Management of measles.

Serminar presentation of a 9 month old infant with Measles. She presented with a 3 day history of body rash associated with general body hotness, irritability and discharge from the eyes.

1. Management - Measles LUKAMA KASOKA K 7 th year, MBChB University Of Zambia

2. Background Also called Rubeola Acute childhood infectious disease caused by a viral infection – ssRNA One attack gives lifelong immunity in immunocompetent . Entry is Resp tract via droplets and infects the Reticuloendothelial system – 1° viremia . Incubation is 7-14 days. Infectivity is 5 days before and 5 days after rash.

3. Clinical picture

4. Convalescence stage: Rash fade in order on appearance. NOTE Catarrhal phase is about 4 days Eruptive phase is 4 to 8 days

5. Classification by severity

6. complications

7. others DIC Malnutrition Thrombocytopenia Myocarditis Aseptic meningitis NOMA ( fusobacterium necrophorum and prevotella intermedia

8. General principles of management Treat the whole including the whole family Treat Multiple complications at the same time. Anticipate Complications Act fast to treat Eye lesions to avoid blindness.

9. Ideal investigations FBC/DC IgG and IgM specific antibodies PCR Viral culture LFT, U and E, Cr COMPLICATIONS SCREENING CXR- TB and pneumonia Gastric lavage – TB Blood culture LP(↔or slightly↑protein , ↔or slightly↓Glucose , ↑lymphocytes)

10. Biopsy from koplick spot shows lymphoid multinucleated giant cells Brain biopsy reveals demyelination , vascular cuffing and infiltration of macrophages in pts with encephalitis

11. What was done for the pt Admitted pt FBC/DC ( microcytic hypochromic , ↑ neutrophil , ↓lymphocytes and ↓ eosinophils ) LFT ↑AST, ↓Total Protein and Albumen U&Cr - ↓Cr 20.2(23-68) NGT CXR – perihilar opacities

12. TREATMENT IS USUALLY SUPPORTIVE Vitamin A 200 000iu Antibiotic therapy Ceftriaxone and cloxacillin Nystatin for the oral candida NG feed – F100 then Mebendazole – suspecting anemia 2° worm infestation and paracetamol . ORS and ZnSO4 for the diarrhoea. Multivitamin syrup Oral wound and eye care (rinse with clean water and swab removal of discharge respectively)

13. Dosing of Vit a in measles

14. Counselling on discharge Inform mother about measles and advise that everyone at home gets immunised. Advise her to bring back the child if condition worsens or has convulsions, laboured breathing, ear ache, eye discharge etc.

15. MEASLES CONTROL IN ZAMBIA at 3 levels Routine vaccination at 9 and 18 months. 18 months introduced in 2016 with mumps and rubella Supplemental Immunization Activities.( 6mo – 14yrs) Surveillance – case based measles surveillance with laboratory confirmation

16. THANK YOU