MEASLES DR JAYAPRAKASH.K.P ASSO. PROF.PEDIATRICS ICH,GOVT 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 To suggest 2
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MEASLES DR JAYAPRAKASH.K.P
ASSO. PROF.PEDIATRICS
ICH,GOVT MEDICAL COLLEGE KOTTAYAM<br>
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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 prevention<br>
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AETIOLOGY Measles virus is a single-stranded, lipid-enveloped RNA virus in the family Paramyxoviridae and genus Morbillivirus<br>
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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.<br>
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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.<br>
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PATHOGENESIS Measles consists of 4 phases:
incubation period, prodromal illness, exanthematous phase, and recovery<br>
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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 fever<br>
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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 premolars<br>
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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 trunk<br>
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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 days<br>
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LAB INV The diagnosis of measles is almost always based on clinical and epidemiologic finding<br>
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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 measles<br>
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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 measles<br>
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Diarrhea and vomiting are common symptoms associated with acute measles
MALNUTRITION,VIT A DEFICIENCY
Febrile seizures, Measles encephalitis<br>
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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.<br>
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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 3rd age-appropriate dose is recommended 2 through 4 wk after the 2nd dose.<br>
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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 MONTHS<br>
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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 infection<br>
