _0"> </span>o do </div><div class="t m8d x16 ha y15a ff6 fs6 fc2 sc0 ls1f wsad">sarampo, hospedado intracelularmente no s<span class="blank _2"></span>is<span class="ls2">-</span></div><div class="t m0 x16 ha y15b ff6 fs6 fc2 sc0 ls2 ws50">tema ner<span class="blank _0"> </span>voso ce<span class="blank _0"> </span>ntral po<span class="blank _0"> </span>r vários anos. Ap<span class="blank _0"> </span>ós 7 a </div><div class="t m0 x16 ha y15c ff6 fs6 fc2 sc0 ls2 ws6e">1<span class="blank _9"></span>0 an<span class="blank _0"> </span>os ele inicia uma n<span class="blank _0"> </span>ov<span class="blank _2"></span>a viru<span class="blank _0"> </span>lência e atac<span class="blank _0"> </span>a as </div><div class="t mb x16 ha y15d ff6 fs6 fc2 sc0 ls12 wsb4">células<span class="blank _2"></span> neuronais, desencadea<span class="blank _2"></span>ndo um processo </div><div class="t m0 x16 ha y15e ff6 fs6 fc2 sc0 ls2 ws83">neu<span class="blank _0"> </span>rodege<span class="blank _0"> </span>nerati<span class="blank _0"> </span>vo<span class="blank _2"></span>. É\ue60f<span class="blank _9"></span>mais c<span class="blank _0"> </span>omum e<span class="blank _0"> </span>m meninos </div><div class="t m8e x16 ha y15f ff6 fs6 fc2 sc0 ls8 ws1e">e quando a aq<span class="blank _0"> </span>uisição do saramp<span class="blank _0"> </span>o ocor<span class="blank _0"> </span>re em ida<span class="ls2">-</span></div><div class="t m0 x16 ha y160 ff6 fs6 fc2 sc0 ls2 ws13">de pre<span class="blank _0"> </span>coce (<span class="blank _2"></span><\ue60f4 anos<span class="blank _2"></span>). <span class="ff8">Inicia<span class="blank _0"> </span>-se com al<span class="blank _0"> </span>teraçõe<span class="blank _0"> </span>s </span></div><div class="t m0 x1b hb y4a ff8 fs6 fc2 sc0 ls2 wsb5">sutis no c<span class="blank _0"> </span>ompo<span class="blank _0"> </span>r<span class="blank _0"> </span>tame<span class="blank _0"> </span>nto ou dese<span class="blank _0"> </span>mpe<span class="blank _0"> </span>nho esco<span class="blank _0"> </span>-</div><div class="t m0 x1b hb y4b ff8 fs6 fc2 sc0 ls2 wsb6">lar<span class="blank _2"></span>, com<span class="blank _0"> </span>o irrita<span class="blank _0"> </span>bilidade o<span class="blank _0"> </span>u reduç<span class="blank _0"> </span>ão da atenç<span class="blank _0"> </span>ão, </div><div class="t m8f x1b hb y71 ff8 fs6 fc2 sc0 ls16 ws1e">evoluindo d<span class="blank _0"> </span>epois co<span class="blank _0"> </span>m mioclo<span class="blank _0"> </span>no maciço q<span class="blank _0"> </span>ue, po<span class="blank _0"> </span>r </div><div class="t m0 x1b hb y72 ff8 fs6 fc2 sc0 ls1f ws87">último, s<span class="blank _2"></span>e transforma em coreoatet<span class="blank _2"></span>ose, imobi<span class="ls2">-</span></div><div class="t m0 x1b ha y73 ff8 fs6 fc2 sc0 ls2 ws9d">lidade<span class="blank _0"> </span>, distonia e ri<span class="blank _0"> </span>gidez<span class="ff6">. De<span class="blank _0"> </span>teriora<span class="blank _0"> </span>, en\ue61f<span class="blank _0"> </span>m, para </span></div><div class="t m0 x1b ha y74 ff6 fs6 fc2 sc0 ls2 wsb7">perda d<span class="blank _0"> </span>o controle d<span class="blank _0"> </span>os centros au<span class="blank _0"> </span>tonômicos d<span class="blank _0"> </span>o </div><div class="t m0 x1b ha y75 ff6 fs6 fc2 sc0 ls2 wsb8">tronco e<span class="blank _0"> </span>ncefálico, evoluind<span class="blank _0"> </span>o para dem<span class="blank _0"> </span>ência<span class="blank _0"> </span>, es-</div><div class="t m0 x1b ha y76 ff6 fs6 fc2 sc0 ls2 wsb9">tupor e c<span class="blank _0"> </span>oma. <span class="ff8">A\ue61dm<span class="blank _0"> </span>aioria dos c<span class="blank _0"> </span>asos morre e<span class="blank _0"> </span>m 1 </span></div><div class="t m0 x1b ha y77 ff8 fs6 fc2 sc0 ls2 ws7">a 3 anos<span class="ff6"> e o trat<span class="blank _0"> </span>amento é ape<span class="blank _0"> </span>nas de supo<span class="blank _0"> </span>r<span class="blank _0"> </span>te.</span></div><div class="t m0 x1a h15 y161 ff5 fs7 fc3 sc0 ls2 ws7"> <span class="blank _6"></span>u</div><div class="t m90 x1b ha y162 ff6 fs6 fc2 sc0 ls10 wsf">Sara<span class="blank _0"> </span>mpo neg<span class="blank _0"> </span>ro ou hemo<span class="blank _0"> </span>rrágico: situação ra<span class="blank _0"> </span>ra </div><div class="t m91 x1b ha y163 ff6 fs6 fc2 sc0 ls58 ws6d">de er<span class="blank _0"> </span>upção c<span class="blank _0"> </span>utânea h<span class="blank _0"> </span>emor<span class="blank _0"> </span>rágica frequ<span class="blank _0"> </span>ente<span class="blank _0"> </span><span class="ls2">-</span></div><div class="t m0 x1b ha y164 ff6 fs6 fc2 sc0 ls11 ws9e">mente fatal.</div><div class="t m0 x1c h6 y165 ff2 fs3 fc0 sc0 ls2 ws7">2<span class="blank _0"> </span>.6<span class="blank _0"> </span>. <span class="ls59 wsba"> PROFI<span class="blank _0"> </span>L<span class="blank _0"> </span>A<span class="blank _0"> </span>X<span class="blank _0"> </span>IA</span></div><div class="t m92 x1c ha y166 ff6 fs6 fc2 sc0 ls41 ws36">A pro\ue61fla<span class="blank _0"> </span>xia primária do sara<span class="blank _0"> </span>mpo é a vacinação co<span class="blank _0"> </span>m </div><div class="t m0 x1c ha y167 ff6 fs6 fc2 sc0 ls2 ws80">a tríplice v<span class="blank _0"> </span>iral (<span class="blank _2"></span>SC<span class="blank _0"> </span>R) aos 1<span class="blank _11"></span>2 m<span class="blank _0"> </span>eses, se<span class="blank _0"> </span>guida de uma </div><div class="t m93 x1c ha y168 ff6 fs6 fc2 sc0 ls52 ws67">dose de reforço aos 1<span class="blank _9"></span>5 meses so<span class="blank _0"> </span>b a f<span class="blank _2"></span>or<span class="blank _0"> </span>ma da vacina </div><div class="t m0 x1c ha y169 ff6 fs6 fc2 sc0 ls2 ws7">tetraviral (<span class="blank _2"></span>SC<span class="blank _0"> </span>R + varicela)<span class="blank _2"></span>.</div><div class="t m94 x1c hb y16a ff8 fs6 fc2 sc0 ls2 ws11">Em indi<span class="blank _0"> </span>víduos sus<span class="blank _0"> </span>cetíveis expo<span class="blank _0"> </span>stos ao sara<span class="blank _0"> </span>mpo, </div><div class="t m95 x1c hb y16b ff8 fs6 fc2 sc0 ls25 wsf">est<span class="blank _0"> </span>á indica<span class="blank _0"> </span>da a pro\ue61fla<span class="blank _0"> </span>xia pós-<span class="blank _0"> </span>expo<span class="blank _0"> </span>sição co<span class="blank _0"> </span>m a </div><div class="t m96 x1c hb y16c ff8 fs6 fc2 sc0 ls9 wsf">adminis<span class="blank _0"> </span>traç<span class="blank _0"> </span>ão da vacina do sar<span class="blank _0"> </span>ampo e<span class="blank _0"> </span>m até 72 </div><div class="t m0 x1c hb y16d ff8 fs6 fc2 sc0 ls2 wsbb">horas d<span class="blank _0"> </span>a exposição o<span class="blank _0"> </span>u com o uso de i<span class="blank _0"> </span>munog<span class="blank _0"> </span>lobu<span class="blank _0"> </span>-</div><div class="t m0 x1c ha y16e ff8 fs6 fc2 sc0 ls2 wsbc">lina e<span class="blank _0"> </span>m até 6 dias da exposiç<span class="blank _0"> </span>ão<span class="ff6 lsd wse">, indicada naqueles </span></div><div class="t m97 x1c ha y16f ff6 fs6 fc2 sc0 lsd ws11">indivíd<span class="blank _0"> </span>uos que não po<span class="blank _0"> </span>dem rec<span class="blank _0"> </span>ebe<span class="blank _0"> </span>r a tríplice vi<span class="blank _0"> </span>ral </div><div class="t m0 x1c ha y170 ff6 fs6 fc2 sc0 ls2 wsbd">(<span class="blank _2"></span>vacina de ag<span class="blank _0"> </span>ente atenuado<span class="blank _2"></span>), com<span class="blank _0"> </span>o <span class="ff8 ls25 wsbe">gestantes,<span class="blank _2"></span> lac<span class="ls2">-</span></span></div><div class="t m1b x1c hb y171 ff8 fs6 fc2 sc0 ls57 wsb5">tentes me<span class="blank _0"> </span>nores d<span class="blank _0"> </span>e 6 meses e imu<span class="blank _0"> </span>nocom<span class="blank _0"> </span>prome<span class="blank _0"> </span>tidos.</div><div class="t m0 x27 h9 y172 ff3 fs0 fc0 sc0 ls6 wsc">3. <span class="blank _0"> </span><span class="ls5a wsbf"> RUBÉO<span class="blank _2"></span>L<span class="blank _0"> </span>A</span></div><div class="t m0 x1c h6 y173 ff2 fs3 fc0 sc0 ls2f ws41">3<span class="blank _1"> </span>.1<span class="blank _1"> </span>.<span class="blank _0"> </span> <span class="ls30 ws42"> EPIDEMIOL<span class="blank _2"></span>OGIA</span></div><div class="t m0 x1c ha y174 ff6 fs6 fc2 sc0 ls2 wsc0">A rub<span class="blank _0"> </span>éola, ta<span class="blank _0"> </span>mbém c<span class="blank _0"> </span>hamada de saram<span class="blank _0"> </span>po alemão </div><div class="t m0 x1c ha y175 ff6 fs6 fc2 sc0 ls2 ws5e">ou de sara<span class="blank _0"> </span>mpo dos 3 dias, é u<span class="blank _0"> </span>ma doenç<span class="blank _0"> </span>a exante-</div><div class="t m98 x1c ha y176 ff6 fs6 fc2 sc0 ls31 wsf">mática agu<span class="blank _0"> </span>da, de al<span class="blank _0"> </span>ta contag<span class="blank _0"> </span>iosidade e leve em </div><div class="t m99 x1c ha y177 ff6 fs6 fc2 sc0 ls37 ws36">lacten<span class="blank _0"> </span>tes e crianças. Em ad<span class="blank _0"> </span>ultos, cos<span class="blank _0"> </span>tuma ser mais </div><div class="t m9a x1c ha y178 ff6 fs6 fc2 sc0 ls3b ws6d">grave, send<span class="blank _0"> </span>o impor<span class="blank _0"> </span>t<span class="blank _0"> </span>ante princi<span class="blank _0"> </span>palmente devid<span class="blank _0"> </span>o </div><div class="t m9b x1c ha y179 ff6 fs6 fc2 sc0 ls12 wsf">à possibilidad<span class="blank _0"> </span>e de infecção transp<span class="blank _0"> </span>lacentár<span class="blank _0"> </span>ia que </div><div class="t m3 x1c ha y17a ff6 fs6 fc2 sc0 ls3a wsc1">oco<span class="blank _0"> </span>rre em ges<span class="blank _0"> </span>tantes e resul<span class="blank _0"> </span>ta na síndrom<span class="blank _0"> </span>e da<span class="blank _2"></span> </div><div class="t m9c x1c ha y17b ff6 fs6 fc2 sc0 lsd wsf">rub<span class="blank _0"> </span>éola con<span class="blank _0"> </span>gênita<span class="blank _0"> </span>. Antes da vacinação u<span class="blank _0"> </span>niversal, </div><div class="t m0 x1c ha y17c ff6 fs6 fc2 sc0 ls2 ws7a">a rub<span class="blank _0"> </span>éola oco<span class="blank _0"> </span>rria em e<span class="blank _0"> </span>pidemias a cada 6 a 9 a<span class="blank _0"> </span>nos </div><div class="t m0 x1c ha y17d ff6 fs6 fc2 sc0 ls2 wsb6">e