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11 Measles
 

11 Measles

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    11 Measles 11 Measles Presentation Transcript

    • MEASLES MBBS.weebly.com
      • 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.
      DEFINITION
    • 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.
    • 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
    • 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 of the capillaries , vasculitis
      • 2) Conjunctivis
    • PATHOGENESIS AND PATHOLOGY
      • 3) Laryngitis, croup, bronchitis :general inflammatory reaction
      • 4) Hyperplasia of lymphoid tissue: multinucleated giant cells (Warthin-Finkeldey reticuloendothelial 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
    • 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)
    • 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 2 nd molars
        • fade soon after rash onset
    • CLINICAL MANIFESTATION Koplik spots
    • 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
        • The severity of the disease is directly related to
        • the extent and confluence of the rash
        • ,
    • CLINICAL MANIFESTATION
    • CLINICAL MANIFESTATION
    • CLINICAL MANIFESTATION
    • 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
    • CLINICAL MANIFESTATION
        • 4. Recovery period
        • 3-4days
        • Exanthem:
        • Fades in order of appearance
        • Branny desquamation and brownish discoloration
        • Entire illness – 10 days
    • CLINICAL MANIFESTATION
    • 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
      • No branny desquamation and brownish discoloration occur as the rash fades
      • No complications and short course
    • 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)
    • CLINICAL MANIFESTATION
    • 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
    • CLINICAL MANIFESTATION Atypical measles syndroma
    • 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
    • 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
    • COMPLICATIONS
      • 2. Myocarditis
      • 3. Malnutrition and Vitamin A deficiency
    • 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
    • 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
    • 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
    • DIFFERENTIAL DIAGNOSIS
      • The rash of measles must be differentiated from that of
      • rubella;
      • roseola intantum;
      • enteroviral infections;
      • scarlet fever;
      • and drug rashes.
    • 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
    • DIFFERENTIAL DIAGNOSIS Scarlet fever
    • DIFFERENTIAL DIAGNOSIS Scarlet fever
    • 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
    • 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.
    • THANK YOU