By Dr. Satti Abdulrahim Satti Consultant Pediatrician بسم الله الرحمن الرحيم Measles By Dr. Satti Abdulrahim Satti Consultant Pediatrician

Called Rubeola . An acute viral infection. Measles virus is : An RNA virus. Only one serotype.

Epidemiology & Pathogenesis Rarely subclinical . No animal reservoir. Highly contagious . Mainly by droplet spray during catarrhal stage . Infants acquire immunity transplacentally.

Hyperplasia of lymphoid tissue. Hecht giant cell pneumonia. Encephalomyelitis & Subacute Sclerosing Panencephalitis ( SSPE )

Clinical Manifestations Three clinical stages : Incubation , Prodromal & Final stage. Incubation phase : IP is 10-12 d. Prodromal phase : !! Very ill pts . !! Fever, Cough & Coryza.

!! A transverse conjunctivitis with Photophobia . !! Koplik spots . !! Red mottling on palates. !! Lasts 3-5 days .

Final stage : !! The Rash * Maculopapular . * Starts up then spreads down till reach feet. * It fades downwards. * Often Hgic . Petechiae & ecchymosis may appear. * Itching is slight.

Koplik spots & Measles rash on face

!! Desquamation & brownish discoloration. !! Black measles = Hgic type. With bleeding. !! ↑ Lymph nodes & Spleenomegaly. !! Abdominal pain . !! V & D, Bronchopneumonia & Otitis media . !! Appendicitis.

Measles desquamation Staining in measles

Complications Otitis Media . Laryngitis . Pneumonia (Bacterial or Giant cell p.) Exacerbation of underlying tuberculous infection . Myocarditis . Disseminated Intravascular coagulation ( DIC )

. Neurologic complications: * Encephalitis (Direct viral invasion or demylinating) * Guillain-Barre` synd. * Hemiplegia . * S S P E .

Diagnosis Clinically (The rash & ? Koplik spots) Measles IgM Abs Isolation of measles virus (by culture) Leucopenia . CSF : ↑ Lymphocytes. ↑ Protein . Normal Glucose.

Differential Diagnosis German measles (Rubella) Roseola infantum (HHV6) Infectious Mononucleosis. Scarlet fever . Kawasaki disease. Drug rash .

Treatment Mainly supportive. Hospitalization for treatment of complications . Bed rest . Standard Antipyretics is appropriate.

Humidified air . Maintenance of good hydration & replacement of fluids lost through diarrhea or emesis . Antibiotics for bacterial complications.

Vitamin A Supplementation !! Lead to 50% reductions in morbidity & mortality and help prevent eye damage and blindness. !! Supplementation is as follows: * < 6 months – 50,000 IU/day PO for 2 doses * 6-11 months - 100,000 IU/day PO for 2 doses * Older than 1 year - 200,000 IU/day PO for 2 doses

Children with clinical signs of vitamin A deficiency : * Children with clinical signs of vitamin A deficiency : ! First 2 doses as appropriate for age. ! Then a third age-specific dose given 2-4 weeks later.

Prevention Isolation : From 7th d. after exposure until 5 d after rash has appeared. Susceptible health care workers should be excused from work from the fifth to the 21st day after exposure.

! It is given to the following individuals: ! Human Ig prevents or modifies disease in susceptible contacts if given within 6 days of exposure. ! It is given to the following individuals: * Those who are immunocompromised. * Infants aged 6 months to 1 year. * Infants younger than 6 months who are born to mothers without measles immunity. * Pregnant women.

Measles Vaccine : ! As MMR : ! Given IM . ! Kept in the freezer. ! Destroyed by light . ! At 12-15 mo age.

! 2nd dose at 18 month of age. ! Contraindicated in : ! At 9 month in developing countries. ! 2nd dose at 18 month of age. ! Contraindicated in : Untreated tuberculosis, Primary immunodeficiency, Organ transplantation or severe HIV infection. ♣♣♣ ♣

Thank You All