era mais c<span class="blank _0"> </span>omum em p<span class="blank _0"> </span>ré<span class="blank _0"> </span>-<span class="blank _0"> </span>escolares e esc<span class="blank _0"> </span>olares. </div><div class="t m0 x1c ha y17e ff6 fs6 fc2 sc0 ls2 ws7">Ap<span class="blank _0"> </span>ós a introduç<span class="blank _0"> </span>ão da vacina, a inc<span class="blank _0"> </span>idênc<span class="blank _0"> </span>ia caiu em </div><div class="t m9d x1c ha y17f ff6 fs6 fc2 sc0 ls12 wsf">mais de 99%<span class="blank _0"> </span>, c<span class="blank _0"> </span>om uma inci<span class="blank _0"> </span>dência re<span class="blank _0"> </span>lativamente </div><div class="t m0 x11 h10 y2a ffa fsa fc4 sc1 ls2 ws7">Ano_1_Pediatria-2.indb 86<span class="blank _a"></span><span class="fc5 sc0">Ano_1_Pediatria-2.indb 86<span class="blank _b"> </span><span class="fc4 sc1">03/11/2021 12:45:46<span class="blank _c"></span><span class="fc5 sc0">03/11/2021 12:45:46</span></span></span></div></div><div class="pi" data-data="{"ctm":[1.000000,0.000000,0.000000,1.000000,0.000000,0.000000]}"></div></div> <div id="pf7" class="pf w0 h0" data-page-no="7"><div class="pc pc7 w0 h0"><img fetchpriority="low" loading="lazy" class="bi x0 y0 w1 h1" alt="" src="https://files.passeidireto.com/cb6739bf-1d15-4a05-9b9e-791388b639c2/bg7.png"><div class="t m0 x1f h16 y2b ff2 fs8 fc0 sc0 ls33 ws7">Doenças ex<span class="blank _2"></span>antemáticas<span class="blank _10"> </span><span class="fs9 fc1 ls18">Cap. 4</span></div><div class="t m0 x1 h2 y1 ff1 fs0 fc0 sc0 ls5b">87</div><div class="t m0 x9 ha y4a ff6 fs6 fc2 sc0 ls2 wsc7">alta da do<span class="blank _0"> </span>ença e<span class="blank _0"> </span>m maiores de 1<span class="blank _9"></span>9 an<span class="blank _0"> </span>os. No Brasil, </div><div class="t m9e x9 ha y4b ff6 fs6 fc2 sc0 ls38 ws36">de 1<span class="blank _9"></span>999 a 20<span class="blank _0"> </span>01 ocor<span class="blank _0"> </span>reram sur<span class="blank _1"> </span>tos em vários estados<span class="blank _0"> </span> </div><div class="t m0 x9 ha y71 ff6 fs6 fc2 sc0 ls2 ws52">do país, co<span class="blank _0"> </span>m aumen<span class="blank _0"> </span>to progressivo no núme<span class="blank _0"> </span>ro de </div><div class="t m9f x9 ha y72 ff6 fs6 fc2 sc0 ls3c ws36">casos suspe<span class="blank _0"> </span>itos de síndrome de r<span class="blank _0"> </span>ubéola c<span class="blank _0"> </span>ongê<span class="blank _0"> </span>nita </div><div class="t ma0 x9 ha y73 ff6 fs6 fc2 sc0 ls2e ws6d">devido à sua inc<span class="blank _0"> </span>idência e<span class="blank _0"> </span>m mulheres e<span class="blank _0"> </span>m idade </div><div class="t m0 x9 ha y74 ff6 fs6 fc2 sc0 ls2 ws5f">fér<span class="blank _0"> </span>til. Foi intensi\ue61f<span class="blank _0"> </span>cada a vigilân<span class="blank _0"> </span>cia epide<span class="blank _0"> </span>miológica </div><div class="t m0 x9 ha y75 ff6 fs6 fc2 sc0 ls2 ws9f">e ampliadas a vacinaç<span class="blank _0"> </span>ão de bloque<span class="blank _0"> </span>io de rub<span class="blank _0"> </span>éola e </div><div class="t m0 x9 ha y76 ff6 fs6 fc2 sc0 ls2 ws52">a vacinação de ad<span class="blank _0"> </span>olesce<span class="blank _0"> </span>ntes e adultos, ating<span class="blank _0"> </span>indo </div><div class="t ma1 x9 ha y77 ff6 fs6 fc2 sc0 ls16 ws36">um con<span class="blank _0"> </span>trole signi\ue61f<span class="blank _0"> </span>cativo da doenç<span class="blank _0"> </span>a, se<span class="blank _0"> </span>ndo o último </div><div class="t ma2 x9 ha y78 ff6 fs6 fc2 sc0 ls9 wsf">caso con<span class="blank _0"> </span>\ue61frmado no B<span class="blank _0"> </span>rasil em 200<span class="blank _0"> </span>8. Em 201<span class="blank _11"></span>5<span class="blank _0"> </span>, o </div><div class="t m0 x9 ha y79 ff6 fs6 fc2 sc0 ls2 ws82">Brasil rec<span class="blank _0"> </span>ebe<span class="blank _0"> </span>u do Comi<span class="blank _0"> </span>tê Internaciona<span class="blank _0"> </span>l de E<span class="blank _0"> </span>xper<span class="blank _0"> </span>ts </div><div class="t ma3 x9 ha y7a ff6 fs6 fc2 sc0 ls31 wsf">os docu<span class="blank _0"> </span>mentos de veri<span class="blank _0"> </span>\ue61fcação da e<span class="blank _0"> </span>liminação da </div><div class="t m0 x9 ha y7b ff6 fs6 fc2 sc0 ls31 ws7e">Rubéola e d<span class="blank _2"></span>a Síndrome d<span class="blank _2"></span>a Rubéola Congênita.</div><div class="t m0 x9 h6 y180 ff2 fs3 fc0 sc0 ls32 ws64">3.2.<span class="blank _9"></span> <span class="ls30 ws65"> <span class="blank _12"></span>ETIOLOGIA<span class="blank _2"></span> E P<span class="blank _9"></span>A<span class="blank _9"></span>TOGÊNES<span class="blank _2"></span>E</span></div><div class="t m0 x9 ha y181 ff6 fs6 fc2 sc0 ls2 wsc8">A rub<span class="blank _0"> </span>éola é causada po<span class="blank _0"> </span>r um vírus d<span class="blank _0"> </span>e RNA d<span class="blank _0"> </span>e \ue61fta </div><div class="t ma4 x9 ha y182 ff6 fs6 fc2 sc0 ls43 ws36">única<span class="blank _0"> </span>, da famí<span class="blank _0"> </span>lia <span class="ff7 ls27 wsc2">Matona<span class="blank _2"></span>viridae<span class="ff6 ls43 ws36"> e do gê<span class="blank _0"> </span>nero </span><span class="ls41 wsc3">Ru<span class="blank _0"> </span>biv<span class="blank _2"></span>irus<span class="ff6 ls2 ws7">, </span></span></span></div><div class="t m0 x9 ha y183 ff6 fs6 fc2 sc0 ls2 ws6b">cujo ún<span class="blank _0"> </span>ico hospe<span class="blank _0"> </span>deiro co<span class="blank _0"> </span>nhec<span class="blank _0"> </span>ido é o humano. S<span class="blank _0"> </span>ua </div><div class="t ma5 x9 ha y184 ff6 fs6 fc2 sc0 ls5c ws36">transmissão o<span class="blank _0"> </span>corre po<span class="blank _0"> </span>r gotículas, preferen<span class="blank _0"> </span>cialmen<span class="blank _0"> </span>te </div><div class="t m0 x9 ha y185 ff6 fs6 fc2 sc0 ls2 ws7">no inverno e na pr<span class="blank _0"> </span>imav<span class="blank _2"></span>er<span class="blank _0"> </span>a.</div><div class="t ma6 x9 ha y186 ff6 fs6 fc2 sc0 ls40 ws36">Ap<span class="blank _0"> </span>ós a inf<span class="blank _2"></span>ec<span class="blank _0"> </span>ção, o vírus rep<span class="blank _0"> </span>lica no epi<span class="blank _0"> </span>télio respirató<span class="ls2">-</span></div><div class="t m0 x9 ha y187 ff6 fs6 fc2 sc0 ls2 ws5c">rio e, e<span class="blank _0"> </span>m seguida<span class="blank _0"> </span>, se dissem<span class="blank _0"> </span>ina para os linfonodos </div><div class="t m0 x9 ha y188 ff6 fs6 fc2 sc0 ls2 wsc9">regiona<span class="blank _0"> </span>is. Segu<span class="blank _0"> </span>e<span class="blank _0"> </span>-se a vire<span class="blank _0"> </span>mia mais intensa do 1<span class="blank _2"></span>0º </div><div class="t m0 x9 ha y189 ff6 fs6 fc2 sc0 ls2 wsca">ao 1<span class="blank _9"></span>7º dia. A\ue60fexcreção vira<span class="blank _0"> </span>l a par<span class="blank _0"> </span>tir da nasof<span class="blank _2"></span>arin<span class="blank _0"> </span>ge </div><div class="t m0 x9 ha y18a ff6 fs6 fc2 sc0 ls2 wscb">com<span class="blank _0"> </span>eça ce<span class="blank _0"> </span>rca de 1<span class="blank _2"></span>0 dias após a infecção e p<span class="blank _0"> </span>ode </div><div class="t ma7 x9 ha y18b ff6 fs6 fc2 sc0 ls3c wse">ser de<span class="blank _0"> </span>tectada até 2 se<span class="blank _0"> </span>manas após o início do exan</div><div class="t ma8 x31 ha y18b ff6 fs6 fc2 sc0 ls2">-</div><div class="t m0 x9 ha y18c ff6 fs6 fc2 sc0 ls5c ws1a">tem<span class="blank _0"> </span>a.<span class="blank _0"> </span> <span class="ff8 ls2 ws7d">O\ue61d<span class="blank _0"> </span>per<span class="blank _0"> </span>íodo de maio<span class="blank _0"> </span>r transm<span class="blank _0"> </span>issibilidad<span class="blank _0"> </span>e é de </span></div><div class="t ma9 x9 hb y18d ff8 fs6 fc2 sc0 ls2 ws11">5 a 7 dias antes a<span class="blank _0"> </span>té 7 dias após o apa<span class="blank _0"> </span>recim<span class="blank _0"> </span>ento </div><div class="t m0 x9 hb y18e ff8 fs6 fc2 sc0 ls31 ws7e">do ex<span class="blank _2"></span>antema.</div><div class="t m0 x9 h6 y18f ff2 fs3 fc0 sc0 ls5d wscc">3.3. <span class="ls44 ws74"> QU<span class="blank _2"></span>ADRO <span class="blank _13"> </span>CLÍNICO</span></div><div class="t m0 x9 ha y190 ff6 fs6 fc2 sc0 ls2 ws7e">Ap<span class="blank _0"> </span>ós um <span class="ff8">perío<span class="blank _0"> </span>do de inc<span class="blank _0"> </span>ubação de 2 a 3 se<span class="blank _0"> </span>manas</span><span class="ws7">, </span></div><div class="t m0 x9 ha y191 ff6 fs6 fc2 sc0 ls31 wsc7">começa um <span class="ff8 ls2 wsc0">pród<span class="blank _0"> </span>romo de feb<span class="blank _0"> </span>re baixa, do<span class="blank _0"> </span>r de gar<span class="blank _2"></span>-</span></div><div class="t m0 x9 hb y192 ff8 fs6 fc2 sc0 ls2 ws84">gant<span class="blank _0"> </span>a, hip<span class="blank _0"> </span>eremia o<span class="blank _0"> </span>cular c<span class="blank _0"> </span>om ou sem d<span class="blank _0"> </span>or<span class="blank _9"></span>, c<span class="blank _0"> </span>efaleia<span class="blank _0"> </span>, </div><div class="t maa x9 ha y193 ff8 fs6 fc2 sc0 lsd ws11">mal-<span class="blank _0"> </span>es<span class="blank _0"> </span>tar<span class="blank _2"></span>, anorexia e li<span class="blank _0"> </span>nfadeno<span class="blank _0"> </span>patia<span class="ff6 wsf">, se<span class="blank _0"> </span>ndo mais </span></div><div class="t mab x9 ha y194 ff6 fs6 fc2 sc0 ls9 ws55">proeminen<span class="blank _0"> </span>t<span class="blank _2"></span>es os <span class="ff8 ls1f wsad">linfonodos cer<span class="blank _0"> </span>vicais suboccipi<span class="ls2">-</span></span></div><div class="t mac x9 ha y195 ff8 fs6 fc2 sc0 ls35 wsf">tais, re<span class="blank _0"> </span>troaur<span class="blank _0"> </span>iculares e a<span class="blank _0"> </span>nteriore<span class="blank _0"> </span>s<span class="ff6 ws6d">. Em crianças<span class="blank _0"> </span>, </span></div><div class="t mad x9 ha y196 ff6 fs6 fc2 sc0 ls2e wscd">geralment<span class="blank _2"></span>e não ocorr<span class="blank _2"></span>e o pródr<span class="blank _2"></span>omo, segui<span class="blank _2"></span>ndo<span class="blank _0"> </span>-se </div><div class="t mae x9 ha y197 ff6 fs6 fc2 sc0 ls37 wse">logo par<span