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Measle Dr Saleem Sharif Medical City Hospital Lahore Peads Department.pptx

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Saleem Nasir

A 2-year-old child presented with a 4-day history of high fever, cough, and runny nose. On examination, the child had a rash on the ears and along the hairline spreading to the trunk, as well as small white lesions inside the mouth. The most likely diagnosis is measles. Measles is an acute viral illness characterized by a fever and rash. It presents initially with cough, runny nose, and red eyes followed by a maculopapular rash that starts on the face and spreads downward.

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Muhammad Saleem
Measle Dr Saleem Sharif Medical City Hospital Lahore Peads Department.pptx
Measle Dr Saleem Sharif Medical City Hospital Lahore Peads Department.pptx
A 2 Years Old Child is brought to OPD with Complaints of High Grade Fever for last 4 Days. He has Cough and Rhinorrhea for last 4 days. O/E, he is having Rash on Ear and along the Hair Line spreading to Trunk small WHITE LESIONS inside patient mouth. Rest of the Examination is not Specific. What can be the diagnosis?
Measle s
Differential Diagnosis
Measle Dr Saleem Sharif Medical City Hospital Lahore Peads Department.pptx
MEASELS(MORBILLI/RUBEOLA) Measles virus is a single stranded RNA Virus Family : Paramyxoviridae Genus: Morbillivirus Measles is an acute highly contagious viral disease characterized by final stage of maculopapular rash erupting successively over the neck,face,boday,arms,legs and is accompanied by high grade fever Highest incidence is in winters
Mode of transmission is by direct or indirect contact and droplets spray Unusual below the age of 4-6 months Period of infectivity 4 days before and 5 days after the appearance of rash
CLINICAL FEATURES There are 3 clinical stages of measles Incubation stage Prodromal stage Maculopapular rash stage
INCUBATION STAGE Last approximately 10_12 days Body temp may increase slightly 9-10 days from the date of infection and then subside for 24 hrs or so The patient may transmit virus by 9th-10th day after exposure and occasionally as early as 7th day, before the illness can b diagnosed
PRODROMAL STAGE Last for 3-5 days Low to moderate grade fever Cough Coryza Conjunctivitis These symptoms nearly almost precedes the appearance of KOPLIKS spots(whitish spots, presents on buccal mucosa opposite to lower molar,Pathogonomic sign of measles)by 2-3 days
KOPLIK SPOTS
MACULOPAPULAR RASH STAGE High grade fever (104-105 F) Rash usually starts as faint macules on the face behind the ears and along the hairlines Fading of rash proceeds downward in same sequence as it appearance Post cervical lymphadenopathy and slight splenomegaly may be present Abdominal pain may be present due to mesenteric lymphadenopathy
Measle Dr Saleem Sharif Medical City Hospital Lahore Peads Department.pptx
Measle Dr Saleem Sharif Medical City Hospital Lahore Peads Department.pptx
Measle Dr Saleem Sharif Medical City Hospital Lahore Peads Department.pptx
DIAGNOSIS Diagnosis of measles is primarily clinical Serology is most common method of laboratory diagnosis Detection of measles virus-specific IgM in a single specimen of serum or oral fluid is considered diagnostic of acute infection Fourfold increase in measles virus specific IgG antibody levels between acute and convalescent phase serum specimens
COMPLICATIONS Respiratory system : otitis media,pneumonia GI complications : post measles gastroeneteritis,gangrene of mouth Haemorrhagic measles Thrombocytopenia Subacute scerolosing panencephalitis(very rare) Eye :corneal ulcerations, conjunctivitis,optic nerve damage occur rarely Heart : myocarditis, cardiac failure
TREATMENT No specific antiviral therapy needed Good nursing care is essential Antipyretics for high grade fever Sedatives Bed rest Adequate fluid intake Relief of cough(humidification of room may relief irritating cough ) Antibacterial therapy for superadded infection Vitamin A (reduce morbidity and mortality) 50,000 IU in < 6 months 1 lac IU < 1 year 2 lac IU > 1 year
Prognosis Self limited disease lasting 7-10 days often without sequelae Prevention Attenuated live measles vaccine : 95% protection against natural disease Immunity appears to be life long Should b administered at 6-9 months of age Acc to EPI schedule MR at 9 Months of age (0.5ml S/C) : left deltoid MR at 15 Months of age (0.5ml S/C) : Left deltoid
IMNCI CLASSIFICATION
Measle Dr Saleem Sharif Medical City Hospital Lahore Peads Department.pptx

