Measles
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Measles ♦
The First Teaching Hospital of Zhengzhou University , Department of Infectious Disease 谷 军生 1
Summarization ♦ ♦ ♦
Infected by measle virus Transmitted through respiratory tract With fever and exanthem
2
Etiolody ♦ Paramyxoviruses ♦ ♦
Measles virus Only one serotype
3
Epidemiology ♦ Source of infection: ♦
Acute patients ♦ Patients are infectious during 2 days before prodrome period to 5 days after the onset of exanthem and are most infectious during the late prodrome. ♦ The virus remains infectious in small particle `aerosols for several hours. 4
Epidemiology ♦ Transmitting routes: ♦
Through respiratory tract or conjunctiva by airborne droplets ♦ By direct contact with infectious secretions
5
Epidemiology ♦ Susceptible groups: ♦ Almost all are susceptible. ♦
The transfer of maternal antibodies gives protection for babies within 6 months. ♦ After this, the incidence rises rapidly to a peak in early childhood. ♦ Infection confers lifelong protection. ♦ Almost all adults have antibodies and lifelong immunity. 6
Epidemiology
♦ Characteristics: ♦
With a high morbidity in winter and spring ♦ Apparent infection is high (> 90% in susceptible groups
7
Pathogenesis ♦
Initially infects the respiratory epithelium. ♦ Then viremia, especially the infection of Monocyte-Macrophage system. ♦ Then a secondary viremia and virus dissemination to other tissues and organs. ♦ Then occurred symptoms. 8
Pathogenesis ♦
Leukopenia, particularly lymphocytopenia, may be secondary to direct destruction of leukocytes.
9
Pathogenesis ♦
Measles virus infection always induces host immune suppression. ♦ --Suppression of delayed hypersensitivity reactions ♦ --And depressed natural killer cell activity for at least 3 weeks after the rash onset. ♦ Nephrotic syndrome abated ♦ Tuberculosis aggravated 10
Pathogenesis ♦
Cellular immunity plays a major role in viral clearance.
11
Clinical Features of typical Measles
♦ Typical Measles: ♦ Incubation period: usually 10~14 d ♦ Prodromal period: 3~4 d ♦ Eruptive Period: 3~5 d ♦ Convalescent period: 1~2w
12
Clinical Features of typical Measles ♦
The prodrome period lasts 2 to 4 days and is characterized by the followings: ♦ 1. High fever, with malaise, anorexia ♦ 2. Upper respiratory tract inflammation always with coryza, cough (a characteristic dry cough is always present) ♦ 3. Conjunctivitis with photophobia and excess lacrimation 13
Clinical Features of typical Measles ♦
The prodrome period lasts 2 to 4 days and is characterized by the followings: ♦ 4. Koplik’s spots: in late prodrome period, always on the third day of fever onset, redbased lesions with central bluish gray specks, appear on the buccal (or labial) mucosa, typically opposite the second molars, toward the end of the prodromal period and last for 2-3 days. 14
Clinical Features of typical Measles ♦ ♦
Eruptive Period: 3~5 d Skin eruption begins about the face and neck behind the ears as discrete erythematous macules, which proceed downward to cover the trunk and extremities, including the palms and soles in the end. (3 days) ♦ Lesions often enlarge, become maculopapular, and coalesce. ♦ The exanthem may become hemorrhagic in a few cases. 15
Clinical Features of typical Measles ♦
Eruptive Period: 3~5 d ♦ When the rash is at its height, fine crepitations can sometimes be heard throughout both lung fields due to a pneumonitis caused by the measles virus rather than secondary invaders.
16
Clinical Features of typical Measles ♦
Convalescent period: 1~2w ♦ The eruption clears after 5 to 6 days in the order of its appearance, often with brownish discoloration and fine desquamation.
17
Atypical Measles ♦
Vesicles singly or in crops, petechiae, purpura, and/or urticarial lesions can develop. Because of the polymorphous nature of the eruption, atypical measles may be mistaken for varicella, scarlet fever, meningococcemia, etc.