class="blank _0"> </span>a a fase do ex<span class="blank _2"></span>antema<span class="blank _0"> </span>, que se inic<span class="blank _0"> </span>ia em face </div><div class="t m0 x9 ha y198 ff6 fs6 fc2 sc0 ls2 wsbb">e pesco<span class="blank _0"> </span>ço com<span class="blank _0"> </span>o <span class="ff8 lsd ws5a">máculas rosadas p<span class="blank _0"> </span>eque<span class="blank _0"> </span>nas, irre<span class="blank _0"> </span><span class="ls2">-</span></span></div><div class="t m0 x9 hb y199 ff8 fs6 fc2 sc0 ls2 ws85">gular<span class="blank _0"> </span>es, coale<span class="blank _0"> </span>scentes e d<span class="blank _0"> </span>issemin<span class="blank _0"> </span>a-se par<span class="blank _0"> </span>a tronc<span class="blank _0"> </span>o </div><div class="t maf x9 ha y19a ff8 fs6 fc2 sc0 ls2 ws35">e extre<span class="blank _0"> </span>midades<span class="ff6 ls37 ws36"> (Figura\ue60f<span class="blank _9"></span>5<span class="blank _0"> </span>)<span class="blank _2"></span>. <span class="ff8 ls11 ws59">O\ue61d<span class="blank _9"></span>exant<span class="blank _2"></span>ema desaparece </span></span></div><div class="t mb0 x9 hb y19b ff8 fs6 fc2 sc0 ls31 wsf">da face à me<span class="blank _0"> </span>dida que d<span class="blank _0"> </span>esce para o c<span class="blank _0"> </span>orpo, du<span class="blank _0"> </span>ra </div><div class="t mb1 x22 ha y4a ff8 fs6 fc2 sc0 ls11 ws11">cer<span class="blank _0"> </span>ca de 3 dias e desa<span class="blank _0"> </span>parece s<span class="blank _0"> </span>em desca<span class="blank _0"> </span>mação<span class="ff6 ls2 ws7">. </span></div><div class="t mb2 x22 ha y4b ff6 fs6 fc2 sc0 ls10 wsf">À\ue60f<span class="blank _1"> </span>orosc<span class="blank _0"> </span>opia pode<span class="blank _0"> </span>mos iden<span class="blank _0"> </span>ti\ue61fcar as <span class="ff8">man<span class="blank _0"> </span>chas de </span></div><div class="t m0 x22 ha y71 ff8 fs6 fc2 sc0 ls31 wsc4">Forchheimer<span class="ff6 ls2 wsce"> (Figura\ue60f<span class="blank _1"> </span>6<span class="blank _9"></span>), qu<span class="blank _0"> </span>e são peque<span class="blank _0"> </span>nas lesões </span></div><div class="t m0 x22 ha y72 ff6 fs6 fc2 sc0 ls2 ws7">róseas ou pe<span class="blank _0"> </span>téquias em palato.</div><div class="t m0 x32 hd y19c ff8 fs8 fc0 sc0 ls2 ws7">Fig<span class="blank _0"> </span>ura 5<span class="blank _0"> </span>. <span class="ff6 fc2 ls23 ws73">Exantema rubeoliforme, caracteriza-se </span></div><div class="t m0 x33 hd y19d ff6 fs8 fc2 sc0 ls2 ws7">po<span class="blank _0"> </span>r mácu<span class="blank _0"> </span>las rosad<span class="blank _0"> </span>as, p<span class="blank _0"> </span>equ<span class="blank _0"> </span>enas<span class="blank _0"> </span>, que p<span class="blank _0"> </span>ode<span class="blank _0"> </span>m </div><div class="t m0 x34 hd y19e ff6 fs8 fc2 sc0 ls2 ws7">coa<span class="blank _0"> </span>lesc<span class="blank _0"> </span>er e<span class="blank _0"> </span>m tronc<span class="blank _0"> </span>o e des<span class="blank _0"> </span>apare<span class="blank _0"> </span>ce<span class="blank _0"> </span>m da </div><div class="t m0 x35 hd y19f ff6 fs8 fc2 sc0 ls2 ws7">face à m<span class="blank _0"> </span>edi<span class="blank _0"> </span>da que a<span class="blank _0"> </span>ting<span class="blank _0"> </span>em o tro<span class="blank _0"> </span>nco.</div><div class="t m0 x36 he y1a0 ff8 fs9 fc0 sc0 ls2 ws7">Fon<span class="blank _0"> </span>te: <span class="ff9 fc2 ls14 ws8">Ge<span class="blank _0"> </span>tt<span class="blank _0"> </span>y Images.</span></div><div class="t m0 x37 h17 y1a1 ff9 fsb fc2 sc0 ls5e wsc5">12</div><div class="t m0 x35 hd y1a2 ff8 fs8 fc0 sc0 ls2 ws7">Fig<span class="blank _0"> </span>ura 6<span class="blank _0"> </span>. <span class="ff6 fc2 ls2e ws30">Manchas<span class="blank _2"></span> de For<span class="blank _2"></span>chheimer à </span></div><div class="t m0 xc hd y1a3 ff6 fs8 fc2 sc0 ls2 ws7">oros<span class="blank _0"> </span>cop<span class="blank _0"> </span>ia, c<span class="blank _0"> </span>arac<span class="blank _0"> </span>ter<span class="blank _0"> </span>izadas p<span class="blank _0"> </span>or le<span class="blank _0"> </span>sões p<span class="blank _0"> </span>equ<span class="blank _0"> </span>enas </div><div class="t m0 x38 hd y1a4 ff6 fs8 fc2 sc0 ls2 ws7">róse<span class="blank _0"> </span>as ou pe<span class="blank _0"> </span>téqu<span class="blank _0"> </span>ias em pa<span class="blank _0"> </span>lato.</div><div class="t m0 x39 he y1a5 ff8 fs9 fc0 sc0 ls2 ws7">Fon<span class="blank _0"> </span>te: <span class="ff9 fc2 ls14 ws8">Pub<span class="blank _0"> </span>lic Health Image Librar<span class="blank _0"> </span>y (PHIL).<span class="blank _9"></span>1<span class="blank _9"></span>3</span></div><div class="t mb3 x22 ha y1a6 ff6 fs6 fc2 sc0 ls29 ws6d">V<span class="blank _2"></span>eja que, a<span class="blank _0"> </span>pesar de o exantema ser pare<span class="blank _0"> </span>cido, a </div><div class="t mb4 x22 ha y1a7 ff6 fs6 fc2 sc0 ls5f ws67">rubé<span class="blank _0"> </span>ola é uma doe<span class="blank _0"> </span>nça be<span class="blank _0"> </span>m mais lev<span class="blank _2"></span>e que o sar<span class="blank _0"> </span>ampo, </div><div class="t mb5 x22 ha y1a8 ff6 fs6 fc2 sc0 ls27 ws36">com exantema de m<span class="blank _0"> </span>enor d<span class="blank _0"> </span>uração e me<span class="blank _0"> </span>nos sintomas </div><div class="t mb6 x22 ha y1a9 ff6 fs6 fc2 sc0 ls60 ws15">si<span class="blank _2"></span>stêm<span class="blank _2"></span>icos<span class="blank _2"></span>. Inc<span class="blank _2"></span>lus<span class="blank _2"></span>ive,<span class="blank _2"></span> podem<span class="blank _2"></span> ocorr<span class="blank _2"></span>er in<span class="blank _2"></span>fec<span class="blank _2"></span>ções<span class="blank _2"></span> </div><div class="t mb7 x22 ha y1aa ff6 fs6 fc2 sc0 ls3c wse">subc<span class="blank _0"> </span>línicas da rub<span class="blank _0"> </span>éola sem exantema e<span class="blank _0"> </span>m 25 a 40%<span class="blank _0"> </span> </div><div class="t m0 x22 ha y1ab ff6 fs6 fc2 sc0 ls2 ws7">dos casos.</div><div class="t m0 x11 h10 y2a ffa fsa fc4 sc1 ls2 ws7">Ano_1_Pediatria-2.indb 87<span class="blank _a"></span><span class="fc5 sc0">Ano_1_Pediatria-2.indb 87<span class="blank _b"> </span><span class="fc4 sc1">03/11/2021 12:45:47<span class="blank _c"></span><span class="fc5 sc0">03/11/2021 12:45:47</span></span></span></div></div><div class="pi" data-data="{"ctm":[1.000000,0.000000,0.000000,1.000000,0.000000,0.000000]}"></div></div> <div id="pf8" class="pf w0 h0" data-page-no="8"><div class="pc pc8 w0 h0"><img fetchpriority="low" loading="lazy" class="bi x0 y0 w1 h1" alt="" src="https://files.passeidireto.com/cb6739bf-1d15-4a05-9b9e-791388b639c2/bg8.png"><div class="t m0 x12 h11 y2b ff4 fs9 fc1 sc0 ls18 ws7">Doenças ex<span class="blank _2"></span>antemáticas<span class="blank _d"> </span><span class="ff2 fs8 fc0 ls19 v0">Urgências pediátricas</span></div><div class="t m0 x13 h2 y1 ff1 fs0 fc0 sc0 ls61">88</div><div class="t m5a x3a h12 ye9 ff2 fs9 fc1 sc0 ls62 ws8e"> DIC<span class="blank _0"> </span>A </div><div class="t m0 x3b h8 yea ff6 fs5 fc2 sc0 ls4e ws91">\ue60bO pri<span class="blank _0"> </span>ncipa<span class="blank _0"> </span>l achad<span class="blank _0"> </span>o clínic<span class="blank _0"> </span>o que d<span class="blank _0"> </span>eve </div><div class="t m0 x3a h8 yeb ff6 fs5 fc2 sc0 ls4f wsd1">levar voc<span class="blank _0"> </span>ê a pensa<span class="blank _0"> </span>r em ru<span class="blank _0"> </span>béo<span class="blank _0"> </span>la nas provas é </div><div class="t m0 x3a h8 yec ff6 fs5 fc2 sc0 ls63 wsd1">o en<span class="blank _0"> </span>con<span class="blank _0"> </span>tro de linfad<span class="blank _0"> </span>eno<span class="blank _0"> </span>patia ce<span class="blank _0"> </span>r<span class="blank _0"> </span>vica<span class="blank _0"> </span>l pos<span class="blank _0"> </span>te<span class="ls2">-</span></div><div class="t m0 x3a h8 yed ff6 fs5 fc2 sc0 ls64 wsd2">rior associada ao ex<span class="blank _2"></span>antema maculo<span class="blank _0"> </span>papular </div><div class="t m0 x3a h8 yee ff6 fs5 fc2 sc0 ls2 ws7">evanes<span class="blank _0"> </span>cen<span class="blank _0"> </span>te e de cur<span class="blank _0"> </span>t<span class="blank _0"> </span>a dura<span class="blank _0"> </span>ção.</div><div class="t m0 x19 h6 y1ac ff2 fs3 fc0 sc0 ls2 ws7">3.<span class="blank _0"> </span>4<span class="blank _0"> </span>. <span class="ls51 ws97"> DIA<span class="blank _2"></span>GNÓSTI<span class="blank _2"></span>CO</span></div><div class="t mb8 x19 ha y1ad ff6 fs6 fc2 sc0 ls31 ws67">O diagnóstico da r<span class="blank _0"> </span>ubéola é clínic<span class="blank _0"> </span>o<span class="blank _0"> </span>-e<span class="blank _0"> </span>pidemioló<span class="blank _0"> </span>gico, </div><div class="t mb9 x19 ha y1ae ff6 fs6 fc2 sc0 ls65 wsf">mas pode<span class="blank _0"> </span>mos enc<span class="blank _0"> </span>ontrar ac<span class="blank _0"> </span>hados labo<span class="blank _0"> </span>ratoriais<span class="blank _2"></span> </div><div class="t mba x19 ha y1af ff6 fs6 fc2 sc0 ls66 wscd">inespecí\ue61fcos, como leucopenia, neutr<span class="blank _2"></span>openia e<span class="blank _2"></span> </div><div class="t m0 x19 ha y1b0 ff6 fs6 fc2 sc0 ls3a wsad">trombo<span class="blank _0"> </span>citope<span class="blank _0"> </span>nia leve. <span class="ff8 ws55">O\ue61d<span class="blank _0"> </span>d<span class="blank _0"> </span>iagnós<span class="blank _0"> </span>tico de ce<span class="blank _0"> </span>r<span class="blank _0"> </span>teza </span></div><div class="t m0 x19 hb y1b1 ff8 fs6 fc2 sc0 ls3a ws86">é esse<span class="blank _0"> </span>ncial em g<span class="blank _0"> </span>esta<span class="blank _0"> </span>ntes com r<span class="blank _0"> </span>ubéola e n<span class="blank _0"> </span>a sín<span class="ls2">-</span></div><div class="t mbb x19 ha y1b2 ff8 fs6 fc2 sc0 ls60 ws58">drome da<span class="blank _2"></span> rubéola congênita<span class="ff6 ls67 wsf">, pod<span class="blank _0"> </span>endo se<span class="blank _0"> </span>r f<span class="blank _2"></span>ei<span class="blank _0"> </span>to<span class="blank _2"></span> </span></div><div class="t m0 x19 ha y1b3 ff6 fs6 fc2 sc0 ls3a wsd3">por me<span class="blank _0"> </span>io da dosagem d<span class="blank _0"> </span>e IgM e IgG o<span class="blank _0"> </span>u pelo iso<span class="blank _0"> </span><span class="ls2">-</span></div><div class="t mbc x19 ha y1b4 ff6 fs6 fc2 sc0 ls68 wsf">lamen<span class="blank _0"> </span>to do vírus em se<span class="blank _0"> </span>creç<span class="blank _0"> </span>ão de nasofaringe, </div><div class="t m0 x19 ha y1b5 ff6 fs6 fc2 sc0 ls68 ws7e">sangue ou<span class="blank _2"></span> urina.