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麻 疹 MEASLES 重庆医科大学儿童医院重庆医科大学儿童医院 DIVISION OF INFECTIOUS DISEASE AND DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGYGASTROENTEROLOGY 1 1 MEASLES Key pointsKey points DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY u Acute respiratory infectious disease caused by measles virus u clinical feature: Fever, Cough, Runny nose, Conjunctivitis, Exanthem u Specific sign: Kopliks Spots (a kind of enanthem ) 2 2 DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY ClassificationClassification: A RNA virus Genus: morbillivirus Family: paramyxoviridae Serotype:Serotype: Only one Location: Location: Nasopharyngeal secretions, Blood, Urine of patients PathogenPathogen 3 3 PathogenPathogen DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY measles virusmeasles virus 4 4 DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY EpidemiologyEpidemiology 1.1.Infectious Infectious sourcessources：Measles patients in acute stage 2.2.Routes of transmissionRoutes of transmission： Droplet spray 3.3.Population susceptibilityPopulation susceptibility： 4.Epidemic features4.Epidemic features： l It is susceptible to all the people without infection or inoculation. l The age of peak incidence was 6 months to 5 years old. l The incidence of baby under 6m is lower. 5 5 DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY Routes of transmissionRoutes of transmission EpidemiologyEpidemiology Droplet sprayDroplet spray 6 6 DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY Prior to the use of vaccineAfter the use of vaccine Morbidity (1/100000) Major epidemics: 500-1000 Mild epidemics: 400 9.5 in 1990 Peak seasonIn winter and springIn any time of a year Epidemic cycle Major epidemics appear by 2-4 yr intervals Epidemic cycle disappeared, Sporadic cases increased Age6m-5y (98%10y)Below 6m and above 5y Clinical manifestations Typical cases severe manifestations more complications high mortality Atypical cases mild manifestations less complications rarely death EpidemiologyEpidemiology Epidemic FeaturesEpidemic Features 7 7 8 8 9 9 DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY 00 03 Measles Vaccine Measles Vaccine Inoculation in whole Inoculation in whole China (1968)China (1968) EpidemiologyEpidemiology Measles cases of in-patients in CHCUMSMeasles cases of in-patients in CHCUMS 1010 DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY PathophysiologyPathophysiology 1111 Respiratory epithelium regional lymph nodes First viremia Monocytes/Macrophage Second viremia Respiratory tract, conjunctiva, skin, etc Virus elimination Measles virus PathophysiologyPathophysiology 1. Incubation period 10-14 days 2. Prodromal period 3-4 days 3.Apparent manifestation period 3-5 days 4. Convalescent period 3-5 days 1212 DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY PathologyPathology 1313 Multinucleated giant cell (Warthin-finkeldey giant cells) Pathology Pathology CytopathicCytopathic change change PATHOGNOMONIC FOR MEASLES = 100m, several nucleus inside the cell, formed by confluence of several virus infected reticuloendothelial cells In smears of the nasal mucosa in the prodromal stage 1414 Multinucleated giant cell Pathology Pathology CytopathicCytopathic change change PATHOGNOMONIC PRESENTATION FOR MEASLES1515 DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY PathologyPathology Respiratory tractRespiratory tract Skin Skin KopliksKopliks spots spots 1616 DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY Pathology Pathology skinskin Red maculopapule 1717 DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY Clinical manifestationsClinical manifestations u Typical manifestations u Atypical manifestations 1818 DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY Typical clinical manifestationsTypical clinical manifestations Incubation stage: 10-14days Prodromal stage: 3-4days The prodrome develops on the day symptom begins (fever) and lasts until rash appear. l Fever l Cough l Coryza l Conjunctivitis l Kopliks spots 1919 DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY Typical clinical manifestationsTypical clinical manifestations Prodromal stage: 3-4days2. l Fever The magnitude and pattern of fever are variable in patients, from a low-grade to moderate fever or a sudden high fever may occur. l Cough l Coryza They are not specific symptoms for measles, which are identical to a common cold but catarrhal symptoms maybe more severe. l Conjunctivitis May suggest measles before Kopliks spots. l Kopliks Spots: Pathognomonic sign 2020 DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY Typical clinical manifestationsTypical clinical manifestations typical facial appearance of measles in prodromal stage 2121 DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY Typical clinical manifestationsTypical clinical manifestations 2222 Typical clinical manifestationsTypical clinical manifestations DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY Exanthem stage: 3-5days l Maculopapular rash: l Fever: temperature rises abruptly l Catarrh: l Other manifestations: enlarged lymph nodes, slight splenomegaly, gastrointestinal symptoms such as diarrhea and vomiting 2323 DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY Typical clinical manifestationsTypical clinical manifestations 2424 Typical clinical manifestationsTypical clinical manifestations Maculopapular rash DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY 2525 DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY Typical clinical manifestationsTypical clinical manifestations appearing sequence of the rash The rash usually starts on the upper lateral parts of the neck, behind the ears, along the hairline, and on the posterior parts of the cheek. 2626 DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY Typical clinical manifestationsTypical clinical manifestations appearing sequence of the rash It become increasingly maculopapular as the rash spreads rapidly over the entire face, neck, upper arms, and upper part of the chest within approximately the 24hr. 2727 DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY Typical clinical manifestationsTypical clinical manifestations appearing sequence of the rash 2828 DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY Typical clinical manifestationsTypical clinical manifestations Convalescent stage: 3-5 days u In uncomplicated cases, as the rash appears in the legs and feet the symptoms subside rapidly within about 3 days usually with an abrupt drop in temperature to normal. u As the rash fades, branny desquamation and brownish discoloration (hyperpigmentation) occur and then disappear within 2-3 weeks. 2929 DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY Typical clinical manifestationsTypical clinical manifestations Branny desquamation and brownish discoloration (hyperpigmentation) Convalescent stage: 3030 Temp Days 1-1412345678910 11 12 13 14 Clinical periods Prodromal stage Exanthem stage Convalescent stage Coryza and conjunctivitis Kopliks spots Rash Cough Branny desquamation correlation of rash and fever; catarrh Branny desquamation and brownish discoloration 4141 DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY Differential DiagnosisDifferential DiagnosisDifferential DiagnosisDifferential Diagnosis 4242 DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY Differential diagnosisDifferential diagnosis u Rubella u Roseola infantum u Enterovirus infection u Exanthem caused by drugs 4343 DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY Differential diagnosisDifferential diagnosis u Rubella 4444 DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY Differential diagnosisDifferential diagnosis Rubella (German Measles ) 4545 DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY Differential diagnosisDifferential diagnosis Measles Roseola infantum The rash typically appears when the elevated temperature has abated, and can last for only a few hours before subsiding. 4646 DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY PreventionPrevention 4747 DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY PreventionPrevention u Control of sources of infections u Abrupt the ways of transmission u Protect the susceptible passive immunization active immunization 4848 DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY TreatmentTreatment 4949 DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY TreatmentTreatment u Antipyretics for fever u Bed rest u Maintenance of an adequate fluid intake u Good nutrition and adequate vitamin A intake u Humidification of the room u To keep the room comfortably warm than cool u Be protected from exposure to strong light u Appropriate antibiotic therapy u Traditional Chinese medicine with antiviral effects 5050 ictory over Diseases 5151
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