Measles is caused by a highly contagious RNA virus from the paramyxoviridae family. It is transmitted through respiratory droplets and direct contact. Despite an effective vaccine, measles causes 350,000 childhood deaths annually in developing countries due to poor immunization coverage. The virus infects respiratory epithelium and spreads to reticuloendothelial cells, causing systemic symptoms over three phases - prodromal, enanthematous with pathognomonic Koplik's spots, and exanthematous with a maculopapular rash. Complications include pneumonia, encephalitis and death. Diagnosis is clinical but can be confirmed with IgM antibodies or virus isolation. Treatment is supportive and prevention is through universal

1. MEASLES

2. Etiology
• Highly contagious disease
• Caused by RNA virus belonging to
paramyxoviridae family.
• Measles is the leading killer among the vaccine
preventable diseases.
• Humans are the only host

3. Global Burden
• Despite of a effective vaccine……..
• Measles still causes 350000 childhood deaths
annually in developing countries
• 80000 per year in India alone.
• Due to poor coverage of routine immunization

4. PATHOGENESIS
• Mainly through droplet infection (secretion from
nose and throat)
• By direct person to person contact also
• Period of communicability is 4 days before and 5
days after the appearance of rash.
• Highly contagious with a secondary attack rate
of more than 90 % .

5. • The portal of entry is respiratory epithelium where the
virus multiplies.
• Primary viremia - infection of the reticuloendothelial cells.
• Secondary viremia – results in systemic symptom.
• Two types of giant cells seen in measles
- Epithelial giant cells in respiratory epithelium
- Warthin- Finkeldey giant cells in reticuloendothelial
system.

6. Clinical features
• Incubation period is 8-12 days ( avg 10 days)
3 phases are seen
Prodromal phase
- Acute onset of fever with cough, coryza, rhinitis,
conjunctivitis ,malaise , anorexia .
- Fever is mostly continuous and usually lasts for 1
week.

7. Enanthematous phase
- on 2nd or 3rd of fever kopliks spots appear on the
buccal mucosa opposite of lower 2nd molars.
-Pathognomonic of measles
- Gray or white lesions like grains of sand with
surrounding edema.
- may also be seen in palate , lips , gums .

9. Exanthematous phase
- Rash appear on the 4th day
- Begins on the face and neck typically behind the
ear , along the posterior hairline and on the
posterior aspect of the cheek.
- Then it spreads to trunk , extremities, palms and
soles.

10. - Rash is erythematous and maculopapular
- Lasts for 5 days.
- It fades in the same manner as appearance.
- Heals with a browny pigmentation which fades
with in 10 days.

13. Modified measles
seen in persons who are partially immune
milder and shorter illness.
Hemorrhagic measles
- Purpuric rash with bleeding from mouth,nose or
bowels ,altered sensorium, seizures , coma
- High fatality rate

14. DIAGNOSIS
• Primarily clinical
• Serological – IgM antibodies in serum present 3
days after the rash and persists for 1 month.
• The virus can also be isolated from the
respiratory secretions , blood , urine during
illness.

15. Complications
• Due to widespread mucosal damage and
immunosupression.
• More in young infants , malnourished ,
immunocompromised .
• Common complications are
- Bronchopneumonia
- Otitis media
- Bronchitis
- Laryngitis
- Bronchiectasis

16. - Persistent diarrhea
- hepatitis
- Ileocolitis
- Appendicitis
- myocarditis
- AGN
- Acute encephalitis
- Post measles encephalitis
- SSPE ( subacute sclerosing panencephalitis)

17. Treatment
• Supportive
• Antipyretics
• Maintain hygiene
• Adequate fluid and calorie intake
• Vitamin a reduces the morbidity and mortality of
measles
dose – 1 lakh units below 1 year
2 lakh units above 1 year
Two doses 24 hours apart

18. Prevention
• By universal immunization
• Strain is Edmonston - Zagreb strain

19. THANK U