</div><div class="t m0 x19 ha y1b6 ff6 fs6 fc2 sc0 ls2 ws15">Não se esque<span class="blank _0"> </span>ça de que <span class="ff8">t<span class="blank _0"> </span>anto a rub<span class="blank _0"> </span>éola qua<span class="blank _0"> </span>nto a </span></div><div class="t mbd x19 hb y1b7 ff8 fs6 fc2 sc0 ls1f wsf">síndro<span class="blank _0"> </span>me da rub<span class="blank _0"> </span>éola con<span class="blank _0"> </span>gêni<span class="blank _0"> </span>ta são doen<span class="blank _0"> </span>ças de </div><div class="t m0 x19 hb y1b8 ff8 fs6 fc2 sc0 ls2 wsae">noti\ue61f<span class="blank _0"> </span>cação co<span class="blank _0"> </span>mpulsó<span class="blank _0"> </span>ria imed<span class="blank _0"> </span>iata, o<span class="blank _0"> </span>u seja, lo<span class="blank _0"> </span>go à </div><div class="t m0 x19 ha y1b9 ff8 fs6 fc2 sc0 ls9 wsd4">suspeita clínica<span class="ff6 ls2">.</span></div><div class="t m0 x19 h6 y1ba ff2 fs3 fc0 sc0 ls2 ws7">3.<span class="blank _0"> </span>5. <span class="ls53 wsa0"> <span class="blank _12"></span>TR<span class="blank _0"> </span>A<span class="blank _9"></span>T<span class="blank _9"></span>A<span class="blank _0"> </span>ME<span class="blank _0"> </span>NTO E C<span class="blank _2"></span>OMPLI<span class="blank _0"> </span>CAÇÕES</span></div><div class="t m0 x19 ha y1bb ff6 fs6 fc2 sc0 ls2 wsd5">A rub<span class="blank _0"> </span>éola é uma doe<span class="blank _0"> </span>nça br<span class="blank _0"> </span>anda com p<span class="blank _0"> </span>rognós<span class="blank _0"> </span>tico </div><div class="t m0 x19 ha y1bc ff6 fs6 fc2 sc0 ls2 ws5d">excelente. O\ue60ftratamen<span class="blank _0"> </span>to é apenas de sup<span class="blank _0"> </span>or<span class="blank _0"> </span>te, com </div><div class="t m0 x19 ha y1bd ff6 fs6 fc2 sc0 lsd ws18">antipiréticos e anal<span class="blank _0"> </span>gésicos. <span class="ff8 ls1f ws6f">Imunoglobulina e cor<span class="blank _2"></span><span class="ls2">-</span></span></div><div class="t mbe x19 hb y1be ff8 fs6 fc2 sc0 lsc ws55">ticoides pode<span class="blank _0"> </span>m ser considerad<span class="blank _0"> </span>os nos casos de </div><div class="t m0 x19 ha y1bf ff8 fs6 fc2 sc0 ls25 ws6f">trombocitopeni<span class="blank _2"></span>a grav<span class="blank _9"></span>e não remitent<span class="blank _2"></span>e<span class="ff6 ls2">.</span></div><div class="t mbf x19 ha y1c0 ff6 fs6 fc2 sc0 ls5c ws36">As com<span class="blank _0"> </span>plicaçõ<span class="blank _0"> </span>es são infrequen<span class="blank _0"> </span>tes e geralme<span class="blank _0"> </span>nte não </div><div class="t m0 x19 ha y1c1 ff6 fs6 fc2 sc0 ls2 wsae">são fatais. As mais rec<span class="blank _0"> </span>orrentes são a trom<span class="blank _0"> </span>boci<span class="blank _0"> </span>to-</div><div class="t mc0 x19 ha y1c2 ff6 fs6 fc2 sc0 ls3c ws36">penia e a ar<span class="blank _0"> </span>tr<span class="blank _0"> </span>ite. <span class="ff8 ls1f ws6e">A\ue61d<span class="blank _11"></span>trombocitopenia<span class="blank _2"></span> pós-inf<span class="blank _2"></span>ecciosa </span></div><div class="t mc1 x19 hb y1c3 ff8 fs6 fc2 sc0 ls5c ws67">manifest<span class="blank _0"> </span>a-se ge<span class="blank _0"> </span>ralme<span class="blank _0"> </span>nte em cr<span class="blank _0"> </span>ianças do sexo femi<span class="ls2">-</span></div><div class="t m0 x19 ha y1c4 ff8 fs6 fc2 sc0 ls12 ws99">nino e geralme<span class="blank _0"> </span>nte é autol<span class="blank _2"></span>imitada.<span class="ff6 ls2 ws58"> A<span class="blank _0"> </span>parece c<span class="blank _0"> </span>erca </span></div><div class="t m76 x19 ha y1c5 ff6 fs6 fc2 sc0 ls10 ws11">de 2 sema<span class="blank _0"> </span>nas após o exantema<span class="blank _0"> </span>, com pe<span class="blank _0"> </span>téquias, </div><div class="t mc2 x19 ha y1c6 ff6 fs6 fc2 sc0 ls52 ws36">epis<span class="blank _0"> </span>taxe, sangra<span class="blank _0"> </span>mento gastroin<span class="blank _0"> </span>testinal e hematú<span class="blank _0"> </span>ria. </div><div class="t m0 x19 hb y1c7 ff8 fs6 fc2 sc0 ls2 wsd6">Já a ar<span class="blank _0"> </span>tri<span class="blank _0"> </span>te é mais comu<span class="blank _0"> </span>m em mulh<span class="blank _0"> </span>eres ad<span class="blank _0"> </span>ultas. </div><div class="t m0 x19 hb y1c8 ff8 fs6 fc2 sc0 ls2 wscb">Com<span class="blank _0"> </span>eça um<span class="blank _0"> </span>a semana a<span class="blank _0"> </span>pós o início d<span class="blank _0"> </span>o exantema </div><div class="t mc3 x19 ha y1c9 ff8 fs6 fc2 sc0 ls2e ws6d">e envolve as peque<span class="blank _0"> </span>nas ar<span class="blank _0"> </span>ticulaç<span class="blank _0"> </span>ões das mãos.<span class="ff6 ls2 ws7"> </span></div><div class="t m0 x19 ha y1ca ff6 fs6 fc2 sc0 ls2 wsd7">É\ue60f<span class="blank _1"> </span>autolimi<span class="blank _0"> </span>tada, desa<span class="blank _0"> </span>parece<span class="blank _0"> </span>ndo sem se<span class="blank _0"> </span>quelas em </div><div class="t m0 x19 ha y1cb ff6 fs6 fc2 sc0 ls11 ws9e">algumas semanas.</div><div class="t mc4 x1c ha y4a ff6 fs6 fc2 sc0 ls40 ws36">A enc<span class="blank _0"> </span>efalite é a complica<span class="blank _0"> </span>ção mais grave da rubéo<span class="blank _0"> </span>la. </div><div class="t mc5 x1c ha y4b ff6 fs6 fc2 sc0 lsb wse">À\ue60f<span class="blank _9"></span>se<span class="blank _0"> </span>melhan<span class="blank _0"> </span>ça do que oc<span class="blank _0"> </span>orre no sara<span class="blank _0"> </span>mpo, po<span class="blank _0"> </span>de ser </div><div class="t m0 x1c ha y71 ff6 fs6 fc2 sc0 ls37 wsc9">de do<span class="blank _0"> </span>is tipos:</div><div class="t m0 x1a h15 y1cc ff5 fs7 fc3 sc0 ls2 ws7"> <span class="blank _6"></span>u</div><div class="t mc6 x1b ha y4d ff6 fs6 fc2 sc0 ls2 ws34">Encefalite pós<span class="blank _0"> </span>-infecciosa: acom<span class="blank _0"> </span>panha a rubé<span class="blank _0"> </span>ola </div><div class="t m0 x1b ha y1cd ff6 fs6 fc2 sc0 ls2 wsc0">aguda<span class="blank _0"> </span>, surge 7 dias ap<span class="blank _0"> </span>ós o início do exantema<span class="blank _0"> </span>, </div><div class="t m0 x1b ha y1ce ff6 fs6 fc2 sc0 ls2 ws99">com c<span class="blank _0"> </span>efaleia, co<span class="blank _0"> </span>nvulsão, coma<span class="blank _0"> </span>, sinais neuro<span class="blank _0"> </span>ló<span class="blank _0"> </span>-</div><div class="t m0 x1b ha y1cf ff6 fs6 fc2 sc0 ls2 ws7d">gicos focais e ata<span class="blank _0"> </span>xia. O\ue60f<span class="blank _0"> </span>líquor é nor<span class="blank _0"> </span>mal ou com </div><div class="t m0 x1b ha y1d0 ff6 fs6 fc2 sc0 ls2 ws69">pleo<span class="blank _0"> </span>citose mono<span class="blank _0"> </span>nuclear b<span class="blank _0"> </span>randa e/<span class="blank _2"></span>ou proteínas </div><div class="t mc7 x1b ha y1d1 ff6 fs6 fc2 sc0 lsd ws11">elevadas. Em ge<span class="blank _0"> </span>ral, oc<span class="blank _0"> </span>orre resoluç<span class="blank _0"> </span>ão total dos </div><div class="t m0 x1b ha y1d2 ff6 fs6 fc2 sc0 ls2 ws82">sintomas, mas já foram rela<span class="blank _0"> </span>tadas taxas de mor<span class="blank _2"></span>-</div><div class="t mc8 x1b ha y1d3 ff6 fs6 fc2 sc0 ls2 ws11">talidade de 20<span class="blank _0"> </span>% e até sequelas n<span class="blank _0"> </span>eurológ<span class="blank _0"> </span>icas a </div><div class="t m0 x1b ha y1d4 ff6 fs6 fc2 sc0 ls10 ws18">longo prazo.</div><div class="t m0 x1a h15 y1d5 ff5 fs7 fc3 sc0 ls2 ws7"> <span class="blank _6"></span>u</div><div class="t mc9 x1b ha y1d6 ff6 fs6 fc2 sc0 ls2 ws1e">Pane<span class="blank _0"> </span>ncefalite progressiva da rub<span class="blank _0"> </span>éola (PPR): dis-</div><div class="t m0 x1b ha y1d7 ff6 fs6 fc2 sc0 ls2 wsaa">túrbio n<span class="blank _0"> </span>eurode<span class="blank _0"> </span>gen<span class="blank _0"> </span>erativo raro que oc<span class="blank _0"> </span>orre anos </div><div class="t mca x1b ha y1d8 ff6 fs6 fc2 sc0 ls52 ws1e">após a r<span class="blank _0"> </span>ubéola. I<span class="blank _0"> </span>nício e curso se<span class="blank _0"> </span>melha<span class="blank _0"> </span>nte à PEES<span class="blank _0"> </span>, </div><div class="t m0 x1b ha y1d9 ff6 fs6 fc2 sc0 ls2 ws7">com mo<span class="blank _0"> </span>r<span class="blank _0"> </span>te 2 a 5 anos dep<span class="blank _0"> </span>ois.</div><div class="t m0 x1c h6 y1da ff2 fs3 fc0 sc0 ls2 ws7">3.<span class="blank _0"> </span>6. <span class="ls59 wsba"> PRO<span class="blank _0"> </span>FIL<span class="blank _0"> </span>A<span class="blank _1"> </span>XI<span class="blank _0"> </span>A</span></div><div class="t mcb x1c ha y1db ff6 fs6 fc2 sc0 ls11 ws11">A pro\ue61fla<span class="blank _0"> </span>xia primár<span class="blank _0"> </span>ia é f<span class="blank _2"></span>ei<span class="blank _0"> </span>ta com a vacina tríp<span class="blank _0"> </span>lice </div><div class="t mcc x1c ha y1dc ff6 fs6 fc2 sc0 ls52 ws36">viral e<span class="blank _0"> </span>m duas doses: com 1<span class="blank _9"></span>2 m<span class="blank _0"> </span>eses e com 1<span class="blank _9"></span>5 me<span class="blank _0"> </span>ses </div><div class="t m0 x1c ha y1dd ff6 fs6 fc2 sc0 ls2 ws7">(<span class="blank _9"></span>so<span class="blank _0"> </span>b a forma da vacina tetraviral).</div><div class="t m0 x1c ha y1de ff6 fs6 fc2 sc0 ls2 ws9e">Os pacien<span class="blank _0"> </span>tes com rub<span class="blank _0"> </span>éola devem se<span class="blank _0"> </span>r isolados por </div><div class="t mcd x1c ha y1df ff6 fs6 fc2 sc0 ls16 wse">7 dias após o iníci<span class="blank _0"> </span>o do exantema, man<span class="blank _0"> </span>tendo<span class="blank _0"> </span>-se <span class="ff8 ls8 wscf">p<span class="blank"> </span>re<span class="blank"> </span><span class="ls2">-</span></span></div><div class="t mce x1c ha y1e0 ff8 fs6 fc2 sc0 ls43 ws67">cauç<span class="blank _0"> </span>ões de co<span class="blank _0"> </span>ntato e de g<span class="blank _0"> </span>otículas se hos<span class="blank _0"> </span>pitalizad<span class="blank _0"> </span>os.