MEASLES (RUBEOLA). Department of Pediatrics Soochow University Affiliated Children’s Hospital. SUMMARY.
Department of Pediatrics
Soochow University Affiliated Children’s Hospital
1.Measles is an acute infectious disease 2.caused by the measles virus. 3. symptoms and signs such as fever, sneezing, cough, conjunctivitis（结膜炎）, koplik spots（科氏斑） and rashes
1.be of paramyxoviridae（副粘病毒属）
2.only one serum type
3.the habit and resistance
4.can be from secretions（分泌物）, urine,blood
2. be found in nasopharyngeal （鼻咽部的）secretions,blood,and urine.
3. can remain active for at least 34 hr at room temperature.
Before widely using Measles virus’s attenuated（减毒的） vaccine,Measles epidemiced once per 2~4 years.But now this epidemic disappears and the adult patients gradully increase.
Measles is very contagious（传染的）;approximately 90% of susceptible family contacts acquire the disease. Maximal dissemination of virus occurs by droplet spray during the prodromal period (前驱期). Transmission to susceptible contacts often occurs prior to diagnosis of the original case
① People are easily affected
② Covert（隐性） infection is rare
③ ＜8M infant, ＞8M people
④ Immunocompetence（免疫力） is forever
Two virus toxemic（毒血的） symptoms
1.Invade the mucosal cells
2.Virus blood symptom
6~18 days,ordinally 10~14 days,even to 21~28 days;
The patient may transmit the virus by the 9th-19th day after exposure and occasionally as early as the 7th day, before the illness can be diagnosed.
about 3~5 days.
Fever,low-grade to moderate fever
a dry cough,coryza,anconjunctivitis. These symptoms nearly always precede the appearance of Koplik spots ,the pathognomonic sign of measles,by 2-3 days.
they are grayish white dots, usually as small as grains of sand, that have slight,reddish areolae,occasionally they are hemorrhagic（出血的）.They tend to occur opposite the lower molars but may spread irregularly over the rest of the buccal mucosa.Rarely they are found within the midportion of the lower lip,on the palate,and on the lacrimal caruncle（泪埠）.
Koplik spots appear and disappear rapidly, usually within 12-18 hr.As they fade a red,spotty discoloration of the mucosa may remain.
The conjunctival inflammation and photophobia（畏光） may suggest measles before Koplik spots appear.In particular,a transverse line of conjunctival inflamma-tion,sharply demarcated（以为划界的） along the eyelid margin,may be of diagnostic assistance in the prodromal stage.As the entire conjunctiva becomes involved,the line disappear.
about 3~5 days.
The turn usually starts as faint macules on the upper lateral parts of the neck,behind the ears,along the hairline,and on the posterior parts of the cheek.The individual lesions become increasingly maculopapular as the rash spreads rapidly over the entire face,neck,upper arms,and upper part of the chest within approximately the first 24 hr.
The rash is often slightly hemorrhagic,in severe cases with a confluent rash,they are maculopapular(斑丘疹）.As the rash fades ,branny desquamation（糠麸状脱屑） and brownish discoloration（棕色色素沉着） occur and then disappear within 7-10 days.
The temperature rises abruptly as the rash appears and often reaches 40oC(104oF) or higher.In uncomplicated cases,as the rash appears on the legs and feet the symptoms subside rapidly within about 2 days usually with an abrupt drop in temperature to normal.
3~5 days after the onset of rashes
1) Rashes fade from face,completely gone within 6 days
2)branny desquamation, brownish
3) Fever falls
1. Tolal leukocyte counts
2. Multinucleated giant cells
3. Measles IgM antibody
4. Tissue culture
5. Measles antigen
②Subacute sclerosing panencephalitis(SSPE)（亚急性硬化性全脑炎）
① Black measles
② Thrombocytopenia（血小板减少症）,appendicitis（阑尾炎）,keratitis（角膜炎）, myocarditis（心肌炎）
③ Reactivation or progression of TB(tuberculosis)
④ Premature delivery or stillbirth (死产）
⑤ Mild liver function test elevation
1. Exposure to measles 10~14 days previously
2. Prodroma of fever,cough,conjunctivitis and coryza（鼻炎）
3. Koplik sports
4. Maculopapular rash
Recovery generally occurs 7~10 days after onset of symptoms
①Eye care,cough relief,fever reduction
②Second bacterial infections:antimicrobial
①First time is after 8M
②Revaccination upon entrance into primary or second school
3.Patient should be isolated 5 days from rashes
①Vaccination within 72 hours
②immune globulin within 6 days
6.Suspected cases should be diagnosed promptly and reported to local health department.