This document provides information on the management of measles. It begins with background details on measles, including that it is an acute childhood infectious disease caused by a viral infection. It then discusses the clinical picture and classifications of severity. Potential complications of measles are outlined. The document details the general principles of management, including treating the whole family and anticipating complications. It provides details on investigations and screening for complications. Treatment for the patient is described, including supportive care, antibiotics, vitamin A, and counseling on discharge. Measles control in Zambia through routine vaccination and supplemental immunization activities is also summarized.

1. MANAGEMENT - MEASLES
LUKAMA KASOKA K
7th year, MBChB
University Of Zambia

2. BACKGROUND
 Also called Rubeola
 Acute childhood infectious disease caused by a
viral infection – ssRNA
 One attack gives lifelong immunity in
immunocompetent.
 Entry is Resp tract via droplets and infects the
Reticuloendothelial system – 1° viremia.
 Incubation is 7-14 days.
 Infectivity is 5 days before and 5 days after rash.

3. CLINICAL PICTURE

4.  Convalescence stage: Rash fade in order on
appearance.
 NOTE
- Catarrhal phase is about 4 days
- Eruptive phase is 4 to 8 days

5. CLASSIFICATION BY SEVERITY

8. COMPLICATIONS

10. OTHERS
 DIC
 Malnutrition
 Thrombocytopenia
 Myocarditis
 Aseptic meningitis
 NOMA (fusobacterium necrophorum and prevotella
intermedia

11. GENERAL PRINCIPLES OF MANAGEMENT
 Treat the whole including the whole family
 Treat Multiple complications at the same time.
 Anticipate Complications
 Act fast to treat Eye lesions to avoid blindness.

12. IDEAL INVESTIGATIONS
 FBC/DC
 IgG and IgM specific antibodies
 PCR
 Viral culture
 LFT, U and E, Cr
COMPLICATIONS SCREENING
o CXR- TB and pneumonia
o Gastric lavage – TB
o Blood culture
o LP(↔or slightly↑protein, ↔or slightly↓Glucose,
↑lymphocytes)

13.  Biopsy from koplick spot shows lymphoid
multinucleated giant cells
 Brain biopsy reveals demyelination, vascular cuffing
and infiltration of macrophages in pts with
encephalitis

14. WHAT WAS DONE FOR THE PT
 Admitted pt
 FBC/DC (microcytic hypochromic , ↑neutrophil,
↓lymphocytes and ↓eosinophils)
 LFT ↑AST, ↓Total Protein and Albumen
 U&Cr - ↓Cr 20.2(23-68)
 NGT
 CXR –perihilar opacities

15.  TREATMENT IS USUALLY SUPPORTIVE
 Vitamin A 200 000iu
 Antibiotic therapy Ceftriaxone and cloxacillin
 Nystatin for the oral candida
 NG feed – F100 then
 Mebendazole – suspecting anemia 2° worm
infestation and paracetamol.
 ORS and ZnSO4 for the diarrhoea.
 Multivitamin syrup
 Oral wound and eye care (rinse with clean water
and swab removal of discharge respectively)

16. DOSING OF VIT A IN MEASLES

17. COUNSELLING ON DISCHARGE
 Inform mother about measles and advise that
everyone at home gets immunised.
 Advise her to bring back the child if condition
worsens or has convulsions, laboured breathing,
ear ache, eye discharge etc.

18. MEASLES CONTROL IN ZAMBIA AT 3
LEVELS
 Routine vaccination at 9 and 18 months. 18 months
introduced in 2016 with mumps and rubella
 Supplemental Immunization Activities.( 6mo –
14yrs)
 Surveillance – case based measles surveillance
with laboratory confirmation

22. THANK YOU