<span class="ff6 ls2 ws7"> </span></div><div class="t mcf x1c hb y1e1 ff8 fs6 fc2 sc0 ls42 ws67">Não se faz rotin<span class="blank _0"> </span>eirame<span class="blank _0"> </span>nte a imun<span class="blank _0"> </span>ização de bloq<span class="blank _0"> </span>ueio </div><div class="t m0 x1c ha y1e2 ff8 fs6 fc2 sc0 ls25 ws7e">para os<span class="blank _2"></span> contatos<span class="ff6 ls2 wsd8">, visto ser uma doe<span class="blank _0"> </span>nça mais leve, </span></div><div class="t m0 x1c ha y1e3 ff6 fs6 fc2 sc0 ls2 wsd9">mas ela pod<span class="blank _0"> </span>eria ser fei<span class="blank _0"> </span>ta com a vacina tríplic<span class="blank _0"> </span>e viral </div><div class="t md0 x1c ha y1e4 ff6 fs6 fc2 sc0 ls42 ws36">aplicada e<span class="blank _0"> </span>m até 72 horas após o co<span class="blank _0"> </span>ntato. <span class="ff8 ls37 ws59">Em<span class="blank _2"></span> mulhe<span class="blank _0"> </span><span class="ls2">-</span></span></div><div class="t m0 x1c hb y1e5 ff8 fs6 fc2 sc0 ls2 wsbb">res grávida<span class="blank _0"> </span>s suscetí<span class="blank _0"> </span>v<span class="blank _2"></span>eis exp<span class="blank _0"> </span>ostas à r<span class="blank _0"> </span>ubéo<span class="blank _0"> </span>la, pod<span class="blank _0"> </span>e </div><div class="t m0 x1c hb y1e6 ff8 fs6 fc2 sc0 ls1f ws4b">ser considerado o uso de<span class="blank _2"></span> imunoglobulina.</div><div class="t m0 x27 h9 y1e7 ff3 fs0 fc0 sc0 ls6 wsc">4. <span class="blank _0"> </span><span class="ws40"> E<span class="blank _0"> </span>X<span class="blank _1"> </span>ANTE<span class="blank _0"> </span>M<span class="blank _0"> </span>A <span class="blank _14"> </span>SÚB<span class="blank _0"> </span>ITO</span></div><div class="t m0 x1c h6 y1e8 ff2 fs3 fc0 sc0 ls2f ws41">4<span class="blank _1"> </span>.1<span class="blank _1"> </span>.<span class="blank _0"> </span> <span class="ls30 ws65"> <span class="blank _12"></span>EPIDEMIOL<span class="blank _2"></span>OGIA E ET<span class="blank _2"></span>IOLOGIA</span></div><div class="t m0 x1c ha y1e9 ff6 fs6 fc2 sc0 ls2 wscb">O exantema súbito, tam<span class="blank _0"> </span>bém ch<span class="blank _0"> </span>amado de roséola </div><div class="t md1 x1c ha y1ea ff6 fs6 fc2 sc0 ls2 ws36">infantum ou de sex<span class="blank _0"> </span>ta do<span class="blank _0"> </span>ença<span class="blank _0"> </span>, é a manifestação clí<span class="blank _0"> </span>-</div><div class="t md2 x1c ha y1eb ff6 fs6 fc2 sc0 ls16 ws36">nica da infecção p<span class="blank _0"> </span>rimária pe<span class="blank _0"> </span>lo Herp<span class="blank _0"> </span>esvírus huma<span class="blank _0"> </span>no </div><div class="t md3 x1c ha y1ec ff6 fs6 fc2 sc0 ls2 ws11">6 e, mais rar<span class="blank _0"> </span>amen<span class="blank _0"> </span>te, pelo He<span class="blank _0"> </span>rpesvír<span class="blank _0"> </span>us human<span class="blank _0"> </span>o 7<span class="blank _11"></span>, </div><div class="t m0 x1c ha y1ed ff6 fs6 fc2 sc0 ls2 ws5b">vírus de D<span class="blank _0"> </span>NA de du<span class="blank _0"> </span>pla \ue61fta da subfamí<span class="blank _0"> </span>lia dos \u03b2<span class="blank _0"> </span>-<span class="blank _0"> </span>her<span class="blank _2"></span>-</div><div class="t md4 x1c ha y1ee ff6 fs6 fc2 sc0 ls40 wse">pesvír<span class="blank _0"> </span>us (<span class="blank _9"></span>a\ue60f<span class="blank _2"></span>mesma do c<span class="blank _0"> </span>itomegal<span class="blank _0"> </span>ovírus<span class="blank _9"></span>). V<span class="blank _2"></span>emos q<span class="blank _0"> </span>ue </div><div class="t m0 x1c ha y1ef ff6 fs6 fc2 sc0 ls2 ws33">a infecção pe<span class="blank _0"> </span>los her<span class="blank _0"> </span>pesvírus hu<span class="blank _0"> </span>mano 6 e 7 oc<span class="blank _0"> </span>orre </div><div class="t m0 x11 h10 y2a ffa fsa fc4 sc1 ls2 ws7">Ano_1_Pediatria-2.indb 88<span class="blank _a"></span><span class="fc5 sc0">Ano_1_Pediatria-2.indb 88<span class="blank _b"> </span><span class="fc4 sc1">03/11/2021 12:45:47<span class="blank _c"></span><span class="fc5 sc0">03/11/2021 12:45:47</span></span></span></div></div><div class="pi" data-data="{"ctm":[1.000000,0.000000,0.000000,1.000000,0.000000,0.000000]}"></div></div> <div id="pf9" class="pf w0 h0" data-page-no="9"><div class="pc pc9 w0 h0"><img fetchpriority="low" loading="lazy" class="bi x0 y0 w1 h1" alt="" src="https://files.passeidireto.com/cb6739bf-1d15-4a05-9b9e-791388b639c2/bg9.png"><div class="t m0 x1f h16 y2b ff2 fs8 fc0 sc0 ls33 ws7">Doenças ex<span class="blank _2"></span>antemáticas<span class="blank _10"> </span><span class="fs9 fc1 ls18">Cap. 4</span></div><div class="t m0 x1 h2 y1 ff1 fs0 fc0 sc0 ls69">89</div><div class="t md5 x9 ha y4a ff6 fs6 fc2 sc0 lsc ws6d">prec<span class="blank _0"> </span>ocem<span class="blank _0"> </span>ente no início da vida<span class="blank _0"> </span>, sen<span class="blank _0"> </span>do mais de </div><div class="t md6 x9 ha y4b ff6 fs6 fc2 sc0 ls1f wsf">95% dos casos em c<span class="blank _0"> </span>rianças me<span class="blank _0"> </span>nores de 3 an<span class="blank _0"> </span>os </div><div class="t m0 x9 ha y71 ff6 fs6 fc2 sc0 ls2 wsdc">de idade<span class="blank _0"> </span>, com <span class="ff8 wsad">pic<span class="blank _0"> </span>o de incid<span class="blank _0"> </span>ência e<span class="blank _0"> </span>ntre os 6 e 1<span class="blank _9"></span>5 </span></div><div class="t md7 x9 ha y72 ff8 fs6 fc2 sc0 ls11 wsb5">meses de idade<span class="ff6 lsb ws36">. Antico<span class="blank _0"> </span>rpos maternos tra<span class="blank _0"> </span>nsf<span class="blank _2"></span>eri<span class="blank _0"> </span>dos </span></div><div class="t md8 x9 ha y73 ff6 fs6 fc2 sc0 ls2 ws36">duran<span class="blank _0"> </span>te a gestação provav<span class="blank _2"></span>elm<span class="blank _0"> </span>ente impe<span class="blank _0"> </span>dem que a </div><div class="t md9 x9 ha y74 ff6 fs6 fc2 sc0 ls5c ws36">infecção oc<span class="blank _0"> </span>orra e<span class="blank _0"> </span>m meno<span class="blank _0"> </span>res de 6 meses. A\ue60f<span class="blank _2"></span>infecção<span class="blank _0"> </span> </div><div class="t mda x9 ha y75 ff6 fs6 fc2 sc0 ls16 wse">pode o<span class="blank _0"> </span>corre<span class="blank _0"> </span>r duran<span class="blank _0"> </span>te t<span class="blank _2"></span>odo o a<span class="blank _0"> </span>no, sem sazonalidad<span class="blank _0"> </span>e </div><div class="t m0 x9 ha y76 ff6 fs6 fc2 sc0 ls2 ws7">espe<span class="blank _0"> </span>cí\ue61fc<span class="blank _0"> </span>a, e a trans<span class="blank _0"> </span>missão ocor<span class="blank _0"> </span>re por gotículas.</div><div class="t m0 x9 h6 y1f0 ff2 fs3 fc0 sc0 ls32 ws64">4.2.<span class="blank _2"></span> <span class="ls30 ws42"> P<span class="blank _9"></span>A<span class="blank _9"></span>TOGÊNES<span class="blank _2"></span>E</span></div><div class="t mdb x9 ha y1f1 ff6 fs6 fc2 sc0 ls43 ws36">O vírus é ad<span class="blank _0"> </span>quirido a par<span class="blank _1"> </span>tir do cont<span class="blank _0"> </span>ato com sec<span class="blank _0"> </span>reções<span class="blank _0"> </span> </div><div class="t m0 x9 ha y1f2 ff6 fs6 fc2 sc0 ls2 wsdd">infectan<span class="blank _0"> </span>tes que pene<span class="blank _0"> </span>tram as muc<span class="blank _0"> </span>osas oral, nasal </div><div class="t m0 x9 ha y1f3 ff6 fs6 fc2 sc0 ls2 ws1d">ou con<span class="blank _0"> </span>juntival. Ap<span class="blank _0"> </span>ós a replicaç<span class="blank _0"> </span>ão viral em um l<span class="blank _0"> </span>ocal </div><div class="t mdc x9 ha y1f4 ff6 fs6 fc2 sc0 ls5f ws67">ainda desc<span class="blank _0"> </span>onhec<span class="blank _0"> </span>ido, ocor<span class="blank _0"> </span>re uma elevada viremia nas </div><div class="t m0 x9 ha y1f5 ff6 fs6 fc2 sc0 ls31 ws15">células<span class="blank _2"></span> mononucleares<span class="blank _2"></span> do sangue.<span class="blank _2"></span> Na sequência </div><div class="t m0 x9 ha y1f6 ff6 fs6 fc2 sc0 ls2 ws84">da infecção agu<span class="blank _0"> </span>da, co<span class="blank _0"> </span>mo todo her<span class="blank _0"> </span>pesvírus<span class="blank _0"> </span>, o vírus </div><div class="t m0 x9 ha y1f7 ff6 fs6 fc2 sc0 ls2 ws81">se torna latente nas cél<span class="blank _0"> </span>ulas mononu<span class="blank _0"> </span>cleares e pos<span class="blank _0"> </span>-</div><div class="t m0 x9 ha y1f8 ff6 fs6 fc2 sc0 ls2 ws15">sivelmen<span class="blank _0"> </span>te nas glândulas salivares, rins<span class="blank _0"> </span>, pulmõ<span class="blank _0"> </span>es </div><div class="t m0 x9 ha y1f9 ff6 fs6 fc2 sc0 ls2 ws7">e no sistema n<span class="blank _0"> </span>er<span class="blank _0"> </span>voso central<span class="blank _0"> </span>.</div><div class="t m0 x9 h6 y1fa ff2 fs3 fc0 sc0 ls2 ws7">4.<span class="blank _0"> </span>3<span class="blank _0"> </span>. <span class="ls44 ws74"> QU<span class="blank _2"></span>ADRO <span class="blank _13"> </span>CLÍNIC<span class="blank _2"></span>O</span></div><div class="t mdd x9 ha y1fb ff6 fs6 fc2 sc0 ls29 ws6d">A maioria dos c<span class="blank _0"> </span>asos cursa ape<span class="blank _0"> </span>nas com febre e </div><div class="t mde x9 ha y1fc ff6 fs6 fc2 sc0 ls16 wse">irri<span class="blank _0"> </span>tabilidade<span class="blank _0"> </span>, sendo qu<span class="blank _0"> </span>e somen<span class="blank _0"> </span>te <span class="ff8 ls37 ws67">25%<span class="blank _2"></span> das c<span class="blank _0"> </span>rianças </span></div><div class="t m0 x9 hb y1fd ff8 fs6 fc2 sc0 ls2 ws6d">infec<span class="blank _0"> </span>tadas ap<span class="blank _0"> </span>resent<span class="blank _0"> </span>am o quadr<span class="blank _0"> </span>o clínico c<span class="blank _0"> </span>lássico </div><div class="t m0 x9 hb y1fe ff8 fs6 fc2 sc0 ls9 wsd4">da doença.