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MEASLES

MEASLES. Dr. Harivansh Chopra, DCH, MD Professor,Community Medicine, LLRM Medical College, Meerut. harichop@gmail.com. Objectives. To study the epidemiology of Measles. To study the differential diagnosis of Measles. How Measles can be prevented.

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MEASLES

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  1. MEASLES Dr. Harivansh Chopra, DCH, MD Professor,Community Medicine, LLRM Medical College, Meerut. harichop@gmail.com DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

  2. Objectives • To study the epidemiology of Measles. • To study the differential diagnosis of Measles. • How Measles can be prevented. DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

  3. Macule - A circumscribed flat area less than 1 cm of discoloration without elevation or depression of surface relative to surrounding skin. DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

  4. DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

  5. Papule - A circumscribed, elevated, solid lesion, less than 1 cm. DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

  6. Vesicle - A small, superficial, circumscribed elevation of the skin, less than 0.5 cm, that contains serous fluid.  DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

  7. Pustule - A small (< 1 cm in diameter), circumscribed superficial elevation of the skin that is filled with purulent material.  Can also be described as a vesicle filled with pus. DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

  8. Measles (Rubeola – Redspots) • Acute febrile eruption. • Communicable viral disease. • Stages – • Incubation stage. • Prodromal stage. • Final stage. DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

  9. Problem Statement • Affects childhood population. • Causes malnutrition. • Breaks immunological barrier. • Flaring of existing T.B. Infection. DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

  10. Problem Statement 5. Developing countries – 100-400 times more mortality. 6. Major cause of morbidity & child hood mortality. 7. Good vaccine is available. Case fatality rate  1-3% DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

  11. Problem staement 1.Measles occurs in endemic as well as in epidemic forms. 2.Epidemic occurs after every three to four years 3. Cyclic trend is present DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

  12. DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

  13. WHO definition of elimination of Measels • Absence of endemic measels for a period of ≥12 months in the presence of adequate surveillence. • One indicator is : a sustained measels incidence of less than 1 per 1000000 population. DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

  14. Measels in India • During 1987 2.47 lakh cases were reported. • After the implementation of UIP, the number of cases have decreased to 40840 with 44 deaths in the year 2009. • ? DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

  15. Agent Factors • Agent  RNA paramyxovirus. • Source of infection  Case. • Infective material  Secretions of Nose, Throat & Respiratory tract of case. DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

  16. Agent Factors 4. Communicability  Prodromal period & at time of eruption. 5. Period of infectivity  4 days before + 5 days after appearance of rash. 6. Secondary attack rate  Over 80% in susceptible contact. DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

  17. Host Factors • Age  • Developing countries – 6 mths to 3 yrs. • Developed countries – over 5 years. • 2. Sex  Equal incidence. DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

  18. Host Factors • 3. Immunity  • One attack – Life long. • Second attack – Rare. • Infants – Transplacentally from mother • (for 4-6 months). DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

  19. Host Factors 4. Nutrition  400 times more mortality in malnourished children. Measles Healthy Child Severe Weight Loss Malnutrition DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

  20. Environmental Factors • Any season. • 2. More in winters  over crowding. • 3. Population density & Movement. • 4. Poorer the socio-economic condition  • lower the age of attack. DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

  21. Transmission  Person to Person by droplet infection & droplet nuclei. Incubation period  10 days from exposure to onset of fever. 14 days to appearance of rash. DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

  22. Clinical Manifestations Three stages in the natural history of measles are: (1) Prodormal or Pre-Eruptive stage. (2) Eruptive stage. (3) Post-measles stage. DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

  23. Prodromal Stage It begins 10 days after infection & last until day 14. Characterised by  (1) Low grade to moderate fever. (2) A hacking dry cough. (3) Coryza. (4) Conjunctivitis. A day or two before the appearance of rash; Koplik’s spots appear. DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

  24. Koplik’s Spots Occur opposite to lower molars, but may spread irregularly over rest of the buccal mucosa. Grayish white dots usually as small grains of sand. With slight reddish areola occasionally hemorrhagic. DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

  25. Eruptive Stage Temperature rises abruptly; often reaches 40-40.5º C. Rash starts on upper lateral parts of neck behind the ears along hair line & posterior part of cheek. DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

