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Measles. Measles. Highly contagious, acute exanthematous respiratory disease with a typical clinical picture and a characteristic enanthem: Koplik’s spots Family: Paramyxoviridae Genus: Morbillivirus. Classic measles: 1. Incubation. 10-14/7 - enters through resp epithelium /

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measles1
Measles
  • Highly contagious, acute exanthematous respiratory disease with a typical clinical picture and a characteristic enanthem: Koplik’s spots
  • Family: Paramyxoviridae
  • Genus: Morbillivirus
classic measles 1 incubation
Classic measles: 1. Incubation
  • 10-14/7

- enters through resp epithelium /

conjunctiva, replicates locally, spreads to

regional lymphatic tissue - disseminates

to RES via blood stream

classic measles 2 prodrome
Classic measles: 2. Prodrome
  • 3 /7 but up to 8/7

- appearance of symptoms :

fever, malaise, anorexia

and then

cough, coryza, conjunctivitis

- enanthem – Koplik’s spots

koplik s spots
Koplik’s spots
  • Pathognomonic
  • “Grains of salt against a

red back ground”

  • Occurs 48hr before rash
  • Often disappear with

appearance of the rash

classic measles 3 exanthem
Classic Measles: 3. Exanthem
  • Maculopapular, blanching
  • Cranial-caudal progression
  • Face – neck, trunk and extremities
  • 3-4 / 7 later – fade, changes to brownish colour with fine desquamation
classical measles 4 recovery
Classical measles: 4. Recovery
  • Clinical improvement after 48hrs
  • Rash fades after 3 days
  • No more fever after > 3/7 after rash appeared
diagnosis of measles
Diagnosis of measles
  • WHO: laboratory diagnosis – IgM
  • IgM: can be undetectable on the first day of exanthem -- from 3rd day onwards for 30days
  • IgG: from day 7 of rash – peaks @ 14/7
  • False +: Parvo B19
slide12

Giant cells with inclusions

- conjunctival

- nasopharyngeal

- buccal epithelial cells

- urine

slide13

Viral cultures from

mononuclear cells

resp secretions

conjunctival swabs

urine

  • Special facilities, difficult
complications
Complications
  • Fever > 3/7 after onset of rash = complications
  • Developing countries – mortality 10%
  • Poor nutritional status
  • Pregnant women
  • Immunocompromised patients
pneumonia
Pneumonia
  • 2’ bacterial pneumonia

Streptococcus pneumonia

Streptococcus pyogenes

Heamophilus influenza

Staphylococcus aureus

  • Viral pneumonia – giant cell
neurological complications
Neurological complications
  • Acute disseminated encephalomeningitis
  • Subacute sclerosing panencephalitis
acute disseminated encephalomyelitis
Acute disseminated encephalomyelitis
  • Demyelinating
  • During recovery phase – within 2/52 of

exanthem

  • Post-infectious auto-immune process
  • Fever, headache, neck stiffness, ataxia,

myoclonus, seizures, mental status changes

  • LP : lymphocytic pleocytosis

elevated protein

  • Residual neurological abnormalities
subacute sclerosing panencephalitis
Subacutesclerosingpanencephalitis
  • Progressively fatal degenerative CNS disease
  • 7-10yrs after measles
  • ? Pathogenesis – persistent CNS measles infection
  • Stages: stage 1 – soft neurological signs

stage 4 – severe deterioration,

flaccidity, decorticate

rigidity and

autonomic dysfunction

slide19

Tracheobronchitis

  • Otitis media
  • Corneal ulceration and keratitis
  • Myocarditis
  • Pericarditis
  • Mesenteric lymphadenitis
  • Appendicitis
  • Diarrhoea
modified measles
Modified measles
  • Similar to classic measles, but milder
  • 17 – 21/7
  • Partial immunity

- babies: transplacental transfer of AB

- live vaccine, with incomplete

antibody response

- rare: previous measles

atypical measles
Atypical measles
  • Previously vaccinated with killed vaccine
  • 7-14/7: fever, headache, cough, pleuritic pain
  • Rash: from extremities to trunk

(vesicular, petechial, purpuric, urticarial)

  • Can cause severe illness
  • Not infective
  • IgM: @ onset of rash: titre< 1:5

day 10: 1:1280

  • Broad differential
immune supressed patients
Immune-supressed patients
  • @ risk for severe, progressive measles
  • Atypical presentation:

- absence of rash

- any rash – purpura / desquamating

- giant cell pneumonia

- measles inclusion body encephalitis

- up to 6/12 later

  • Deficient antibody synthesis
  • Biopsies
isolation
Isolation
  • Infective 5/7 before exanthem till 4/7 after it started
  • Aerosol spread
  • Strict respiratory isolation
  • Private room with negative air ventilation
  • Masks should be worn at all times
treatment
Treatment
  • Supportive
  • Secondary infections
  • Vit A 200 000u po as stat dose
vaccination
Vaccination
  • Live attenuated vaccine
contra indications
Contra-indications
  • HIV with CD4 < 200
  • Glucocorticoid therapy

>2mg/kg

20mg alternate days - wait 1/12

  • Leukaemia in remission – wait 3/12
  • Pregnancy
  • Gelatine allergy
  • Thrombocytopenia
post exposure prophylaxis immunoglobulin
Post exposure prophylaxis: Immunoglobulin
  • At risk: Immunocompromised

Pregnancy

Babies < 1yr

  • Within 6/7 of exposure
  • However, if not high risk and < 72hrs after exposure = Vaccinate
thank you
Thank you

The greatest obstacle to discovery is not ignorance -- it is the illusion of knowledge."

~ Daniel Boorstin