18
Atypical Measles ♦
Sometimes face spared, Koplik’s spots absent ♦ Conjunctivitis and glossitis with strawberry tongue
19
Complications ♦
Measles pneumonia ♦ Secondary bacterial pneumonia is commonly associated with measles pneumonia and more severe than the latter. ♦ ♦
Myocarditis Laryngitis
20
Other Clinical Presentations ♦
Tuberculin reactivity may be depressed, for up to 4 weeks after infection. Measles may activate tuberculosis.
21
Laboratory Diagnosis ♦
Classic measles is easily diagnosed clinically, but laboratory diagnosis may be helpful in cases of atypical measles.
22
Laboratory Diagnosis ♦ Leukopenia: ♦
Common during the prodrome and early eruptive stage ♦ Associated with a poor prognosis ♦ The development of leukocytosis suggests bacterial superinfection or other complications.
23
Laboratory Diagnosis ♦
Detection of measles virus RNA in respiratory secretions by RT-PCR has been developed and is potentially more practical than cell culture.
24
Laboratory Diagnosis ♦
Serologic studies of paired specimens constitute the most practical method of laboratory diagnosis of measles.
25
Laboratory Diagnosis ♦
Detection of measles-specific IgM is a sensitive indicator of recent infection and can yield positive findings within 1 week of rash onset.
26
Prevention ♦
Hospitalized patients require respiratory isolation.
27
Prevention ♦
Live attenuated measles virus vaccine, a safe, effective vaccine has been developed. ♦ This vaccine provides durable immunity in at least 95% of recipients vaccinated at 8 months or older.
28
Prevention ♦
Combined measles-mumps-rubella (MMR) vaccine is preferred because mumps can also occur in highly vaccinated populations, with the first dose at age 8 months and the second at entrance to school.
29
Treatment ♦
There is no specific antiviral therapy for measles. ♦ Bed rest is the `essence of treatment in benign self limited disease.
30
Treatment ♦
Short-term administration of Vitamin A reduces mortality in severe measles in children. ♦ Ribavirin and immunoglobulin have been used in immunocompromised patients with measles pneumonia.
31
Treatment
♦ ♦
Symptomatic therapy: Antipyretics
32
33
34
35
36
Class
is
over! 37
The First Teaching Hospital of Zhengzhou University , Department of Infectious Disease 谷 军生 1
Summarization ♦ ♦ ♦
Infected by measle virus Transmitted through respiratory tract With fever and exanthem
2
Etiolody ♦ Paramyxoviruses ♦ ♦
Measles virus Only one serotype
3
Epidemiology ♦ Source of infection: ♦
Acute patients ♦ Patients are infectious during 2 days before prodrome period to 5 days after the onset of exanthem and are most infectious during the late prodrome. ♦ The virus remains infectious in small particle `aerosols for several hours. 4
Epidemiology ♦ Transmitting routes: ♦
Through respiratory tract or conjunctiva by airborne droplets ♦ By direct contact with infectious secretions
5
Epidemiology ♦ Susceptible groups: ♦ Almost all are susceptible. ♦
The transfer of maternal antibodies gives protection for babies within 6 months. ♦ After this, the incidence rises rapidly to a peak in early childhood. ♦ Infection confers lifelong protection. ♦ Almost all adults have antibodies and lifelong immunity. 6
Epidemiology
♦ Characteristics: ♦
With a high morbidity in winter and spring ♦ Apparent infection is high (> 90% in susceptible groups
7
Pathogenesis ♦
Initially infects the respiratory epithelium. ♦ Then viremia, especially the infection of Monocyte-Macrophage system. ♦ Then a secondary viremia and virus dissemination to other tissues and organs. ♦ Then occurred symptoms. 8
Pathogenesis ♦
Leukopenia, particularly lymphocytopenia, may be secondary to direct destruction of leukocytes.
9
Pathogenesis ♦
Measles virus infection always induces host immune suppression. ♦ --Suppression of delayed hypersensitivity reactions ♦ --And depressed natural killer cell activity for at least 3 weeks after the rash onset. ♦ Nephrotic syndrome abated ♦ Tuberculosis aggravated 10
Pathogenesis ♦
Cellular immunity plays a major role in viral clearance.
