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麻 疹
MEASLES
重庆医科大学儿童医院
DIVISION OF INFECTIOUS DISEASE AND
GASTROENTEROLOGY
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MEASLESKey points
DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
? Acute respiratory infectious disease
caused by measles virus
? clinical feature,Fever,Cough,Runny
nose,Conjunctivitis,Exanthem
? Specific sign,Koplik’s Spots
(a kind of enanthem )
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DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Classification,A RNA virus
Genus,morbillivirus
Family,paramyxoviridae
Serotype,Only one
Location,Nasopharyngeal secretions,
Blood,Urine of patients
Pathogen
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Pathogen
DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
measles virus
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DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Epidemiology
1.Infectious sources,Measles patients in
acute stage
2.Routes of transmission,Droplet spray
3.Population susceptibility：
4.Epidemic features：
? It is susceptible to all the people without
infection or inoculation,
? The age of peak incidence was 6 months to
5 years old,
? The incidence of baby under 6m is lower,
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DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Routes of transmission
Epidemiology
Droplet spray
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DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Prior to the use of vaccine After the use of vaccine
Morbidity
(1/100000)
Major epidemics,500-1000
Mild epidemics,400 9.5 in 1990
Peak season In winter and spring In any time of a year
Epidemic cycle Major epidemics appear by 2-4 yr intervals
Epidemic cycle
disappeared,Sporadic
cases increased
Age 6m-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
Epidemiology
Epidemic Features
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DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
1728
1125
192
493
595
250
293
383
195
152
139
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13 7
21
110
155
120
297
112
0
200
400
600
800
1000
1200
1400
1600
1800
2000
1960 64 68 72 76 80 84 88 92 96 2000
麻疹病例数
00 03
Measles Vaccine
Inoculation in whole
China (1968)
Epidemiology
Measles cases of in-patients in CHCUMS
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DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Pathophysiology
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Respiratory epithelium
regional lymph nodes
First viremia
Monocytes/Macrophage
Second viremia
Respiratory tract,
conjunctiva,skin,etc
Virus elimination
Measles virus
Pathophysiology
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
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DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Pathology
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Multinucleated giant cell
(Warthin-finkeldey giant cells)
Pathology – Cytopathic change
PATHOGNOMONIC FOR MEASLES
Φ= 100μm,several
nucleus inside the cell,
formed by confluence of
several virus infected
reticuloendothelial cells
In smears of the nasal
mucosa in the prodromal
stage
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Multinucleated giant cell
Pathology – Cytopathic change
PATHOGNOMONIC PRESENTATION FOR MEASLES
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DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Pathology
? Respiratory tract
? Skin
? Koplik’s spots
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DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Pathology – skin
Red maculopapule
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DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Clinical manifestations
? Typical manifestations
? Atypical manifestations
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DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Typical clinical manifestations
Incubation stage,10-14days
Prodromal stage,3-4days
The prodrome develops on the day symptom
begins (fever) and lasts until rash appear.
? Fever
? Cough
? Coryza
? Conjunctivitis
? Koplik’s spots
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DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Typical clinical manifestations
Prodromal stage,3-4days2.
? 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.
? Cough
? Coryza They are not specific symptoms for
measles,which are identical to a common cold but
catarrhal symptoms maybe more severe.
? Conjunctivitis May suggest measles before
Koplik’s spots.
? Koplik’s Spots,Pathognomonic sign
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DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Typical clinical manifestations
typical facial appearance of measles in prodromal stage
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DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Typical clinical manifestations
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Typical clinical manifestations
DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Exanthem stage,3-5days
? Maculopapular rash:
? Fever,temperature rises abruptly
? Catarrh,
? Other manifestations,enlarged lymph
nodes,slight splenomegaly,gastrointestinal
symptoms such as diarrhea and vomiting
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DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Typical clinical manifestations
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Typical clinical manifestations
Maculopapular rash
DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
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DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Typical 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.
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DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Typical 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.
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DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Typical clinical manifestations
appearing sequence of the rash
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DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Typical clinical manifestations
Convalescent stage,3-5 days
? 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.
? As the rash fades,branny desquamation and
brownish discoloration (hyperpigmentation)
occur and then disappear within 2-3 weeks.
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DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Typical clinical manifestations
Branny desquamation and brownish
discoloration (hyperpigmentation)
Convalescent stage:
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Temp ℃
Days 1-14 1 2 3 4 5 6 7 8 9 10 11 12 13 14
Clinical
periods
Prodromal
stage Exanthem stage
Convalescent
stage
Coryza and
conjunctivitis
Koplik’s spots
Rash
Cough
Branny desquamation
& hyperpigmentation
Summary of typical clinical features
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DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Clinical manifestations
Atypical manifestations
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DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Clinical manifestations
Atypical manifestations
1,Mild measles
2,Measles in adults
3,Severe measles
Occurs in the patient with partial immunity
Occurs in the patients with
immunocompromised
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DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Complications
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DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Complications
1,Pneumonia
2,Subacute sclerosing panencephalitis
(SSPE) & Encephalitis
3,Laryngitis
4,Exacerbation of tuberculosis
5,Malnutrition and Vitamin A deficiency
the most frequent complication of measles
(1) Primary pneumonia (2) Secondary pneumonia
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DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Lab studies
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DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Lab studies
? The white blood cell count tends to be low
with a relative lymphocytosis.
? Multinucleated giant cells can be
demonstrated in smears of the nasal mucosa
during the prodromal stage.
? Testing of specific IgM in serum
? Measles virus isolation
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DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Diagnosis
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DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Diagnosis
? Epidemiologic data
? Clinical data
? Laboratory data
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DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Diagnosis
? Epidemiologic data
Age
Season
History of contact with patient
History of inoculation
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DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Diagnosis
? Clinical data
Prodromal period
Exanthem period
Convalescent period
Koplik’s spots
Typical rash; correlation of rash and
fever; catarrh
Branny desquamation and brownish
discoloration
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DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Differential Diagnosis
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DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Differential diagnosis
? Rubella
? Roseola infantum
? Enterovirus infection
? Exanthem caused by drugs
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DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Differential diagnosis
? Rubella
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DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Differential diagnosis
Rubella (German Measles )
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DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Differential diagnosis
Measles Roseola infantum
The rash typically appears when the elevated temperature
has abated,and can last for only a few hours before
subsiding,
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DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Prevention
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DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Prevention
? Control of sources of infections
? Abrupt the ways of transmission
? Protect the susceptible
passive immunization
active immunization
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DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Treatment
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DIVISION OF INFECTIOUS DISEASE AND GASTROENTEROLOGY
Treatment
? Antipyretics for fever
? Bed rest
? Maintenance of an adequate fluid intake
? Good nutrition and adequate vitamin A intake
? Humidification of the room
? To keep the room comfortably warm than cool
? Be protected from exposure to strong light
? Appropriate antibiotic therapy
? Traditional Chinese medicine with antiviral effects
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