  26. Eruptive Stage • Individual lesions become increasingly maculopapulous as rash spreads rapidly – 1st 24 hrs. : Entire face  neck  upper arm  upper part of chest. Next 24 hrs. : Back  abdomen  entire arms  thighs. DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

  27. Eruptive Stage 4.On 2-3rd day it finally reaches feet & begins to fade on face. DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

  28. Eruptive Stage Measles rash as seen in a dark skinned child. In severe cases, with confluent rash Petechiae may be present in large numbers. There may be extensive Ecchymoses. Fading of the rash proceeds down wards in the same sequence in which it appears. DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

  29. Eruptive Stage Complete absence of rash is rare except in patients  1) Those who have received human antibodies during incubation period. 2) Some patients with AIDS. 3) In infants less than 8 months of age. DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

  30. Eruptive Stage Lymph nodes at the angle of jaws & in the posterior cervical region are usually enlarged & slight splenomegaly may be noted. DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

  31. Eruptive Stage Mesentric Lymphadenopathy may be noted. Symptoms of Appendicitis appears when there is obliteration of lumen of appendix. DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

  32. Complications • Diarrhea is the most common complication of Measles in India. DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

  33. Complications 2. Otitis media 3. Pneumonia 4. Encephalitis DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

  34. Pneumonia Pneumonia may be caused by the measles virus itself. Bronchopneumonia is most common complication in India. It is due to secondary invading bacteria particularly Pneumococcus, Streptococcus, & Haemophilus influenzae. DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

  35. Encephalitis Encephalitis may present in the incubation period, or may be post measles. Incidence is 1 in 1000 cases of measles. DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

  36. SSPE – Sub-acute Sclerosing Pan-Encephalitis • Rare complication. • Develops many years after the initial measles infection. • Incidence 7 cases for each 1 million cases of natural measles. DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

  37. Other Complications • Exacerbation of an existing tubercular process is one of potential danger of measles. • Myocarditis is an infrequent complication. DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

  38. DIFFERENTIAL DIAGNOSIS DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

  39. TYPICAL RASH OF MEASLES • Maculopapulous rash of Measles is often slightly hemorrhagic. May have Petechiae, and Ecchymoses. DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

  40. RUBELLA / GERMAN MEASLES • Tender lymph node  post-cervical, post-occipital, post-auricular region, post-occipital & post-auricular never enlarged in measles. • Evolution of rash is very rapid. • No rise in temperature. • Occurs mainly in teenagers & young adults. DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

  41. RASH OF RUBELLA • Evolution of rash in Rubella is very rapid and not associated with fever. DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

  42. ROSEOLA INFANTUM • High fever (104-105OF); no accompanying signs. • No photophobia or conjunctivitis & little cough may be present. • After 3-5 days Maculopapular rash starting on trunk  arm & neck & slightly involves face & leg. DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

  43. ROSEOLA INFANTUM • As soon as rash appears fever disappears. • Duration of rash is hardly 24 hrs. • Caused by Human Herpes Virus 6 (HHV-6). DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

  44. RASH OF ROSEOLA INFANTUM • Fever disappears as soon as maculopapular rash of Roseola Infantum appears. DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

  45. ERYTHEMA INFECTIOSUM(Fifth Disease) • Usually in school going age group. • No prodromal symptoms; Fever absent or low grade. • Slapped face appearance. DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

  46. ERYTHEMA INFECTIOSUM(Fifth Disease) • A day or later Maculopapular rash on arms, legs & trunk but rarely on palms & soles. • Duration of rash quite long (2-6 wks); with waxing & waning • Rash is highly pruritic in nature – caused by Parvo-virus B19. DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

  47. RASH OF ERYTHEMA INFECTIOSUM • Maculopapular lesions of Erythema Infectiosum give Slapped Face appearance. The rashes remain for longer time. DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

  48. INFECTIOUS MONONUCLEOSIS • Moderate fever (102OF). • Pharyngitis, Lymphadenopathy & Splenomegaly. DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

  49. INFECTIOUS MONONUCLEOSIS • Lymphocytosis & presence of atypical lymphocytes. • Caused by Ebstein Barr Virus. DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

  50. RASH OF INFECTIOUS MONONUCLEOSIS • Enanthema at junction of hard & soft palate. • Maculopapular rash in Infectious Mononucleosus appears on treatment with Ampicillin. DR. HARIVANSH CHOPRA-(www.observerzparadise.com)

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