Fen Hua Chen, M.D.,PhD. Department of Pediatrics, The Third Affiliated Hospital Sun Yat-sen University Yat-

Measles is«
an acute viral infection characterized by a maculopapular rash erupting successively over the neck, face, body, and extremitis and accompanied by a high fever. fever.

Measles virus
An RNA virus of the genus Morbillivirus in the family of Paramyxoviridae One serotype, human¶s only host Stable antigenicity Rapidly inactivated by heat and light Survival in low temperature.

onset of rash Seasons: in the spring. peak in Feb-May Feb- Transmission     . approximately 90% of susceptible contacts acquire the disease.EPIDEMIOLOGY PIDEMIOLOGY Infection sources  Patients of acute stage and viral carriers of atypical measles Highly contagious. Contagious from 5 days before symptoms. 5 days after symptoms. Respiratory secretions: maximal dissemination of virus secretions: occurs by droplet spray during the prodromal period (catarrhal stage).

PATHOGENESIS AND PATHOLOGY Portal of entry   Respiratory tract and regional lymph nodes Enters bloodstream (primary viraemia) monocyte ± phagocyte system target organs (secondary viraemia) The skin. and intestinal tract. the mucous membranes of the nasopharynx. Target organs  Resulting In----In----1) Koplik spots and skin rash: serous exudation and proliferation of endothelial cells around the capillaries 2) Conjunctivis . ect conjunctivae. and in the conjunctivae. bronchi.

pneumonia. bronchitis :general inflammatory reaction 4) Hyperplasia of lymphoid tissue: multinucleated giant cells (Warthin(Warthin-Finkeldey giant cells) may be found 5) Interstitial pneumonitis: Hecht giant cell pneumonia. croup. 8) Subacute sclerosing panencephalitis(SSPE): degeneration of the cortex and white matter with intranuclear and intracytoplasmic inclusion bodies . 6) Bronchopneumonia: due to secondary bacterial infections 7) Encephalomyelitis: perivascular demyelinization occurs in areas of the brain and spinal cord.PATHOGENESIS AND PATHOLOGY 3) Laryngitis.

CLINICAL MANIFESTATION Typical Manifestation: patients havn¶t had measles immunization. headache Classical triad: cough. malaise. or vaccine failure with normal immunity or those havn¶t used immune globulin 1. Prodromal period:    3-4 days NonNon-specific symptoms: fever. anorexia. conjunctivitis (with photophobia. coryza. lacrimation) . Incubation period (infection to symptoms) : 6-18days (average 10 days) 2.

opposite the lower 2nd molars increase within 1day and spread fade soon after rash onset . grayish white dots with slight. reddish areolae Buccal mucosa.CLINICAL MANIFESTATION Enanthem (Koplik spots):       Pathognomonic for measles 2424-48 hr before rash appears 1mm.


face trunk arms and legs feet The severity of the disease is directly related to the extent and confluence of the rash  . Rash period 3-4days Exanthem:  Erythematous. behind ears. maculopapular nonUpper lateral of the neck. hairline.CLINICAL MANIFESTATION 3. . non-pruritic.




vomiting  Chest X ray: May be abnormal.CLINICAL MANIFESTATION Temperature:     Rises abruptly as the rash appears Reaches 40 or higher Settles after 4-5 days ± if persists. even in uncomplicated cases . fever. mesenteric) splenomegaly. and cough: Increasingly severe up to the time the rash has covered the body Lymphadenopathy (posterior cervical region. suspect secondary 4infection Coryza. diarrhoea.

Recovery period 3-4days Exanthem: Fades in order of appearance Branny desquamation and brownish discoloration Entire illness ± 10 days   .CLINICAL MANIFESTATION 4.


CLINICAL MANIFESTATION Atypical Manifestation: 1. in infants <8mo Long incubation period and short prodromal phase Mild symptom No Koplik spot The rash tends to be faint. pinpoint No branny desquamation and brownish discoloration occur as the rash fades No complications and short course . Mild measles        In patients: administered immune globulin products during the incubation period and immunized against measles. less macular.

hypoimmunity and secondary infection Persistent hyperpyrexia.CLINICAL MANIFESTATION 2. nose. petechiae. Severe measles:      In cases with malnutrition. sometimes with convulsions and even coma Exanthem: Completely covered the skin Confluent. disseminated intravascular coagulation (DIC) . ecchymoses The hemorrhagic type of measles (black measles). bleeding may occur from the mouth. or bowel.


who later come in contact with wild-type measles virus. Atypical measles syndroma:      Recipients of killed measles virus vaccine. soles. often with vomiting. Koplik spots rarely appear . severe headache. myalgias. wrists. and ankles. Maculopapular vesicular purpuric or hemorrhagic. and progresses in a centripetal direction. severe abdominal pain.CLINICAL MANIFESTATION 3. pneumonia with pleural effusion Exanthem: First appears on the palms. wildDistinguished by high fever. respiratory symptoms.

