Unit 3 Emotional Intelligence and Spiritual Intelligence.pdf
8 measles
1. MEASLES
Fen Hua Chen, M.D.,PhD.
Department of Pediatrics, The Third Affiliated Hospital
Sun Yat-sen University
2. DEFINITION
Measles is…
an acute viral infection characterized by a
maculopapular rash erupting successively
over the neck, face, body, and extremitis
and accompanied by a high fever.
3. ETIOLOGY
Measles virus
An RNA virus of the genus Morbillivirus in the family of
Paramyxoviridae
One serotype, human’s only host
Stable antigenicity
Rapidly inactivated by heat and light
Survival in low temperature.
4. EPIDEMIOLOGY
Infection sources
Patients of acute stage and viral carriers of atypical
measles
Transmission
Highly contagious, approximately 90% of susceptible
contacts acquire the disease.
Respiratory secretions: maximal dissemination of virus
occurs by droplet spray during the prodromal period
(catarrhal stage).
Contagious from 5 days before symptoms, 5 days after
onset of rash
Seasons: in the spring, peak in Feb-May
5. PATHOGENESIS AND
PATHOLOGY
Portal of entry
Respiratory tract and regional lymph nodes
Enters bloodstream (primary viraemia) monocyte –
phagocyte system target organs (secondary viraemia)
Target organs
The skin; the mucous membranes of the nasopharynx,
bronchi, and intestinal tract; and in the conjunctivae, ect
Resulting In-----
1) Koplik spots and skin rash: serous exudation and proliferation
of endothelial cells around the capillaries
2) Conjunctivis
6. PATHOGENESIS AND
PATHOLOGY
3) Laryngitis, croup, bronchitis :general inflammatory reaction
4) Hyperplasia of lymphoid tissue: multinucleated giant cells
(Warthin-Finkeldey giant cells) may be found
5) Interstitial pneumonitis: Hecht giant cell pneumonia.
6) Bronchopneumonia: due to secondary bacterial infections
7) Encephalomyelitis: perivascular demyelinization occurs in
areas of the brain and spinal cord.
8) Subacute sclerosing panencephalitis(SSPE):
degeneration of the cortex and white matter with intranuclear
and intracytoplasmic inclusion bodies
7. CLINICAL MANIFESTATION
Typical Manifestation:
patients havn’t had measles immunization, or vaccine failure
with normal immunity or those havn’t used immune globulin
1. Incubation period (infection to symptoms) :
6-18days (average 10 days)
2. Prodromal period:
3-4 days
Non-specific symptoms: fever, malaise, anorexia,
headache
Classical triad: cough, coryza, conjunctivitis (with
photophobia, lacrimation)
8. CLINICAL MANIFESTATION
Enanthem (Koplik spots):
Pathognomonic for measles
24-48 hr before rash appears
1mm, grayish white dots with
slight, reddish areolae
Buccal mucosa, opposite the
lower 2nd molars
increase within 1day and spread
fade soon after rash onset
10. CLINICAL MANIFESTATION
3. Rash period
3-4days
Exanthem:
Erythematous, non-pruritic, maculopapular
Upper lateral of the neck, behind ears, hairline,
face trunk arms and legs feet
The severity of the disease is directly related to
the extent and confluence of the rash
,
14. CLINICAL MANIFESTATION
Temperature:
Rises abruptly as the rash appears
Reaches 40℃ or higher
Settles after 4-5 days – if persists, suspect secondary
infection
Coryza, fever, and cough:
Increasingly severe up to the time the rash has covered the
body
Lymphadenopathy (posterior cervical region, mesenteric)
splenomegaly, diarrhoea, vomiting
Chest X ray:
May be abnormal, even in uncomplicated cases
15. CLINICAL MANIFESTATION
4. Recovery period
3-4days
Exanthem:
Fades in order of appearance
Branny desquamation and brownish discoloration
Entire illness – 10 days
17. CLINICAL MANIFESTATION
Atypical Manifestation:
1. Mild measles
In patients: administered immune globulin products
during the incubation period and immunized against
measles; in infants <8mo
Long incubation period and short prodromal phase
Mild symptom
No Koplik spot
The rash tends to be faint, less macular, pinpoint
No branny desquamation and brownish discoloration
occur as the rash fades
No complications and short course
18. CLINICAL MANIFESTATION
2. Severe measles:
In cases with malnutrition, hypoimmunity and secondary
infection
Persistent hyperpyrexia, sometimes with convulsions and even
coma
Exanthem:
Completely covered the skin
Confluent, petechiae, ecchymoses
The hemorrhagic type of measles (black measles), bleeding
may occur from the mouth, nose, or bowel. disseminated
intravascular coagulation (DIC)
20. CLINICAL MANIFESTATION
3. Atypical measles syndroma:
Recipients of killed measles virus vaccine, who later come in
contact with wild-type measles virus.
