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1. MEASLES, MUMPS & RUBELLA

DIRECTED BY - DR. SHOEBA MAM
SUBMITTED BY - SHIVANI PATIDAR

COMMUNITY MEDICINE
NARAYAN SHREE HOMOEOPATHIC
MEDICAL COLLEGE,BHOPAL

2. MEASLES

+ RUBEOLA
° Acute viral infection — fever, coryza, cough,
lacrimation and koplik spots, followed by
maculopapular rash on the 4" or 5% day
* Epidemiology
— Developing countries
— Winter and spring seasons
— Decline in cases in India

3. MEASLES

* Etiology
— RNA virus
— Morbillivirur genus of Paramyxovirus family
— Usually below 3 years
— Unusual below 6 months

— Transmission
« Direct contact
« Droplet infection - highly contagious

4. MEASLES

« Pathogenesis

— Entry through respiratory epithelium of nasopharynx
replicates buccal mucosa & conjunctiva

— Spreads - viremia

5. MEASLES

+ Clinical features

— 3 stages

» Incubtion period 10-14 days

« Prodromal phase — 2 days
EC VEL
— Coryza
— Conjunctivitis
— Enanthem (kopik’s spot)

+ Maculaopapular rash
— Starts when fever is present
— Fever subsides

6. MEASLES

+ KOPLIK SPOTS
— Pathgmonic of Measles
— Serous exudation & proliferation of endothelial cells
— 2-3 days after onset of prodomal symptoms

— Greyish white dots (grains of sand) surrounded by

reddish areola, inner side of cheek- oppsite to lower
molars

— Disappears in 12-18 hrs

8. MEASLES

Rash starts behind the ear, hairline & neck
Measles march

Rash disappears in 7 days

Brawny desquamation

Infective period

— 2-4 days before & 4 days after the rash disappears

12. 12

13. MEASLES

COMPLICATIONS
— Respiratory system
+ Interstitial / broncho pneumonia
+ Flaring of TB
+ Bronchectasis
— GIT
+ Diarrhea, vomiting, appendicitis, Mesenteric adenitis
— ENT
* Otitis media, laryngo tracheo bronchitis
— Eyes

+ Keratitis, conjunctivitis, corneal ulceration

14. MEASLES

+ COMPLICATIONS
— Eyes
« Keratitis, conjunctivitis, corneal ulceration
— CNS

+ Measles encephalitis
« Long term — SSPE

+ PROGNOSIS
— 1-3% Mortality
— 5-15% complications

15. MEASLES

+ Management
— Symptomatic
— Single dose of Vit A
+ < 1 yr- 1,00,000 Units
+ > 1 yr — 2,00,000 Units

16. MEASLES

Prevention

— Measles vaccine

— MMR at 1 yr 3 months
Modified measles
Atypical meales
Hemorrhagic Measles

Absence of rash
— HIV, <9 months age, Immunoglobin treatment

16

17. MUMPS

18. MUMPS

« Parotitis is most common illness
+ Can affect any organ
* Epidemiology

— Endemic world wide

— Late winter & early spring

19. rau

19

20. MUMPS

+ Natural history

— Droplet infection (Saliva)

— Virus proliferates in URT

— Enters circulation

— Localizes in glandular and neural tissue
» Infective period

— 24 hours before onset of swelling

— 3 days after swelling has subsided

21. MUMPS

One or both parotid may be involved

1/4" cases unilateral

One parotid swells a day or two earlier than
the other

Earliest complaints — earache & difficulty in
chewing

Obliterates the space b/w the post border of
mandible and the mastoid

22. MUMPS

Rapidly increases in size, peaks in 1-3 days
Parotid swelling is better seen than felt
Earlobe is pushed upwards and backwards

Pain increases on tasting sour liquids like
lemon juice & vinegar

Redness around the stenson’s duct

23. MUMPS

Tonsils may be displaced medially

Edema over manubrium due to lymphatic obstn
Fever subsides in 1-6 days, swelling in 1-2 wks
Submaxillary, submandibular glands may be
involved

Testes, pancreas, ovaries, CNS, prostrate may
be involved

26. MUMPS

» In pregnant mothers

— Fetus
+ Endocardial fibroelastosis
» Aqueductal stenosis

27. MUMPS

+ Differential diagnosis
— Other viral causes of Parotitis
— Acute Suppurative Parotitis = staph aureus
— Salivary calculus
— Anterior cervical lymphadenitis

28. MUMPS

+ Treatment
— No specific treatment
— Analgesics

+ Prevention

— MMR vaccination

29. RUBELLA

31. RUBELLA

+ GERMAN MEASLES
« 3 Day measles

* Mild disease, known more for teratogenic
effects

32. RUBELLA

* Etiology
— Rubella virus — family Togaviridea
— RNA virus
— Transmitted via respiratory route

33. RUBELLA

» Clinical manifestation
— Incubation period — 14-21 days
— Prodomal symptoms — Fever, malaise,
headache
— Rash appears on face, spreads downwards,
fades in 3 days
— Usually accompanied by
+ Pre & post auricular lymphadenopathy
+ Suboccipital lymphadenopathy

36. RUBELLA

* Congenital Rubella Syndrome
— 1* trimester
+ Triad
— Cataract

— Sensory neural deafness
— Congenital heart disease

— IUGR
— Microcephaly
— Mental and Motor Retardation

37. Rash of Congenital Rubella

40. Rubellla cataract

41. RUBELLA

Prognosis of CRS
— Depends on severity
Childhood rubella is good
— Complication rare
Treatment — no specific
Prevention — MMR vaccine, Rubella vaccine

42. THANK YOU

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