2 DefinitionMeasles is a communicable disease manifesting with fever , cough , coryza , lacrimation and koplik spots in the pre – eruptive phase and a maculopapular rash starting at 4th or 5th day of the illness.Coryza : profuse discharge from the mucous membrane of the nosekoplik spot : small, white spots (often on a reddened background) that occur on the inside of the cheeks early in the course of measles.Koplik spotsCoryza
3 Ecological triad Agent: Measles( paramyxovirus ,RNA virus) Age: children (6months -3 years)Measles tend to be very serious in malnourished children, mortality is 400 times higher.Both sexes are affectedImmunity : -one attack of measles gives immunity for life.Infants acquire immunity transplacentally from mothers who have had measles or measles immunization. This immunity is usually completed for the first 4–6 months of life.Reservoir : - Man is only the reservoir of infection.
4 Environment Incidence is higher in spring and winter Incidence is higher in densely populated urban areasNatural historyReservoir is a case of measlesSource of infection: nasopharyngeal secretions, lacrimal secretion, urineInfectious period: 4 days before, and 5 days after the onset of rash
5 Mode of transmissionDirectly from person to person by droplet infection, droplet nucleiOther modes –fomites, airborneIncubation period: 8 – 12 days
6 Pathogenesis Two types of gaint cell are seen : - Virus infects by invasive of respiratory tract .After entering the viral particles infects the respiratory epithelium and local multiplication leads to primary viremia ( day 2 – 3 ) and subsequently spread to the reticuloendothelial system.Cells of reticuloendothelial system necrose , causing secondary viremia ( day 5 – 7 ) which is responsible for systemic symptoms.Multinucleated gaint cells can be demonstrated in both epidermis and oral epithelium by 7 – 11 daysTwo types of gaint cell are seen : -Warthin – Finkeledy cells of reticuloendothelial systemEpithelium gaint cells of respiratory tractDuring infection , CD4T and CD8 cells are activated and participate in clearance of virus and development of rash. During recovery,level of interleukin 4 is elevatedIL-4: protein that stimulates the immune system to develop mast cells, resting T-cells, and activated B-cells.
7 Clinical features Prodromal : - onset is acute with moderate elevation of temperature , cough , running of nose , sneezing , redness of eyes and excessive lacrimation- on second or third day : koplik spots appear on the inner side of the cheek, opposite to the second molars .- Koplik spots increase in number for 2 to 3 days and disappear by the end of second day of the rash
9 Eruptive phase :With the appearance of rash on the 4th day the fever tends to rise againEarly rash is erythematous and blanches on pressure ( blotchy )First appears behind the ears , near the hair line on the forehead , face and neck and spread to trunk , extremities , palms and soles within 3 days.The rash now appears brownish , and does not fade on pressure.Rash start disappearing after 4 to 5 days in the same order in which it appearedFever and rash lasts for about a week in uncomplicated casesMay complain anorexia , malasie , generalised lymphadenopathy
11 Diagnosis Clinical diagnosis: Laboratory diagnosis: Blood count – leucocytosis in early stages followed by increased lymphocytesSputum or urine cultureSerological testsComplement fixation testHaemagglutination testEnzyme-linked immunosorbent assay (ELISA)
12 Differential diagnosis Rubella : rash is pink , maculopapular and discreteInfectious mononucleosis : rash is associated with generalised lymphadenopathy and hepatosplenomegalyMeningococcemia : rash appears within 24 hours. Fever , vomiting , irritability and possibly stiff neck are presentDrug rash : H / o drugs administrationSunburnRoseola infantum : - faint pink maculopapular rash.
13 Treatment : It is a self limiting disease unless it is complicated Symptomatic and supportiveBody and oral hygiene are attended toParents are encouraged to give bath to the child and mouth is washed and teeth are brushed dailyAdequate amount of fluids orallyFever (paracetamol and hydrotherapy )Severe cough ( saline nebulization )Vitamin A decrease the severity , complication rate and mortality. Dose : 2 lac units , orally children older than one year of age for 2 consecutive days.
14 Prevention and control Control measuresIsolationBed restSupportive Tx- vit. A ,Immunization of contacts within 2 days of exposurePreventive measuresActive immunization(9 months, 0.5cc,IM/SC,deltoid)Passive immunization (Human gamma globuline0.25ml/kg IM within 5 days of exposure)
15 Vaccines Dose and schedule: 0.5ml – S/C – 9months Adverse reactions: Measles like illness, febrile convulsion, toxic shock syndrome, transient thrombocytopeniaContraindications: acute illness, untreated malignant diseases, immunodeficiency, pregnancy, received any live vaccine within 3 weeks
16 complications Respiratory tract : Encephalitis Digestive system : otitis media , cervical lymphadenopathy , laryngitis , laryngotracheitis , interstitial pneumonia ,bronchopneumoniaEncephalitisDigestive system :Persistent diarrhea , appendicitis ( lymphoid tissue blocking the lumen of appendix ) , hepatitis , ileocolitisMalnutrition : PEMOthers : acute glomerulonephritis , disseminated intravascular coagulation .
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