Distinguished by high fever, severe headache, severe abdominal
pain, often with vomiting, myalgias, respiratory symptoms,
pneumonia with pleural effusion
Exanthem:
First appears on the palms, wrists, soles, and ankles, and
progresses in a centripetal direction.
Maculopapular vesicular purpuric or hemorrhagic.
Koplik spots rarely appear
22. CLINICAL MANIFESTATION
4. Measles absent of rush
Immunodepressed, or passive immunized recently cases and
occasionally in infants <9mo who have appreciable levels
of maternal antibody
Non-specificity
Difficult to diagnosis
23. COMPLICATIONS
1. Respiratory Tract
Laryngitis, tracheitis, bronchitis – due to measles
itself
Laryngotrachobronchitis (croup) –cause airway
obstruction to require tracheostomy
Secondary pneumonia – immunocompromised,
malnourished patients. pneumococcus, group A
Streptococcus, Staphylococcus aureus and
Haemophilus influenzae type B.
Exacerbation of TB
25. COMPLICATIONS
4. CNS
The incidence of encephalomyelitis is 1-2/l,000 cases of
measles
Onset occurs 2-5 days after the appearance of the rash
No correlation between the severity of the rash illness and
that of the neurologic involvement
Earlier - direct viral effect in CNS
Later – immune response causing demyelination
Significant morbidity, permanent sequelae – mental
retardation and paralysis
Subacute sclerosing panencephalitis (SSPE): extremely rare,
6-10 years after infection. Progressive dementia, fatal.
Interaction of host with defective form of virus
26. LABORATORY EXAMINATION
Isolation of measles virus from a clinical specimen (e.g.,
nasopharynx, urine)
Significant rise in measles IgG by any standard serologic assay
Positive serologic test for measles IgM antibody
Immunofluorescence detects Measles antigens
Multinucleated giant cells in smears of nasal mucosa
Low white blood cell count and a relative lymphocytosis in PB
Measles encephalitis – raised protein, lymphocytes in CSF
27. DIAGNOSIS
characteristic clinical picture:
Measles contact
Koplik spot
Features of the skin rash
The relation between the eruption and fever
Laboratory confirmation is rarely needed
28. DIFFERENTIAL DIAGNOSIS
The rash of measles must be differentiated from that of
rubella;
roseola intantum;
enteroviral infections;
scarlet fever;
and drug rashes.
29. Pathogen Features Rash fever Vs Rash
Measles Measles virus Cough coryza, conjunctivitis Red maculopapule fever for3-4days
Koplik spot after the Face trunk limbs rises abruptly as
2nd -3rd fever Desquamation and the rash appears
discoloration
Rubella Rubella virus Disease is mild, postau- Maculopapule fever for1-2days
ricular lymphadenopathy Face trunk limbs low or absent
No desquamation and during the rash
discoloration
Roseola Human Generally well, Seizures Rose colored, spreads high fever for3-5
Infantum herpesvirus 6 (5-10%) due to high to the neck and the days, ceases with
fever trunk the onset of rash
Scarlet fever Group A High fever, toxicity, Gooseflesh texture on fever for1-2days
Streptococcus Angina, strawberry tongue an erythematous base higher as the
Circumoral pallor, tonsillitis for 3-5 day, desquam- rash appears
ation after 1 week
Enteroviral Echovirus, Accompanied by respiratory Scattered macule or Rash appears
Infections Coxsackievirus or gastrointestinal maculopapule, few during or after
manifestation confluent, 1-3 days, fever
no desquamation
Drug Rash Manifestations of Urticarial, maculopapula Relates to the
primary disease, itching or scarlatiniform rash drugs taken
32. TREATMENT
Supportive, symptom-directed
Antipyretics for fever
Bed rest
Adequate fluid intake
Be protected from exposure to strong light
Antibiotics for otitis media, pneumonia
High doses Vitamin A in severe/ potentially
severe measles/ patients less than 2 years
100,000IU—200,000IU
33. PREVENTION
1. Quarantine period
5 days after rash appears, longer for complicated measles
2. Vaccine
The initial measles immunization is recommended at 8mo of
age
A second immunization is recommended routinely at 7yr of
age
3. Postexposure Prophylaxis
Passive immunization with immune globulin (0.25mL/kg)
is effective for prevention and attenuation of measles within
5 days of exposure.