CLINICAL MANIFESTATION Atypical measles syndroma .

or passive immunized recently cases and occasionally in infants <9mo who have appreciable levels of maternal antibody NonNon-specificity Difficult to diagnosis . Measles absent of rush    Immunodepressed.CLINICAL MANIFESTATION 4.

group A Streptococcus. Staphylococcus aureus and Haemophilus influenzae type B. Exacerbation of TB . bronchitis ± due to measles itself Laryngotrachobronchitis (croup) ±cause airway obstruction to require tracheostomy Secondary pneumonia ± immunocompromised. pneumococcus. tracheitis.COMPLICATIONS 1. malnourished patients. Respiratory Tract Laryngitis.

COMPLICATIONS 2. Malnutrition and Vitamin A deficiency . Myocarditis 3.

direct viral effect in CNS  Later ± immune response causing demyelination  Significant morbidity.000 cases of 1measles Onset occurs 2-5 days after the appearance of the rash 2No correlation between the severity of the rash illness and that of the neurologic involvement  Earlier . CNS The incidence of encephalomyelitis is 1-2/l. permanent sequelae ± mental retardation and paralysis Subacute sclerosing panencephalitis (SSPE): extremely rare. fatal. Progressive dementia.COMPLICATIONS 4. 6-10 years after infection. Interaction of host with defective form of virus .

.LABORATORY EXAMINATION Isolation of measles virus from a clinical specimen (e. lymphocytes in CSF . urine) Significant rise in measles IgG by any standard serologic assay Positive serologic test for measles IgM antibody Immunofluorescence detects Measles antigens Multinucleated giant cells in smears of nasal mucosa Low white blood cell count and a relative lymphocytosis in PB Measles encephalitis ± raised protein. nasopharynx.g.

DIAGNOSIS characteristic clinical picture: Measles contact Koplik spot Features of the skin rash The relation between the eruption and fever Laboratory confirmation is rarely needed .

. scarlet fever. and drug rashes.DIFFERENTIAL DIAGNOSIS The rash of measles must be differentiated from that of rubella. enteroviral infections. roseola intantum.

few during or after confluent. conjunctivitis Koplik spot after the 2nd -3rd fever Disease is mild. Coxsackievirus Drug Rash Red maculopapule fever for3-4days for3Face trunk limbs rises abruptly as Desquamation and the rash appears discoloration Maculopapule fever for1-2days for1Face trunk limbs low or absent No desquamation and during the rash discoloration Rose colored. Seizures (5(5-10%) due to high fever High fever. spreads high fever for3-5 for3to the neck and the days. strawberry tongue Circumoral pallor. toxicity. itching Enteroviral Infections Echovirus. 1-3 days. Angina. ceases with trunk the onset of rash Gooseflesh texture on fever for1-2days for1an erythematous base higher as the for 3-5 day. desquam3desquamrash appears ation after 1 week Scattered macule or Rash appears maculopapule. maculopapula Relates to the or scarlatiniform rash drugs taken . tonsillitis Accompanied by respiratory or gastrointestinal manifestation Manifestations of primary disease. postaupostauricular lymphadenopathy Rash fever Vs Rash Rubella Rubella virus Roseola Infantum Human herpesvirus 6 Scarlet fever Group A Streptococcus Generally well.Pathogen Measles Measles virus Features Cough coryza. 1fever no desquamation Urticarial.



pneumonia High doses Vitamin A in severe/ potentially severe measles/ patients less than 2 years 100. symptom-directed symptomAntipyretics for fever Bed rest Adequate fluid intake Be protected from exposure to strong light Antibiotics for otitis media.TREATMENT Supportive.000IU .000IU²200.000IU² 100.

longer for complicated measles 2. Postexposure Prophylaxis Passive immunization with immune globulin (0. Quarantine period 5 days after rash appears.PREVENTION 1. .25mL/kg) is effective for prevention and attenuation of measles within 5 days of exposure. Vaccine The initial measles immunization is recommended at 8mo of age A second immunization is recommended routinely at 7yr of age 3.


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