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Measle Dr Saleem Sharif Medical City Hospital Lahore Peads Department.pptx

  • 4. A 2 Years Old Child is brought to OPD with Complaints of High Grade Fever for last 4 Days. He has Cough and Rhinorrhea for last 4 days. O/E, he is having Rash on Ear and along the Hair Line spreading to Trunk small WHITE LESIONS inside patient mouth. Rest of the Examination is not Specific. What can be the diagnosis?
  • 8. MEASELS(MORBILLI/RUBEOLA) Measles virus is a single stranded RNA Virus Family : Paramyxoviridae Genus: Morbillivirus Measles is an acute highly contagious viral disease characterized by final stage of maculopapular rash erupting successively over the neck,face,boday,arms,legs and is accompanied by high grade fever Highest incidence is in winters
  • 9. Mode of transmission is by direct or indirect contact and droplets spray Unusual below the age of 4-6 months Period of infectivity 4 days before and 5 days after the appearance of rash
  • 10. CLINICAL FEATURES There are 3 clinical stages of measles Incubation stage Prodromal stage Maculopapular rash stage
  • 11. INCUBATION STAGE Last approximately 10_12 days Body temp may increase slightly 9-10 days from the date of infection and then subside for 24 hrs or so The patient may transmit virus by 9th-10th day after exposure and occasionally as early as 7th day, before the illness can b diagnosed
  • 12. PRODROMAL STAGE Last for 3-5 days Low to moderate grade fever Cough Coryza Conjunctivitis These symptoms nearly almost precedes the appearance of KOPLIKS spots(whitish spots, presents on buccal mucosa opposite to lower molar,Pathogonomic sign of measles)by 2-3 days
  • 14. MACULOPAPULAR RASH STAGE High grade fever (104-105 F) Rash usually starts as faint macules on the face behind the ears and along the hairlines Fading of rash proceeds downward in same sequence as it appearance Post cervical lymphadenopathy and slight splenomegaly may be present Abdominal pain may be present due to mesenteric lymphadenopathy
  • 18. DIAGNOSIS Diagnosis of measles is primarily clinical Serology is most common method of laboratory diagnosis Detection of measles virus-specific IgM in a single specimen of serum or oral fluid is considered diagnostic of acute infection Fourfold increase in measles virus specific IgG antibody levels between acute and convalescent phase serum specimens
  • 19. COMPLICATIONS Respiratory system : otitis media,pneumonia GI complications : post measles gastroeneteritis,gangrene of mouth Haemorrhagic measles Thrombocytopenia Subacute scerolosing panencephalitis(very rare) Eye :corneal ulcerations, conjunctivitis,optic nerve damage occur rarely Heart : myocarditis, cardiac failure
  • 20. TREATMENT No specific antiviral therapy needed Good nursing care is essential Antipyretics for high grade fever Sedatives Bed rest Adequate fluid intake Relief of cough(humidification of room may relief irritating cough ) Antibacterial therapy for superadded infection Vitamin A (reduce morbidity and mortality) 50,000 IU in < 6 months 1 lac IU < 1 year 2 lac IU > 1 year
  • 21. Prognosis Self limited disease lasting 7-10 days often without sequelae Prevention Attenuated live measles vaccine : 95% protection against natural disease Immunity appears to be life long Should b administered at 6-9 months of age Acc to EPI schedule MR at 9 Months of age (0.5ml S/C) : left deltoid MR at 15 Months of age (0.5ml S/C) : Left deltoid

Editor's Notes

  • #19: Measles virus specific IgM may not b detectable 4-5 days or more after rash onset and usually fall to undetectable levels within 4-8 weeks of rash onset