</div><div class="t mdf x9 ha y1ff ff6 fs6 fc2 sc0 ls41 wse">Ap<span class="blank _0"> </span>ós um <span class="ff8 ws36">perío<span class="blank _0"> </span>do de inc<span class="blank _0"> </span>ubaçã<span class="blank _0"> </span>o de 5 a 1<span class="blank _9"></span>5 dia<span class="ff6 ls52 ws7c">s<span class="blank _0"> </span>, inicia<span class="blank _0"> </span> </span></span></div><div class="t me0 x9 ha y200 ff6 fs6 fc2 sc0 ls3c ws5f">o <span class="blank _9"></span><span class="ff8 ls1f ws6e">período prodrôm<span class="blank _2"></span>ico, que<span class="blank _2"></span> pode ser ass<span class="blank _2"></span>intomát<span class="blank _2"></span>ico </span></div><div class="t me1 x9 hb y201 ff8 fs6 fc2 sc0 ls3c ws36">ou cu<span class="blank _0"> </span>rsar co<span class="blank _0"> </span>m sintomas leves do tr<span class="blank _0"> </span>ato respir<span class="blank _0"> </span>atório </div><div class="t me2 x9 ha y202 ff8 fs6 fc2 sc0 ls25 wsa9">superior<span class="blank _2"></span><span class="ff6 ls10 ws11">, com<span class="blank _0"> </span>o rinorre<span class="blank _0"> </span>ia leve, in\ue61eamação leve da </span></div><div class="t m0 x9 ha y203 ff6 fs6 fc2 sc0 ls2 wsde">faringe e hi<span class="blank _0"> </span>perem<span class="blank _0"> </span>ia conjuntival disc<span class="blank _0"> </span>reta. <span class="ff8 ws7">A\ue61ddoen<span class="blank _0"> </span>ça </span></div><div class="t m0 x9 hb y204 ff8 fs6 fc2 sc0 ls2 wsdf">clínic<span class="blank _0"> </span>a inicia co<span class="blank _0"> </span>m febre alt<span class="blank _0"> </span>a (<span class="blank _9"></span>m<span class="blank _0"> </span>édia de 39°C)<span class="blank _2"></span>, que </div><div class="t m0 x9 hb y205 ff8 fs6 fc2 sc0 ls2 ws9b">pode o<span class="blank _0"> </span>u não ser ac<span class="blank _0"> </span>ompan<span class="blank _0"> </span>hada de ir<span class="blank _0"> </span>ritabili<span class="blank _0"> </span>dade e </div><div class="t me3 x9 hb y206 ff8 fs6 fc2 sc0 ls47 ws67">anorexia<span class="blank _0"> </span>, per<span class="blank _0"> </span>siste por 3 a 5 d<span class="blank _0"> </span>ias e depois d<span class="blank _0"> </span>esaparec<span class="blank _0"> </span>e </div><div class="t me4 x9 ha y207 ff8 fs6 fc2 sc0 ls16 ws36">em c<span class="blank _0"> </span>rise<span class="ff6 wse">. Convulsõ<span class="blank _0"> </span>es febris pod<span class="blank _0"> </span>em oc<span class="blank _0"> </span>orrer du<span class="blank _0"> </span>rante </span></div><div class="t m0 x9 ha y208 ff6 fs6 fc2 sc0 ls2 ws7">esse pe<span class="blank _0"> </span>ríodo em 5 a 1<span class="blank _2"></span>0% das c<span class="blank _0"> </span>rianças.</div><div class="t me5 x9 hb y209 ff8 fs6 fc2 sc0 ls16 ws67">O exantema su<span class="blank _0"> </span>rge den<span class="blank _0"> </span>tro de 1<span class="blank _9"></span>2 a 24 ho<span class="blank _0"> </span>ras do desa<span class="blank _0"> </span><span class="ls2">-</span></div><div class="t me6 x9 hb y20a ff8 fs6 fc2 sc0 ls40 ws35">parecimen<span class="blank _0"> </span>to da<span class="blank _2"></span> febre, como lesões individualizadas </div><div class="t m1b x9 hb y20b ff8 fs6 fc2 sc0 ls57 ws67">peq<span class="blank _0"> </span>uenas<span class="blank _0"> </span>, róseas e leveme<span class="blank _0"> </span>nte elevadas. D<span class="blank _0"> </span>istrib<span class="blank _0"> </span>uem<span class="blank _0"> </span><span class="ls2">-</span></div><div class="t m0 x9 hb y20c ff8 fs6 fc2 sc0 ls2 ws5b">-se no tro<span class="blank _0"> </span>nco e de<span class="blank _0"> </span>pois se espa<span class="blank _0"> </span>lham para p<span class="blank _0"> </span>escoç<span class="blank _0"> </span>o, </div><div class="t m0 x9 ha y20d ff8 fs6 fc2 sc0 ls2 ws7">face e ex<span class="blank _0"> </span>tre<span class="blank _0"> </span>midades<span class="ff6"> (Fig<span class="blank _0"> </span>ura\ue60f7). O\ue60fexantema não é </span></div><div class="t me7 x9 ha y20e ff6 fs6 fc2 sc0 ls8 ws36">pru<span class="blank _0"> </span>riginoso e não cu<span class="blank _0"> </span>rsa com vesículas ou pús<span class="blank _0"> </span>tulas. </div><div class="t me8 x9 ha y20f ff6 fs6 fc2 sc0 lsb ws36">Gera<span class="blank _0"> </span>lmente desapare<span class="blank _0"> </span>ce após 1 a 3 dias se<span class="blank _0"> </span>m deixar </div><div class="t m0 x9 ha y210 ff6 fs6 fc2 sc0 ls11 ws89">descamação.</div><div class="t m0 x3c hd y2c ff8 fs8 fc0 sc0 ls2 ws7">Fig<span class="blank _0"> </span>ura 7<span class="blank _9"></span>. <span class="ff6 fc2">E<span class="blank _0"> </span>xan<span class="blank _0"> </span>tema rós<span class="blank _0"> </span>eo mac<span class="blank _0"> </span>ulo<span class="blank _0"> </span>papu<span class="blank _0"> </span>lar em </span></div><div class="t m0 x3d hd y211 ff6 fs8 fc2 sc0 ls2 ws7">tron<span class="blank _0"> </span>co de l<span class="blank _0"> </span>acte<span class="blank _0"> </span>nte, s<span class="blank _0"> </span>uge<span class="blank _0"> </span>stivo d<span class="blank _0"> </span>e roséo<span class="blank _0"> </span>la.</div><div class="t m0 x3e he y212 ff8 fs9 fc0 sc0 ls2 ws7">Fon<span class="blank _0"> </span>te: <span class="ff9 fc2 ls6a wsda">Ma<span class="blank"> </span>m<span class="blank"> </span>e5<span class="blank _0"> </span>5.</span></div><div class="t m0 x3f h17 y213 ff9 fsb fc2 sc0 ls6b">14</div><div class="t m0 x22 ha y214 ff6 fs6 fc2 sc0 ls2 wse1">A\ue60f<span class="blank _1"> </span>transmissão do vír<span class="blank _0"> </span>us oco<span class="blank _0"> </span>rre apenas na fase de </div><div class="t me9 x22 ha y215 ff6 fs6 fc2 sc0 lsc ws6d">viremia<span class="blank _0"> </span>, ou seja<span class="blank _0"> </span>, duran<span class="blank _0"> </span>te a f<span class="blank _2"></span>ebre<span class="blank _0"> </span>, de forma que<span class="blank _0"> </span>, </div><div class="t mea x22 ha y216 ff6 fs6 fc2 sc0 ls1f wsf">quando a <span class="ff8 lsf wscd">doença é clinicament<span class="blank _2"></span>e identi\ue61fcá<span class="blank _2"></span>vel, o<span class="blank _2"></span> </span></div><div class="t meb x22 hb y217 ff8 fs6 fc2 sc0 ls5f ws36">pacie<span class="blank _0"> </span>nte não é mais tra<span class="blank _0"> </span>nsmisso<span class="blank _0"> </span>r<span class="blank _9"></span>, não re<span class="blank _0"> </span>com<span class="blank _0"> </span>enda<span class="blank _0"> </span>-se </div><div class="t m0 x22 hb y218 ff8 fs6 fc2 sc0 ls2 ws7">o isolame<span class="blank _0"> </span>nto.</div><div class="t m5a xb h12 y219 ff2 fs9 fc1 sc0 ls2 ws8e"> DIC<span class="blank _0"> </span>A </div><div class="t m0 x40 h8 y21a ff6 fs5 fc2 sc0 ls2 wse2">\ue60bA febre a<span class="blank _0"> </span>lta em l<span class="blank _0"> </span>acte<span class="blank _0"> </span>ntes, se<span class="blank _0"> </span>m ou<span class="blank _0"> </span>-</div><div class="t m0 xb h8 y21b ff6 fs5 fc2 sc0 ls2 wse3">tros sin<span class="blank _0"> </span>ais e sintom<span class="blank _0"> </span>as, reso<span class="blank _0"> </span>lvida e<span class="blank _0"> </span>m cris<span class="blank _0"> </span>e </div><div class="t m0 xb h8 y21c ff6 fs5 fc2 sc0 ls6c ws91">seg<span class="blank _0"> </span>uida de u<span class="blank _0"> </span>m exantem<span class="blank _0"> </span>a, é um p<span class="blank _0"> </span>adrão c<span class="blank _0"> </span>líni<span class="blank _0"> </span><span class="ls2">-</span></div><div class="t m0 xb h8 y21d ff6 fs5 fc2 sc0 ls2 wse4">co cl<span class="blank _0"> </span>ássico q<span class="blank _0"> </span>ue deve sug<span class="blank _0"> </span>eri<span class="blank _0"> </span>r o diagnó<span class="blank _0"> </span>stic<span class="blank _0"> </span>o </div><div class="t m0 xb h8 y21e ff6 fs5 fc2 sc0 ls6d wse5">de e<span class="blank _0"> </span>xante<span class="blank _0"> </span>ma<span class="blank _0"> </span> súb<span class="blank _0"> </span>ito.</div><div class="t m0 x22 h6 y21f ff2 fs3 fc0 sc0 ls6e wse6">4.4. <span class="ls51 ws97"> DIA<span class="blank _9"></span>GNÓSTICO</span></div><div class="t mec x22 ha y220 ff6 fs6 fc2 sc0 ls31 wsf">O diagnós<span class="blank _0"> </span>tico é clínico, basea<span class="blank _0"> </span>do princi<span class="blank _0"> </span>palmente </div><div class="t med x22 ha y221 ff6 fs6 fc2 sc0 ls31 wsf">na idade e no pad<span class="blank _0"> </span>rão de febre do pacie<span class="blank _0"> </span>nte. Nos </div><div class="t mee x22 ha y222 ff6 fs6 fc2 sc0 ls35 ws6d">prime<span class="blank _0"> </span>iros dias de febre pode<span class="blank _0"> </span>m ser en<span class="blank _0"> </span>contradas </div><div class="t m0 x22 ha y223 ff6 fs6 fc2 sc0 ls2 ws9e">leuc<span class="blank _0"> </span>ometr<span class="blank _0"> </span>ia de 80<span class="blank _0"> </span>00 a 9<span class="blank _0"> </span>00<span class="blank _0"> </span>0 leuc<span class="blank _0"> </span>ócitos/mm3, que </div><div class="t mef x22 ha y224 ff6 fs6 fc2 sc0 ls3c wse">dep<span class="blank _0"> </span>ois cai para 4<span class="blank _0"> </span>00<span class="blank _0"> </span>0 a 60<span class="blank _0"> </span>0<span class="blank _0"> </span>0 leucó<span class="blank _0"> </span>citos/mm3, com </div><div class="t m0 x22 ha y225 ff6 fs6 fc2 sc0 ls2 ws69">relativa linfocitose na fase do exantema. O\ue60f<span class="blank _1"> </span>líquor<span class="blank _2"></span>, </div><div class="t mf0 x22 ha y226 ff6 fs6 fc2 sc0 ls2 ws36">por vezes colhid<span class="blank _0"> </span>o em dec<span class="blank _0"> </span>orrên<span class="blank _0"> </span>cia da febre elevada </div><div class="t m0 x22 ha y227 ff6 fs6 fc2 sc0 ls2 ws7">e da convulsão feb<span class="blank _0"> </span>ril, é nor<span class="blank _0"> </span>mal.