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Published byVanessa Davidson Modified over 9 years ago
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MEASLES
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Measles Highly contagious, acute exanthematous respiratory disease with a typical clinical picture and a characteristic enanthem: Koplik’s spots Family: Paramyxoviridae Genus: Morbillivirus
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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
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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
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Koplik’s spots Pathognomonic “Grains of salt against a red back ground” Occurs 48hr before rash Often disappear with appearance of the rash
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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
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Classical measles: 4. Recovery Clinical improvement after 48hrs Rash fades after 3 days No more fever after > 3/7 after rash appeared
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Diagnosis of measles WHO: laboratory diagnosis – IgM IgM: can be undetectable on the first day of exanthem -- from 3 rd day onwards for 30days IgG: from day 7 of rash – peaks @ 14/7 False +: Parvo B19
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Giant cells with inclusions - conjunctival - nasopharyngeal - buccal epithelial cells - urine
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Viral cultures from mononuclear cells resp secretions conjunctival swabs urine Special facilities, difficult
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Complications Fever > 3/7 after onset of rash = complications Developing countries – mortality 10% Poor nutritional status Pregnant women Immunocompromised patients
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Pneumonia 2’ bacterial pneumonia Streptococcus pneumonia Streptococcus pyogenes Heamophilus influenza Staphylococcus aureus Viral pneumonia – giant cell
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Neurological complications Acute disseminated encephalomeningitis Subacute sclerosing panencephalitis
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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
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Subacute sclerosing panencephalitis 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
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Tracheobronchitis Otitis media Corneal ulceration and keratitis Myocarditis Pericarditis Mesenteric lymphadenitis Appendicitis Diarrhoea
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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
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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
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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
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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
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Treatment Supportive Secondary infections Vit A 200 000u po as stat dose
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Vaccination Live attenuated vaccine
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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
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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
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Thank you The greatest obstacle to discovery is not ignorance -- it is the illusion of knowledge." ~ Daniel Boorstin
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