ASSO PROFPEDIATRICS ICHGOVT MEDICAL COLLEGE KOTTAYAM LEARNING OBJECTIVES To list essential features of clinical measles To list 2 complications of measles To write a treatment protocol for measles ID: 631676
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Slide1
MEASLES
DR JAYAPRAKASH.K.P
ASSO. PROF.PEDIATRICS
ICH,GOVT MEDICAL COLLEGE KOTTAYAMSlide2
LEARNING OBJECTIVES
To list essential features of clinical measles
To list 2 complications of measles
To write a treatment protocol for measles
To suggest 2 interventions for preventionSlide3
AETIOLOGY
Measles
virus is a single-stranded, lipid-enveloped
RNA
virus in the family
Paramyxoviridae
and genus
MorbillivirusSlide4
TRANSMISSION
The
portal of entry
of measles virus is through
the respiratory tract or conjunctivae
following contact with
large droplets or small-droplet aerosols
in which the virus is suspended.
Patients are
infectious from 3 days before to up to 4-6 days after the onset of rash
.Slide5
PATHOLOGY
Measles infection causes
necrosis of the respiratory tract epithelium
and an accompanying lymphocytic infiltrate.
Measles produces
small vessel vasculitis
on the skin and on the oral mucous membranes.Slide6
PATHOGENESIS
Measles consists of 4 phases:
incubation period, prodromal illness,
exanthematous
phase, and recoverySlide7
CLINICAL MANIFESTATIONS
Measles is a serious infection characterized by high fever, an
enanthem
, cough,
coryza
, conjunctivitis, and a prominent
exanthem
.
After an incubation period of 8-12 days, the prodromal phase begins with a mild fever followed by the onset of conjunctivitis with photophobia,
coryza
, a prominent cough, and increasing feverSlide8Slide9
Koplik
spots
represent the
enanthem
and are the pathognomonic sign of measles,
appearing 1-4 days prior to the onset of the rash.
They first appear as
discrete red lesions with bluish white spots in the
center
on the inner aspects of the cheeks
at the level of the premolarsSlide10
The rash
begins on the forehead
(around the hairline),
behind the ears
, and on the upper neck as a red maculopapular eruption.
It
then spreads downward to the torso and extremities,
reaching the palms and soles in up to 50% of cases.
The
exanthem
frequently becomes confluent on the face and upper trunkSlide11
With the onset of the rash, symptoms begin to subside
. The rash
fades over about 7 days
in the same progression as it evolved, often leaving a fine desquamation of skin in its wake.
Of the
major symptoms of measles, the cough lasts the longest, often up to 10 daysSlide12
LAB INV
The diagnosis of measles is almost always based on clinical and epidemiologic findingSlide13
D/D
rubella, adenovirus infection, enterovirus infection, and Epstein-Barr virus infection.
Exanthem
subitum
(in infants) and erythema
infectiosum
.
Group A streptococcus may also produce rashes similar to that of measles.
Kawasaki syndrome can cause many of the same findings as measlesSlide14
COMPLICATIONS
Pneumonia is the most common cause of death in measles. The most common
bacterialpathogens
are Streptococcus pneumoniae, Haemophilus
influenzae
,
andStaphylococcus
aureus.
Acute otitis media is the most common complication of measlesSlide15
Diarrhea
and vomiting are common symptoms associated with acute measles
MALNUTRITION,VIT A DEFICIENCY
Febrile seizures, Measles encephalitisSlide16
Subacute
sclerosing
panencephalitis
(SSPE) is a chronic complication of measles with a delayed onset and an outcome that is nearly always fatal.
It appears to result from a persistent infection with an altered measles virus that is
harbored
intracellularly in the central nervous system for several years. Slide17
TREATMENT
Management of measles is supportive.
Vitamin A should be administered once daily for 2 days at doses of 200,000 IU for children 12
mo
of age or older; 100,000 IU for infants 6
mo
through 11
mo
of age; and 50,000 IU for infants younger than 6
mo
of age.
In children with signs and symptoms of vitamin A deficiency, a 3
rd
age-appropriate dose is recommended 2 through 4
wk
after the 2nd dose.Slide18
PREVENTION
Patients shed measles virus from 7 days after exposure to 4-6 days after the onset of rash. Exposure of susceptible individuals to patients with measles should be avoided during this period.
MEASLES VACCINE AT 9 MONTHS &18 MONTHSSlide19
POST EXPOSURE PROPHYLAXIS
The vaccine is effective in prevention or modification of measles if given within 72 hr of exposure.
Immune globulin may be given up to 6 days after exposure to prevent or modify infectionSlide20
OMP