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

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

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

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

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

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

7. 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.

9. Koplik spots & Measles rash on face

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

12. Measles desquamation
Staining in measles

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

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

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

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

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

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

19. 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
* months - 100,000 IU/day PO for 2 doses
* Older than 1 year - 200,000 IU/day PO for 2 doses

20. 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.

21. 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.

22. ! 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.

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

24. ! 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.
♣♣♣ ♣

25. Thank You All