Measles.pptx

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1. MEASLES   Mr. Abhijit Bhoyar COMMUNICABLE DISEASES

2. INTRODUCTION Measles is a highly infectious disease of childhood caused by measles virus. It is characterized by fever, catarrhal symptoms of the upper respiratory tract followed by typical rash. In our country, it is a major cause of ill health and morbidity.

3. It is a significant contributor to childhood mortality, especially in the malnourished children below the age of 3 years. Measles is endemic in all parts of the world and it tends to occur in epidemics.

4. EPIDEMIOLOGY The causative agent of measles is the specific measles virus, a RNA virus of the genus morbilli virus, of paramyxoviridae family. Human body is the only reservoir of this infection. The only source of infection is a case of measles.

5. Infective materials are secretions of nose, throat and respiratory tract of the infected patient. The period of communicability is approximately 4 days before and 5 days after the appearance of rash. One attack of infection gives life-long immunity.

6. Mode of transmission is mainly by droplet infections and droplet nuclei. Portal of entry is the respiratory tract and sometimes through conjunctiva. It can spread directly by air borne route or by indirect contact with fomites . Incubation period is 10 to 15 days .

7. Measles usually occurs in the children between the age of one year and 5 years. Infants are protected by maternal antibodies up to 6 months of age. It is rare in infants of 6 to 12 months. Before 6 months it is uncommon. It may found around 6 months in mild form. Sometimes it may occur in older children. The disease is found in very severe form in malnourished children.

8. Measles usually occurs in winter and spring months but may found in all seasons. It is common in poor community and related to social belief as 'Curse of the goddess' Parents prefer to visit temple rather than consulting doctor and usually provide neglected care and negligible foods.

9. PATHOLOGICAL CHANGES Pathological changes are related to the invasion of virus in the respiratory epithelium which results in local multiplication and viremia . The infection spreads to reticulo -endothelial system and causes secondary viremia which produces systemic symptoms.

10. Superficial blood vessels of skin and mucous membrane are affected and formed inclusion bodies. This multinucleated giant cell can be demonstrated in both epidermis and oral epithelium.

11. CLINICAL MANIFESTATIONS Clinical features of measles are manifested in three stages,

12. Prodromal (catarrhal) or pre-eruptive stage Prodromal stage usually starts after 10 days of infection and lasts 3 to 5 days. This stage is manifested with Fever, Malaise, Sneezing, Nasal discharge,.

13. Lymphadenopathy Vomiting and diarrhea Koplik's spots, Brassy cough, Redness of eyes, Lacrimation and photophobia Koplik spot  looks like a small, bluish-white spot with a red background on the inside of the cheek. 

14. Eruptive stage Eruptive stage is characterized by a typical irregular dusky red macular or maculopapular rash which found behind the ears and face first, usually 3 to 5 days after the onset of the disease. Then it spreads to neck, trunk, limbs, palms and soles in next 3 to 4 days.

15. Fever usually rise again or regress gradually within 3 days. Anorexia , malaise and cervical lymphadenopathy may present. Fever and rash usually disappear in 4 to 5 days in the same order of appearance.

16. There is fine shedding of superficial skin of face, trunk and limbs, leaving brownish discoloration which may persist for 2 months or more.

17. Convalescent or post-measles stage Convalescent stage is the period of disappearance of constitutional symptoms, fever and rash. But usually the child remains sick for number of days and lost weight. There may be gradual deterioration into chronic illness due to bacterial or viral infections, nutritional and metabolic disturbances or other complications.

18. INVESTIGATIONS Usually clinical features help in diagnosis, no investigations needed. But serological tests, viral isolation, ELISA test to detect the presence of measles antibody and routine blood examination can be done.

19. COMPLICATIONS Complications of measles are potentially dangerous and fatal than the disease. The common complications are : Respiratory tract infections as bronchopneumonia, laryngitis, laryngo - tracheo -bronchitis, bronchiolites , activation of primary tuberculosis, otitis media and mastoiditis . These are most common complications causing long-term problems.

20. Neurological complications : These include encephalitis, febrile convulsions, sub-acute sclerosing panencephalitis , GB syndrome, cerebral thrombophlebitis , brain abscess, hemiplegia , retrobulbar neuritis, mental retardation, etc. CNS infections are most serious complications and may be fatal .

21. Gastrointestinal complications : These include persistent diarrhea, appendicitis, stomatitis , enteritis , cancrum oris ( noma ), etc Other complications are myocarditis , acute glomerulonephritis , DIC and bleeding diathesis, keratitis and corneal ulcer secondary to vitamin 'A' deficiency, malnutrition, etc.

22. MANAGEMENT There is no specific management for measles. The symptomatic management is done with antipyretic, antihistamines / antipruritics , cough sedatives, vasoconstrictor nasal drops and vitamin 'A' supplementations.

23. Antibiotics may be given in superadded bacterial infections. The use of antiviral drugs, gamma globulins and steroids are doubtful.

24. Good nursing care and supportive measures promote the outcome. They include isolation, rest, calm and quiet environment, dim light, good nourishing diet, adequate amount of fluid, oral hygiene, general cleanliness, meticulous skin care and daily bath, tepid sponge to reduce fever, clearing nasal and mouth secretions, eye care and careful observation for features of complications .

25. Early detection and management of complications should be done promptly to prevent poor prognosis

26. PREVENTIVE MEASURES Active immunization with live attenuated measles vaccine is administered 0.5 mL subcutaneously in single dose at 9 to 12 months of age. A booster dose of measles vaccine is now recommended at the age of 16 to 24 months. It provides protection to the susceptible children for the life time. MMR vaccine can be administered for protection against measles along with mumps and rubella.

27. Passive immunization with gamma globulin can be administered intramuscularly 0.25 mL /kg for infants and 0.5 mL /kg for the children more than one year. It provides short term immunity . Isolation of the infected child and appropriate disposal of infected materials are necessary to prevent spread of infection to others.

28. PROGNOSIS Prognosis of a well-nourished child with measles is usually good. Measles is self-limiting disease unless it is complicated. Approximately 90% of death may occur in severe respiratory and neurological complications. The survivors of post measles long-term encephalopathy sequelae may have neurological deficits

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