BY

DR.DANIYA WAZEEF
MEASLES.
MOMIN
 INTRODUCTION;
 MEASLES IS AN ACUTE COMMUNICABLE DISEASE CHARAC-
TERIZED BY PRODROMAL STAGE HAVING FEVER ,COUGH,
CORYZA, LACRIMATION AND KOPLIK’S SPOT FOLLOWED
BY ERUPTIVE PHASE HAVING MACULOPAPULAR RASHES
.THE RASH HEALS LEAVING BRAWNY PIGMENTATION.
 CAUSATIVE ORGANISM:
 IT IS CAUSED BY RNA VIRUS CLASSIFIED AS MORBILLI-
VIRUS BELONGING TO PARAMYXOVIRUS FAMILY.
 IT IS PRESENT IN THE NASOPHARYNGEAL SECRETIONS,
BLOOD AND URINE ATLEAST DURING THE PRODROMAL
PERIOD AND FOR A SHORT TIME AFTER RASH APPEARS.
 IT CAN REMAIN ACTIVE FOR ATLEAST 34hr AT ROOM
TEMP.
INCUBATION PERIOD:
 INCUBATION PERIOD IS OF APPROX. 8-12
DAYS.
 EPIDEMIOLOGY:
 MEASLES IS AN ENDEMIC OVER MOST OF THE WORLD.
 MAN IS THE ONLY RESERVOIR.
 NO EVIDENCE OF CARRIER STATE.
 DISEASE IS COMMAN IN PRE-SCHOOL CHILDREN.
 CAN OCCUR IN ALL SEASONS MORE SO IN WINTER AND
SPRING MONTH.
 INFECTION IS TRANSMITTED BY DIRECT CONTACT AND
DROPLET SPREAD FROM SECRETION OF THE NOSE AND
THROAT USUALLY 4 DAYS BEFORE AND 5 DAYS AFTER THE
APPEARANCE OF RASHES.
 INFANTS ACQUIRE IMMUNITY TRANSPLACENTALLY FROM
MOTHERS WHO HAVE HAD MEASLES.
 PATHOLOGY:
 MEASLES VIRUS INFECTS BY INVASION OF
RESP.EPIT-HELIUM.
 LOCAL MULTIPLICATION LEADS TO
VIREMIA(DAY2-3) AND SUBSEQUENTLY SPREAD
TO RETICULO-ENDOTHELIAL SYSTEM.
 CELLS OF RES NECROSE ,CAUSING SECONDARY
VIREMIA(DAY5-7).
 SECONDARY VIREMIA IS RESPONSIBLE FOR
SYSTEMIC SYSTEM.
 MULTINUCLEATED GIANT CELLS CAN BE
DEMONSTRATED IN BOTH EPIDERMIS AND ORAL
EPITHELIUM.
 CLINICAL MANIFESTATION:
1:PRODROMAL PHASE:
 IT USUALLY LAST FOR 3-5 DAYS.
 IT IS CHARACTERIZED BY LOW GRADE TO MODERATE
FEVER, SLIGHT DRY HACKING COUGH,CORYZA AND
CONJUNCTIVITIS.
 ON 2nd OR 3rd DAY KOPLIK SPOTS,THE PATHOGNOMIC
SIGN OF MEASLES APPEAR ON INNER SIDE OF CHEEK,
OPP. THE SECOND MOLARS.
 THESE MAY BE SINGLE OR MULTIPLE AND APPEAR AS
GREYISH OR BLUISH WHITE GRAINS OF SANDS
SURROUNDED BY REDDISH AREOLA.
 KOPLIK SPOTS INCREASES IN NO. FOR 2-3 DAYS AND
DISAPPEAR BY END OF SECOND DAY OF RASH.
 OCCASSIONALLY PRODROMAL PHASE MAY BE SEVERE BEING
USHERED IN BY SUDDEN HIGH FEVER AT TIMES WITH
CONVULSION AND EVEN PNEUMONIA.
2:ERUPTIVE PHASE:
 WITH THE APPEARTANCE OF RASH ON THE 4th DAY FEVER

RISES AND OFTEN REACHES 40-40.5 C .