11
Clinical Features of typical Measles
♦ Typical Measles: ♦ Incubation period: usually 10~14 d ♦ Prodromal period: 3~4 d ♦ Eruptive Period: 3~5 d ♦ Convalescent period: 1~2w
12
Clinical Features of typical Measles ♦
The prodrome period lasts 2 to 4 days and is characterized by the followings: ♦ 1. High fever, with malaise, anorexia ♦ 2. Upper respiratory tract inflammation always with coryza, cough (a characteristic dry cough is always present) ♦ 3. Conjunctivitis with photophobia and excess lacrimation 13
Clinical Features of typical Measles ♦
The prodrome period lasts 2 to 4 days and is characterized by the followings: ♦ 4. Koplik’s spots: in late prodrome period, always on the third day of fever onset, redbased lesions with central bluish gray specks, appear on the buccal (or labial) mucosa, typically opposite the second molars, toward the end of the prodromal period and last for 2-3 days. 14
Clinical Features of typical Measles ♦ ♦
Eruptive Period: 3~5 d Skin eruption begins about the face and neck behind the ears as discrete erythematous macules, which proceed downward to cover the trunk and extremities, including the palms and soles in the end. (3 days) ♦ Lesions often enlarge, become maculopapular, and coalesce. ♦ The exanthem may become hemorrhagic in a few cases. 15
Clinical Features of typical Measles ♦
Eruptive Period: 3~5 d ♦ When the rash is at its height, fine crepitations can sometimes be heard throughout both lung fields due to a pneumonitis caused by the measles virus rather than secondary invaders.
16
Clinical Features of typical Measles ♦
Convalescent period: 1~2w ♦ The eruption clears after 5 to 6 days in the order of its appearance, often with brownish discoloration and fine desquamation.
17
Atypical Measles ♦
Vesicles singly or in crops, petechiae, purpura, and/or urticarial lesions can develop. Because of the polymorphous nature of the eruption, atypical measles may be mistaken for varicella, scarlet fever, meningococcemia, etc.
18
Atypical Measles ♦
Sometimes face spared, Koplik’s spots absent ♦ Conjunctivitis and glossitis with strawberry tongue
19
Complications ♦
Measles pneumonia ♦ Secondary bacterial pneumonia is commonly associated with measles pneumonia and more severe than the latter. ♦ ♦
Myocarditis Laryngitis
20
Other Clinical Presentations ♦
Tuberculin reactivity may be depressed, for up to 4 weeks after infection. Measles may activate tuberculosis.
21
Laboratory Diagnosis ♦
Classic measles is easily diagnosed clinically, but laboratory diagnosis may be helpful in cases of atypical measles.
22
Laboratory Diagnosis ♦ Leukopenia: ♦
Common during the prodrome and early eruptive stage ♦ Associated with a poor prognosis ♦ The development of leukocytosis suggests bacterial superinfection or other complications.
23
Laboratory Diagnosis ♦
Detection of measles virus RNA in respiratory secretions by RT-PCR has been developed and is potentially more practical than cell culture.
24
Laboratory Diagnosis ♦
Serologic studies of paired specimens constitute the most practical method of laboratory diagnosis of measles.
25
Laboratory Diagnosis ♦
Detection of measles-specific IgM is a sensitive indicator of recent infection and can yield positive findings within 1 week of rash onset.
26
Prevention ♦
Hospitalized patients require respiratory isolation.
27
Prevention ♦
Live attenuated measles virus vaccine, a safe, effective vaccine has been developed. ♦ This vaccine provides durable immunity in at least 95% of recipients vaccinated at 8 months or older.
28
Prevention ♦
Combined measles-mumps-rubella (MMR) vaccine is preferred because mumps can also occur in highly vaccinated populations, with the first dose at age 8 months and the second at entrance to school.
29
Treatment ♦
There is no specific antiviral therapy for measles. ♦ Bed rest is the `essence of treatment in benign self limited disease.
30
Treatment ♦
Short-term administration of Vitamin A reduces mortality in severe measles in children. ♦ Ribavirin and immunoglobulin have been used in immunocompromised patients with measles pneumonia.
31
Treatment
♦ ♦
Symptomatic therapy: Antipyretics
32
33
34
35
36
Class
is
over! 37