</div><div class="t mf1 x22 ha y228 ff6 fs6 fc2 sc0 ls10 ws11">O diagnós<span class="blank _0"> </span>tico etiológ<span class="blank _0"> </span>ico pod<span class="blank _0"> </span>e ser feito por me<span class="blank _0"> </span>io </div><div class="t m0 x22 ha y229 ff6 fs6 fc2 sc0 ls2 ws18">da sorologia I<span class="blank _0"> </span>gM (prese<span class="blank _0"> </span>nte a par<span class="blank _0"> </span>tir do 5º ao 7º dia </div><div class="t m0 x22 ha y22a ff6 fs6 fc2 sc0 ls2 ws19">de doe<span class="blank _0"> </span>nça co<span class="blank _0"> </span>m pico na 2ª e 3ª semanas e desapa<span class="blank _0"> </span>-</div><div class="t m0 x22 ha y22b ff6 fs6 fc2 sc0 ls2 ws5d">recim<span class="blank _0"> </span>ento em 2 mes<span class="blank _0"> </span>es<span class="blank _9"></span>), soro<span class="blank _0"> </span>conversão do IgG e<span class="blank _0"> </span>m </div><div class="t m57 x22 ha y22c ff6 fs6 fc2 sc0 ls38 ws36">amos<span class="blank _0"> </span>tras pareadas com 2 a 3 se<span class="blank _0"> </span>manas de inter<span class="blank _0"> </span>valo, </div><div class="t m0 x22 ha y22d ff6 fs6 fc2 sc0 ls2 wsd3">cultu<span class="blank _0"> </span>ra viral e teste de am<span class="blank _0"> </span>pli\ue61fcaç<span class="blank _0"> </span>ão viral po<span class="blank _0"> </span>r PCR </div><div class="t m0 x11 h10 y2a ffa fsa fc4 sc1 ls2 ws7">Ano_1_Pediatria-2.indb 89<span class="blank _a"></span><span class="fc5 sc0">Ano_1_Pediatria-2.indb 89<span class="blank _b"> </span><span class="fc4 sc1">03/11/2021 12:45:47<span class="blank _c"></span><span class="fc5 sc0">03/11/2021 12:45:47</span></span></span></div></div><div class="pi" data-data="{"ctm":[1.000000,0.000000,0.000000,1.000000,0.000000,0.000000]}"></div></div> <div id="pfa" class="pf w0 h0" data-page-no="a"><div class="pc pca w0 h0"><img fetchpriority="low" loading="lazy" class="bi x0 y0 w1 h1" alt="" src="https://files.passeidireto.com/cb6739bf-1d15-4a05-9b9e-791388b639c2/bga.png"><div class="t m0 x12 h11 y2b ff4 fs9 fc1 sc0 ls18 ws7">Doenças ex<span class="blank _2"></span>antemáticas<span class="blank _d"> </span><span class="ff2 fs8 fc0 ls19 v0">Urgências pediátricas</span></div><div class="t m0 x13 h2 y1 ff1 fs0 fc0 sc0 ls1">90</div><div class="t mf2 x19 ha y4a ff6 fs6 fc2 sc0 ls29 ws6d">(<span class="blank _2"></span>não implica ne<span class="blank _0"> </span>cessar<span class="blank _0"> </span>iamente infecção ativa, já </div><div class="t m0 x19 ha y4b ff6 fs6 fc2 sc0 ls2 ws18">que o vír<span class="blank _0"> </span>us pode pe<span class="blank _0"> </span>rmane<span class="blank _0"> </span>cer laten<span class="blank _0"> </span>te nos tecidos<span class="blank _2"></span>).</div><div class="t m0 x19 h6 y22e ff2 fs3 fc0 sc0 ls2 ws7">4.<span class="blank _0"> </span>5. <span class="ls53 wsa0"> <span class="blank _12"></span>TR<span class="blank _1"> </span>A<span class="blank _9"></span>T<span class="blank _9"></span>AM<span class="blank _0"> </span>ENTO E COMPLICAÇÕES</span></div><div class="t mf3 x19 hb y22f ff8 fs6 fc2 sc0 ls41 wsac">O tratament<span class="blank _2"></span>o é de suporte com ant<span class="blank _2"></span>itérmicos durant<span class="blank _2"></span>e </div><div class="t m0 x19 ha y230 ff8 fs6 fc2 sc0 ls2 ws4b">a fase de febr<span class="blank _0"> </span>e alta<span class="ff6">. O\ue60fprog<span class="blank _0"> </span>nóstico é excele<span class="blank _0"> </span>nte e a </span></div><div class="t m0 x19 ha y231 ff6 fs6 fc2 sc0 ls2 wsb6">doen<span class="blank _0"> </span>ça não traz ne<span class="blank _0"> </span>nhuma se<span class="blank _0"> </span>quela. <span class="ff8">Em p<span class="blank _0"> </span>acientes </span></div><div class="t m0 x19 hb y232 ff8 fs6 fc2 sc0 ls25 wscb">imunodeprimidos,<span class="blank _2"></span> podem ocorrer manif<span class="blank _2"></span>estações </div><div class="t m0 x19 ha y233 ff8 fs6 fc2 sc0 ls2 ws94">mais graves, co<span class="blank _0"> </span>mo enc<span class="blank _0"> </span>efalite e pne<span class="blank _0"> </span>umon<span class="blank _0"> </span>ite<span class="ff6">, indi<span class="blank _0"> </span>-</span></div><div class="t mf4 x19 ha y234 ff6 fs6 fc2 sc0 ls3c wse">cand<span class="blank _0"> </span>o-<span class="blank _0"> </span>se o tratam<span class="blank _0"> </span>ento com an<span class="blank _0"> </span>tivirais, c<span class="blank _0"> </span>omo o gan</div><div class="t mf5 x41 ha y234 ff6 fs6 fc2 sc0 ls2">-</div><div class="t m0 x19 ha y235 ff6 fs6 fc2 sc0 ls2 ws7">ciclovir, por 2 a 3 semanas.</div><div class="t m0 x30 h9 y236 ff3 fs0 fc0 sc0 ls6 wsc">5. <span class="blank _0"> </span><span class="ls6f wse9"> ERITEM<span class="blank _0"> </span>A <span class="blank _14"> </span>INFECCIOSO</span></div><div class="t m0 x19 h6 y237 ff2 fs3 fc0 sc0 ls2f ws41">5<span class="blank _0"> </span>.1<span class="blank _1"> </span>.<span class="blank _1"> </span> <span class="ls30 ws65"> <span class="blank _12"></span>EPID<span class="blank _2"></span>EMIOLOGIA E<span class="blank _2"></span> ETIOL<span class="blank _2"></span>OGIA</span></div><div class="t m0 x19 ha y238 ff6 fs6 fc2 sc0 ls2 wsd8">O eri<span class="blank _0"> </span>tema infeccioso, tam<span class="blank _0"> </span>bém ch<span class="blank _0"> </span>amado de quint<span class="blank _0"> </span>a </div><div class="t mf6 x19 ha y239 ff6 fs6 fc2 sc0 ls9 wsf">doen<span class="blank _0"> </span>ça, é u<span class="blank _0"> </span>ma doenç<span class="blank _0"> </span>a ex<span class="blank _2"></span>antemá<span class="blank _0"> </span>tica que oco<span class="blank _0"> </span>rre </div><div class="t mf7 x19 ha y23a ff6 fs6 fc2 sc0 ls38 wse">prin<span class="blank _0"> </span>cipalme<span class="blank _0"> </span>nte em <span class="ff8 ls8 ws35">crianças em idade escolar<span class="blank _9"></span>, e<span class="blank _0"> </span>ntre </span></div><div class="t m0 x19 ha y23b ff8 fs6 fc2 sc0 ls2 wsc9">os 5 e 1<span class="blank _9"></span>5 anos<span class="blank _0"> </span><span class="ff6">, com picos sa<span class="blank _0"> </span>zonais entre o \ue61fm do </span></div><div class="t m0 x19 ha y23c ff6 fs6 fc2 sc0 ls2 wsdd">inverno e a pri<span class="blank _0"> </span>mav<span class="blank _2"></span>era<span class="blank _0"> </span>. É\ue60f<span class="blank _0"> </span>causad<span class="blank _0"> </span>o pelo <span class="ff8 ls12 ws17">par<span class="blank _0"> </span>vo<span class="blank _2"></span>vírus </span></div><div class="t m0 x19 ha y23d ff8 fs6 fc2 sc0 ls70 wse7">B<span class="blank"> </span>19<span class="blank"> </span><span class="ff6 ls2 wsae">, um ví<span class="blank _0"> </span>rus de DN<span class="blank _0"> </span>A de \ue61fta ún<span class="blank _0"> </span>ica da famí<span class="blank _0"> </span>lia Par<span class="blank _9"></span>-</span></div><div class="t m6d x19 ha y23e ff6 fs6 fc2 sc0 ls11 wsf">vo<span class="blank _2"></span>virida<span class="blank _0"> </span>e e do gêne<span class="blank _0"> </span>ro <span class="ff7 ls2 ws0">Er<span class="blank"> </span>y<span class="blank _0"> </span>th<span class="blank"> </span>rovir<span class="blank"> </span>us</span>. Os par<span class="blank _0"> </span>vovírus </div><div class="t mf8 x19 ha y23f ff6 fs6 fc2 sc0 ls38 ws36">infectam di<span class="blank _0"> </span>versas espéc<span class="blank _0"> </span>ies de animais, m<span class="blank _0"> </span>as apenas </div><div class="t m0 x19 ha y240 ff6 fs6 fc2 sc0 ls2 wsea">o B1<span class="blank _11"></span>9 é pa<span class="blank _0"> </span>togênico par<span class="blank _0"> </span>a humanos. A\ue60f<span class="blank _0"> </span>transmissão </div><div class="t m0 x19 ha y241 ff6 fs6 fc2 sc0 ls2 ws9e">oco<span class="blank _0"> </span>rre por gotícu<span class="blank _0"> </span>las, sendo a t<span class="blank _0"> </span>axa de transmissão </div><div class="t mf9 x19 ha y242 ff6 fs6 fc2 sc0 ls47 ws67">domiciliar d<span class="blank _0"> </span>e 1<span class="blank _11"></span>5<span class="blank _0"> </span>-<span class="blank _0"> </span>30% para o<span class="blank _0"> </span>s contatos transmissí<span class="blank _0"> </span>v<span class="blank _2"></span>eis<span class="blank _0"> </span> </div><div class="t m0 x19 ha y243 ff6 fs6 fc2 sc0 ls2 ws82">e de 1<span class="blank _2"></span>0 a 60% e<span class="blank _0"> </span>m sur<span class="blank _0"> </span>tos em esc<span class="blank _0"> </span>olas. O\ue60fparvovírus </div><div class="t m0 x19 ha y244 ff6 fs6 fc2 sc0 ls2 wsa3">B1<span class="blank _11"></span>9 t<span class="blank _0"> </span>ambém p<span class="blank _0"> </span>ode ser tr<span class="blank _0"> </span>ansmitido p<span class="blank _0"> </span>or via place<span class="blank _0"> </span>n-</div><div class="t mfa x19 ha y245 ff6 fs6 fc2 sc0 lsb ws36">tária e sang<span class="blank _0"> </span>uínea, se<span class="blank _0"> </span>ndo desc<span class="blank _0"> </span>rito em cr<span class="blank _0"> </span>ianças com </div><div class="t m0 x19 ha y246 ff6 fs6 fc2 sc0 ls2 wscb">hem<span class="blank _0"> </span>o\ue61flia que rec<span class="blank _0"> </span>ebem tr<span class="blank _0"> </span>ansfusões de fatores de </div><div class="t m0 x19 ha y247 ff6 fs6 fc2 sc0 ls31 ws7e">coagul<span class="blank _2"></span>ação frequent<span class="blank _2"></span>emente.</div><div class="t m0 x19 h6 y248 ff2 fs3 fc0 sc0 ls32 ws64">5.2.<span class="blank _9"></span> <span class="ls30 ws42"> P<span class="blank _9"></span>A<span class="blank _9"></span>TOGÊNESE</span></div><div class="t mfb x19 hb y249 ff8 fs6 fc2 sc0 ls35 ws11">O alvo primá<span class="blank _0"> </span>rio da infecç<span class="blank _0"> </span>ão são os pre<span class="blank _0"> </span>cur<span class="blank _0"> </span>sores </div><div class="t mfc x19 ha y24a ff8 fs6 fc2 sc0 lsd ws13">eritroides <span class="blank _9"></span><span class="ff6 ls8 ws36">próximos ao es<span class="blank _0"> </span>tágio de pró<span class="blank _0"> </span>-<span class="blank _0"> </span>norm<span class="blank _0"> </span>oblasto. </span></div><div class="t mfd x19 ha y24b ff6 fs6 fc2 sc0 ls8 ws67">A\ue60f<span class="blank _9"></span>infecç<span class="blank _0"> </span>ão produz lise destas c<span class="blank _0"> </span>élulas com de<span class="blank _0"> </span>pleç<span class="blank _0"> </span>ão </div><div class="t m0 x19 ha y24c ff6 fs6 fc2 sc0 ls25 wse1">progres<span class="blank _0"> </span>siva e <span class="ff8 ls3a wsb2">para<span class="blank _2"></span>da transit<span class="blank _2"></span>ória da<span class="blank _2"></span> eritropoiese<span class="blank _2"></span><span class="ff6 ls2 ws7">. </span></span></div><div class="t mfe x19 ha y24d ff6 fs6 fc2 sc0 ls29 wsf">São freq<span class="blank _0"> </span>uentes tamb<span class="blank _0"> </span>ém trombo<span class="blank _0"> </span>citope<span class="blank _0"> </span>nia e neu<span class="blank _0"> </span><span class="ls2">-</span></div><div class="t m0 x19 ha y24e ff6 fs6 fc2 sc0 ls25 ws99">trope<span class="blank _0"> </span>nia, mas não se sabe a pa<span class="blank _0"> </span>togênese de<span class="blank _0"> </span>sses </div><div class="t m0 x19 ha y24f ff6 fs6 fc2 sc0 ls35 wsc4">achados.