 THE EARLY RASH IS ERYTHEMATOUS AND BLANCHES ON

PRESSURE.
 THE RASH USUALLY START AS FAINT MACULES ON UPPER

LATERAL PARTS OF NECK,BEHIND THE EARS, ALONG THE

HAIRLINE ON THE FOREHEAD,FACE AND THAN SPREAD TO
TRUNK,EXTREMETIES,PALMS AND SOLES WITHIN 3 DAYS .
 THE RASH NOW APPEARS BROWNISH AND DOES NOT FADE

ON PRESSURE.
 THE RASH STARTS DISAPPEARING AFTER 4-5 DAYS IN THE

SAME ORDER IN WHICH APPEARED .

 IT LEAVES BEHIND A BROWNY OR FURFURACEOUS

DESQUAMATION.
 THE RASH STARTS DISAPPEARING AFTER 4-5 DAYS IN
THE SAME ORDER IN WHICH IT APPEARED .
 IT LEAVES BEHIND A BROWNY OR FURFURACEOUS
DESQUAMATION.
 SEVERELY MALNOURISHED CHILDREN MAY DEVELOP
SEVERE EXFOLIATION.
 RASH MAY BE ATYPICAL IN SOME CASES AND MAY BE
MODIFIED OR EVEN HAEMORRHAGIC.
 HAEMORRHAGIC MEASLES IS CHARACTERIZED BY HIGH
FEVER ,CONVULSION ,BLEEDING FROM NOSE ,MOUTH OR
BOWEL,etc.
 GENERELIZED MODERATE LYMPHADENOPATHY MAY
ALSO BE SEEN.
 SLIGHT SPLENOMEAGALY IS ALSO NOTED.
 COMPLICATION:
1:RESPIRATORY COMPLICATION:
 IT IS THE MOST COMMON AND CAUSED PROLONGED

MORBIDITY.
 OTITIS MEDIA,CERVICAL LYMPHADENOPATHY,

LARYNGITIS ,LARYNGOTRACHITIS,INTERSTITIAL PNEUM

ONIA ARE COMMAN.
 PRIMARY TB MAY FLARE UP FOL. MEASLES.

2:NEUROLOGICAL COMPLICATION:
A: ENCEPHALOMYELITIS IS ESTIMATED TO BE 1-2/1000
REPORTED CASES OF MEASLES.MEASLES ENCEPHALITIS
IS A SERIOUS COMPLICATION WITH HIGH RATE OF
HANDICAPPING SEQUELE,MENTAL RETARDATION AND
MORTALITY.
B:SSPE(SUB ACUTE SCLEROSING PAN-ENCEPHALITIS): IT IS
A DISORDER CHARACTERIZED BY MYOCLONIC JERKS,
MENTAL DETERIORATION AND FATAL COURSE WITHIN
6mnths IS A LATE COMPLICATION MEASLES.IT OCCURS
AFTER 3-8yrs OF PRIMARY MEASLES INFECTION.
 DIAGNOSIS:
 DIAGNOSIS MAINLY BASED ON CLINICAL GROUNDS.
 CAN BE CONFIRMED BY SEROLOGICAL TEST.
 MEASLES SPECIFIC IgM PERSIST FOR 30-60 DAYS AFTER
RASH.
 ELISA AND HAEMAGGLUTINATION INHIBITION ARE THE
MOST SENSITIVE TO DETECT MEASLES ANTIBODY.
 PREVENTION;
 LIVE ATTENUATED MEASLES VACCINE OFFERS GOOD
PROTECTION.
 IT IS NOW RECOMMENDED THAT MEASLES VACCINE
BE ADMINISTERED AT 9-12 MONTHS WITH
REVACCINATION AT 15-18 MONTHS AS A PART OF
MMR.
 PROTECTION LAST FOR LIFE TIME.
 PASSIVE IMMUNIZATION IS INDICATED IN EXPOSED
INFANTS AND YOUNGER SIBLINGS.
 GAMMA GLOBULIN IS INJECTED IM 0.25
ML/kg(MAX. DOSE15ml)CAN BE GIVEN WITHIN 5
DAYS AFTER EXPOSURE.
 TREATMENT:
 SYMPTOMATIC AND SUPPORTIVE.
 BODY AND ORAL; HYGIENE IS MAINTAINED.
 IF PERSISTENT VOMITTING IS PRESENT ,THAN FLUIDS
ARE GIVEN IV.
 FEVER IS CONTROLLED BY PARACETAMOL.
 SEVERE COUGH MAY BE RELIEVED BY NEBULIZATION.
SCARLET
FEVER.
INTRODUCTION:
• IT IS AN ACUTE CONTAGIOUS DISEASE CHARACTERIZED BY
PHARYNGITIS AND PIMPLY RED RASH.
• FOR REASONS THAT ARE NOT CLEAR ,SCARLET FEVER HAS
BECOME LESS COMMAN IN RECENT YEARS.
• SYNONYM: SCARLATINA.
• LATIN: SCARLETEM= RED.
CAUSATIVE ORGANISM:

• GRAM +VE STREPTOCOCCAL BACTERIA i.e. GROUP A

STREPTOCOCCI.
• THE RASH ARISES FROM THE EFFECTS OF ONE OF THREE
TOXINS ,CURRENTLY DESIGNATED STREPTOCOCCAL
PYROGENIC EXOTOXINS A,B,C AND PREVIOUSLY KNOWN AS
ERYTHROGENIC OR SCARLET FEVER TOXIN .
INCUBATION PERIOD:
• 1-7 DAYS.

• MODE OF TRANSMISSION:
• IT USUALLY SPREAD BY INHALATION.
• BUT CAN BE TRANSMITTED BY DIRECT CONTACT AND
FOMITES.
CLINICAL FEATURES:

• FEVER WITH CHILLS,

• MALAISE,
• SORE THROAT ,
• VOMITTING,etc.
• SYMPTOMS OF SCARLET FEVER ARE SAME AS THOSE OF
PHARYNGITIS.
• PHARYNX AND TONSILS ARE SWOLLEN AND RED .
• RASH TYPICALLY BEGINS ON FIRST OR SECOND DAY OF ILL-
NESS OVER THE UPPER TRUNK ,SPREADING TO INVOLVE THE
EXTREMITIES BUT SPARING THE PALMS,SOLES,NOSE AND LIPS.
• THE RASH IS MADE UP OF MINUTE PAPULES GIVING A
CHARACTERISTIC ‘SAND PAPER’FEEL TO SKIN.
• ‘STAWBERRY TONGUE’(ENLARGED PAPILLAE ON COATED
TONGUE ).
• CIRCUMORAL PALLOR ,AGAINST A BACKGROUND OF
FLUSHED CHEEKS IS CHARACTERISTIC .
• RASH IS ACCENTUATED IN SKIN FOLDS (PASTIA’S LINE).
• USUALLY THE RASH IS AT ITS MAX. IN 2 DAYS AND FADES BY
END ON ONE WEEK.
DIAGNOSIS:
 Scarlet fever can be diagnosed by clinical signs and
symptoms. Complete blood count (CBC) findings
characteristic of Scarlet fever would show a
marked increase in white blood cell count with 
neutrophilia and conserved or increased 
eosinophils, high erythrocyte sedimentation rate
 (ESR) and C-reactive protein (CRP) (both
indications of inflammation). Blood culture is
rarely positive but the streptococci can usually be
demonstrated in throat culture.[citation needed]
PREVENTION:
• NO VACCINE AVAILABLE.
TREATMENT:

• Greater than 1 month to less than 12 years: 25 to 50 mg/kg

per day orally in divided doses every 6 to 8 hours
Maximum dose: 3 g/day
 12 years or older: 125 to 500 mg orally every 6 to 8 hours