IKA - measles

Monday, July 12, 2021 5:19 PM

• Etiologi
○ RNA virus
○ Paramyxoviridae, genus morbilivirus
• Epidemiology
○ Endemic
○ Winter, spring
○ Currently <1 case/1 jt population
• Transmission
○ Entry respiratory tract/ conjunctivae
○ Infectious 3 days before rash, up to 4-6 days after its onset
• Pathology
○ Necrosis of respiratory tract epithelium, accompanying lymphocytic infiltrate
○ Small vessel vasculitis on the skin and oral mucous membrane
○ Intracell edema, dyskeratosis
○ Warthin finkeldey giant cells
• Pathogenesis
○ 4 phase
▪ Incubation
□ Primary/ secondary viremia
▪ Prodromal illness
□ Epithelial necrosis and giant cell formation
□ Viral replication
□ Viral shedding begins
▪ Exanthemathous
□ Antibody production begins
□ Immunosuppressive effects
▪ Recovery
• Gejala
○ High fver, enanthem, cough, coryza, conjunctivitis, prominent exanthem
○ Incubation 8-12 days
○ Koplik spots
○ Rash begin in forehead, bhind ears, upper neck as maculopapular eruption
○ Onset of rash, symptoms begin to subside
○ Rash fade over 7 days
○ Cough last longest
• Lab
○ Low total WBC, lymphocyte decreased more than neutrophils
○ ESR and CRP normal
• Diagnose
○ Clinical manifes
○ Serologic= IgM
○ igG rise 4x in acute and convalescent specimen
○ Viral isolation
○ PCR
• DD
○ Exanthem subitum
○ Erythema infectiosum

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• Complication

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• Complication
○ Morbidity and mortality greatest in <5yo, >20 yo
○ Severe malnutrition
○ Low serum retinol level
○ Immunocompromised
○ Pneumonia
○ Acute otitis media
○ Suppress skin test responsiveness to purified tuberculin antigen
○ Diare, vomit
○ Febrile seizure
○ Encephaltis
○ Hemorrhagic, black measles
○ Myocarditis
○ Subacute sclerosing parencephalitis
▪ Chronic measle complication
▪ Cuz of persistent infection
• SSPE
○ Stages

○ Diagnose
▪ Measle antibody in CSF
▪ ECG finding
▪ Histologic, viral isolation
○ Management
▪ Supportive
▪ Isoprinosine with / without IFN
▪ Most die in 1-3 yr
▪ Prevention depend on prevention of primary measles
▪ Antiviral is not effective
• Prognosis
○ Pneumonia and encephalitis is most common fatal case
• Prevention
○ Vaccine
▪ 1st - 9mo, 15mo, 2yo, 5yo
▪ Don’t administer to pregnant / immunodeficient

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