</div><div class="t m0 x1c ha y4a ff6 fs6 fc2 sc0 ls2 ws7e">O par<span class="blank _0"> </span>vovírus B1<span class="blank _11"></span>9 p<span class="blank _0"> </span>ode origi<span class="blank _0"> </span>nar diferentes quadros </div><div class="t mff x1c ha y4b ff6 fs6 fc2 sc0 ls12 wsf">clínicos<span class="blank _0"> </span>, como o e<span class="blank _0"> </span>ritema infecc<span class="blank _0"> </span>ioso, a ar<span class="blank _0"> </span>trite e a </div><div class="t m100 x1c ha y71 ff6 fs6 fc2 sc0 lsb ws36">crise aplásic<span class="blank _0"> </span>a transitória. <span class="ff8">A\ue61d<span class="blank _9"></span>c<span class="blank _0"> </span>rise aplásic<span class="blank _0"> </span>a transi<span class="blank _0"> </span>tó<span class="ls2">-</span></span></div><div class="t m0 x1c hb y72 ff8 fs6 fc2 sc0 ls2 ws82">ria resul<span class="blank _0"> </span>ta da infec<span class="blank _0"> </span>ção viral d<span class="blank _0"> </span>ireta<span class="blank _0"> </span>, ao passo que o </div><div class="t m101 x1c hb y73 ff8 fs6 fc2 sc0 ls47 ws67">exantema e a ar<span class="blank _0"> </span>tri<span class="blank _0"> </span>te são fenôme<span class="blank _0"> </span>nos pós-<span class="blank _0"> </span>infecciosos<span class="blank _0"> </span> </div><div class="t m0 x1c ha y74 ff8 fs6 fc2 sc0 ls2 ws7">relacio<span class="blank _0"> </span>nados à res<span class="blank _0"> </span>post<span class="blank _0"> </span>a imune<span class="ff6">.</span></div><div class="t m102 x1c hb y250 ff8 fs6 fc2 sc0 ls5c ws36">Indi<span class="blank _0"> </span>víduos co<span class="blank _0"> </span>m anem<span class="blank _0"> </span>ia hemolí<span class="blank _0"> </span>tica crô<span class="blank _0"> </span>nica são mais<span class="blank _0"> </span> </div><div class="t m103 x1c hb y251 ff8 fs6 fc2 sc0 ls10 ws11">susce<span class="blank _0"> </span>tíveis a per<span class="blank _0"> </span>tur<span class="blank _0"> </span>bações n<span class="blank _0"> </span>a eritro<span class="blank _0"> </span>poiese, c<span class="blank _0"> </span>om </div><div class="t m104 x1c hb y252 ff8 fs6 fc2 sc0 lsb ws36">que<span class="blank _0"> </span>da abru<span class="blank _0"> </span>pta da h<span class="blank _0"> </span>emogl<span class="blank _0"> </span>obina e do<span class="blank _0"> </span>s reticul<span class="blank _0"> </span>ócitos </div><div class="t m0 x1c hb y253 ff8 fs6 fc2 sc0 ls1f ws51">e, às v<span class="blank _2"></span>ezes, at<span class="blank _2"></span>é necessidade de hemotransfusão<span class="blank _2"></span> </div><div class="t m105 x1c ha y254 ff8 fs6 fc2 sc0 ls11 ws11">dur<span class="blank _0"> </span>ante a infecç<span class="blank _0"> </span>ão pelo p<span class="blank _0"> </span>ar<span class="blank _0"> </span>vo<span class="blank _2"></span>víru<span class="blank _0"> </span>s B<span class="blank _2"></span>1<span class="blank _9"></span>9<span class="blank _2"></span><span class="ff6 ls1f ws55">. Aqueles </span></div><div class="t m106 x1c ha y255 ff6 fs6 fc2 sc0 lsd ws48">com de\ue61fciência da<span class="blank _2"></span> imunidade h<span class="blank _2"></span>umoral apresentam </div><div class="t m107 x1c ha y1d6 ff6 fs6 fc2 sc0 ls31 wsf">um risco maio<span class="blank _0"> </span>r de infecção pe<span class="blank _0"> </span>rsistente ou mais </div><div class="t m0 x1c ha y1d7 ff6 fs6 fc2 sc0 ls2 ws9a">grave, que ge<span class="blank _0"> </span>ralmen<span class="blank _0"> </span>te se manifesta como ap<span class="blank _0"> </span>lasia </div><div class="t m108 x1c ha y1d8 ff6 fs6 fc2 sc0 ls11 ws6e">crônica<span class="blank _2"></span> da série<span class="blank _2"></span> vermelha, tr<span class="blank _2"></span>ombocitopeni<span class="blank _2"></span>a, neutro<span class="blank _0"> </span><span class="ls2">-</span></div><div class="t m109 x1c ha y1d9 ff6 fs6 fc2 sc0 ls8 ws36">penia e falê<span class="blank _0"> </span>ncia de me<span class="blank _0"> </span>dula óssea. <span class="ff8">As i<span class="blank _0"> </span>nfecçõe<span class="blank _0"> </span>s em </span></div><div class="t m0 x1c hb y256 ff8 fs6 fc2 sc0 ls2 wsd6">feto e recé<span class="blank _0"> </span>m-<span class="blank _0"> </span>nascid<span class="blank _0"> </span>os se comp<span class="blank _0"> </span>or<span class="blank _0"> </span>tam da m<span class="blank _0"> </span>esma </div><div class="t m0 x1c hb y257 ff8 fs6 fc2 sc0 ls2 wsbb">forma qu<span class="blank _0"> </span>e em imu<span class="blank _0"> </span>node<span class="blank _0"> </span>primido<span class="blank _0"> </span>s, associa<span class="blank _0"> </span>ndo<span class="blank _0"> </span>-se a </div><div class="t m0 x1c hb y258 ff8 fs6 fc2 sc0 ls2 wsae">natimo<span class="blank _0"> </span>r<span class="blank _0"> </span>tos e hidropsia fe<span class="blank _0"> </span>tal não imu<span class="blank _0"> </span>ne, mas se<span class="blank _0"> </span>m </div><div class="t m0 x1c ha y259 ff8 fs6 fc2 sc0 ls10 ws18">efeitos teratogênicos<span class="ff6 ls2">.</span></div><div class="t m0 x1c h6 y25a ff2 fs3 fc0 sc0 ls2 ws7">5.<span class="blank _0"> </span>3. <span class="ls44 ws74"> QUADRO<span class="blank _2"></span> <span class="blank _13"> </span>CLÍNICO</span></div><div class="t m10a x1c ha y25b ff6 fs6 fc2 sc0 ls3c wse">O eri<span class="blank _0"> </span>tema infeccioso é a man<span class="blank _0"> </span>if<span class="blank _2"></span>es<span class="blank _0"> </span>tação clínic<span class="blank _0"> </span>a mais </div><div class="t m0 x1c ha y25c ff6 fs6 fc2 sc0 ls2 wseb">comu<span class="blank _0"> </span>m da infecção pe<span class="blank _0"> </span>lo par<span class="blank _0"> </span>vo<span class="blank _2"></span>víru<span class="blank _0"> </span>s B<span class="blank _2"></span>1<span class="blank _9"></span>9. Após um </div><div class="t m10b x1c ha y25d ff8 fs6 fc2 sc0 ls29 wsf">per<span class="blank _0"> </span>íodo de in<span class="blank _0"> </span>cubaç<span class="blank _0"> </span>ão de 4 a 28 dias<span class="ff6">, a c<span class="blank _0"> </span>riança </span></div><div class="t m10c x1c ha y25e ff6 fs6 fc2 sc0 lsd wsf">evolui com uma <span class="ff8 ws11">fase p<span class="blank _0"> </span>rodrô<span class="blank _0"> </span>mica leve com febre </span></div><div class="t m10d x1c hb y25f ff8 fs6 fc2 sc0 ls29 wsf">baixa, ce<span class="blank _0"> </span>faleia e sintom<span class="blank _0"> </span>as de infecç<span class="blank _0"> </span>ão do trato </div><div class="t m0 x1c ha y260 ff8 fs6 fc2 sc0 ls12 ws94">respiratório superior<span class="blank _9"></span><span class="ff6 ls2 wsd3">. Em s<span class="blank _0"> </span>eguida<span class="blank _0"> </span>, come<span class="blank _0"> </span>ça a fase </span></div><div class="t m10e x1c ha y261 ff6 fs6 fc2 sc0 ls9 wsad">ex<span class="blank _2"></span>antemática, que evolui<span class="blank _2"></span> caracteristicamente em </div><div class="t m0 x1c ha y262 ff6 fs6 fc2 sc0 lsd ws13">3 estágios:</div><div class="t m0 x1a hc y263 ff5 fs7 fc3 sc0 ls2 ws7"> <span class="blank _6"></span>u<span class="blank _7"> </span><span class="ff6 fs6 fc2 wsec v2">Face esbofeteada: enru<span class="blank _0"> </span>bescime<span class="blank _0"> </span>nto facial erite<span class="blank _0"> </span>-</span></div><div class="t m0 x1b ha y264 ff6 fs6 fc2 sc0 ls2 wsed">matoso, poupan<span class="blank _0"> </span>do região pe<span class="blank _0"> </span>rioral, fro<span class="blank _0"> </span>nte e nariz </div><div class="t m0 x1b ha y265 ff6 fs6 fc2 sc0 ls2 wse8">(Figur<span class="blank _0"> </span>a\ue60f8<span class="blank _2"></span>).</div><div class="t m0 x1a h15 y266 ff5 fs7 fc3 sc0 ls2 ws7"> <span class="blank _6"></span>u</div><div class="t m10f x1b ha y267 ff6 fs6 fc2 sc0 ls5f ws34">E<span class="blank _0"> </span>xantema rendilhado: disseminaç<span class="blank _0"> </span>ão do exantema </div><div class="t m0 x1b ha y268 ff6 fs6 fc2 sc0 ls2 ws67">macular par<span class="blank _0"> </span>a tronco e ex<span class="blank _0"> </span>tremida<span class="blank _0"> </span>des, que o<span class="blank _0"> </span>corre </div><div class="t m110 x1b ha y269 ff6 fs6 fc2 sc0 ls40 ws1e">após 1 a 4 dias. O\ue60f<span class="blank _9"></span>clarea<span class="blank _0"> </span>mento ce<span class="blank _0"> </span>ntral das lesões<span class="blank _0"> </span> </div><div class="t m0 x1b ha y26a ff6 fs6 fc2 sc0 ls2 wsac">é imed<span class="blank _0"> </span>iato, dando à <span class="ff8 ls35 wsee">erupção cutânea<span class="blank _2"></span> um aspec<span class="ls2">-</span></span></div><div class="t m111 x1b ha y26b ff8 fs6 fc2 sc0 ls9 ws55">to rendilhado<span class="ff6 ls2 ws11"> (Figura\ue60f<span class="blank _8"> </span>9<span class="blank _2"></span>). Poupa as palmas das </span></div><div class="t m0 x1b ha y26c ff6 fs6 fc2 sc0 ls2 ws59">mãos e dos pés e é mais in<span class="blank _0"> </span>tenso nas super<span class="blank _0"> </span>fícies </div><div class="t m112 x1b ha y26d ff6 fs6 fc2 sc0 ls16 ws1e">ex<span class="blank _0"> </span>tensoras. Nessa fase, o pa<span class="blank _0"> </span>ciente não tem mais </div><div class="t m0 x1b ha y26e ff6 fs6 fc2 sc0 ls47 ws86">fe<span class="blank _0"> </span>br<span class="blank _0"> </span>e. <span class="blank _9"></span><span class="ff8 ls1f wsb0">A\ue61d<span class="blank _9"></span>eru<span class="blank _0"> </span>pção desaparece espontaneamente </span></div><div class="t m0 x1b ha y26f ff8 fs6 fc2 sc0 ls2 ws7">após c<span class="blank _0"> </span>erca d<span class="blank _0"> </span>e 1<span class="blank _9"></span>0 dias, s<span class="blank _0"> </span>em desc<span class="blank _0"> </span>amação<span class="ff6">.</span></div><div class="t m0 x1a hc y270 ff5 fs7 fc3 sc0 ls2 ws7"> <span class="blank _6"></span>u<span class="blank _7"> </span><span class="ff6 fs6 fc2 wsef v2">Recid<span class="blank _0"> </span>iva: o ex<span class="blank _2"></span>antema re<span class="blank _0"> </span>ndilhado pod<span class="blank _0"> </span>e recidivar </span></div><div class="t m0 x1b ha y271 ff6 fs6 fc2 sc0 ls2 wsf0">ainda dur<span class="blank _0"> </span>ante 1 a 3 semanas co<span class="blank _0"> </span>m a exposição </div><div class="t m0 x1b ha y272 ff6 fs6 fc2 sc0 ls2 ws7">à luz solar<span class="blank _2"></span>, calor, ex<span class="blank _2"></span>ercícios físic<span class="blank _0"> </span>os e estresse.</div><div class="t m0 x11 h10 y2a ffa fsa fc4 sc1 ls2 ws7">Ano_1_Pediatria-2.indb 90<span class="blank _a"></span><span class="fc5 sc0">Ano_1_Pediatria-2.indb 90<span class="blank _b"> </span><span class="fc4 sc1">03/11/2021 12:45:47<span class="blank _c"></span><span class="fc5 sc0">03/11/2021 12:45:47</span></span></span></div></div><div class="pi" data-data="{"ctm":[1.000000,0.000000,0.000000,1.000000,0.000000,0.000000]}"></div></div>
Compartilhar