Transcript MEASLES

MEASLES
(RUBEOLA)
Department of Pediatrics
Soochow University Affiliated Children’s Hospital
MEASLES（麻疹）
SUMMARY
1.Measles is an acute infectious disease
2.caused by the measles virus.
3. symptoms and signs such as fever, sneezing,
cough, conjunctivitis（结膜炎）, koplik spots（科氏
斑） and rashes
MEASLES（麻疹）
ETIOLOGY
1.be of paramyxoviridae（副粘病毒属）
2.only one serum type
3.the habit and resistance
4.can be from secretions（分泌物）, urine,blood
MEASLES（麻疹）
1.Measles is an RNA virus
2. be found in nasopharyngeal （鼻咽
部的）secretions,blood,and urine.
3. can remain active for at least 34 hr
at room temperature.
MEASLES（麻疹）
EPIDEMICOLDGIC FEATURE
Before widely using Measles virus’s
attenuated（减毒的） vaccine,Measles
epidemiced once per 2~4 years.But now this
epidemic disappears and the adult patients
gradully increase.
MEASLES（麻疹）
1. epidemic throughout the world
2. In the past,epidemiced in the spring , 2~4 yr
intervals ,new groups of susceptible（易感
者） children
3. be rarely subclinical
4. the age of peak incidence was 5~10yr
5. Individuals born before 1957 are considered
to be immune from natural infection.
MEASLES（麻疹）
Infectious resourse:
Patient,only
Measles is very contagious（传染的）;approximately
90% of susceptible family contacts acquire the
disease. Maximal dissemination of virus occurs by
droplet spray during the prodromal period (前驱期).
Transmission to susceptible contacts often occurs
prior to diagnosis of the original case
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1. Infants acquire immunity transplacentally
（经胎盘） from mothers who have had
measles or measlesimmunization.
2. This immunity is usually complete for the
first 4~6mo of life and disappears at a
variable rate.
3. Although maternal antibody levels are
generally undetectable in the infant by the
usual tests performed after 9 mo of age,
some protection persists, which may
interfere with immunization
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1. infants of mothers with measles vaccine-
induced immunity lose passive antibody at a
younger age than infants of mothers who
had measles infection.
2. Infants of mothers who are susceptible to
measles have no measles immunity and
may contract the disease with the mother
before or after delivery.
MEASLES（麻疹）
Infectivity
① People are easily affected
② Covert（隐性） infection is rare
③ ＜8M infant, ＞8M people
④ Immunocompetence（免疫力） is forever
MEASLES（麻疹）
PATHOGENESIS
Two virus toxemic（毒血的） symptoms
1.Invade the mucosal cells
2.Virus blood symptom
MEASLES（麻疹）
1. 1.The essential lesion（损害） is found in the skin,
in the mucous membrances of the
nasopharynx,bronchi, and intestinal tract,and in
the conjunctivae.
2. Serous exudate（渗出） and proliferation of
mononuclear cells and a few polymorphonuclear
cells occur around the capillaries.
MEASLES（麻疹）
3. Hyperplasia（肿大） of lymphoid tissue
usually occurs,perticularly in the
appendix,where multinucleated giant cells（多
核巨细胞） of up to 100 uM in
diameter(Warthin-Finkeldey giant cells) may
be found.
MEASLES（麻疹）
 Koplik spots consist of serous exudate and
proliferation of endothelial cells similar to those
in the skin lesion.
 A general inflammatory reaction of the buccal
and pharyngeal mucosa extends into the
lymphoid tissue and the tracheobronchial
mucous membrane. Interstitial pneumonitis
resulting from measles virus takes the form of
Hech giant cell pneumonia.Bronchopneumonia
may be due to secondary bacterial infection.
MEASLES（麻疹）
CLINICAL MANIFESTATION
Typical measles
1.Incubation period（潜伏期）
6~18 days,ordinally 10~14 days,even to
21~28 days;
low fever,uncomfortable
MEASLES（麻疹）
CLINICAL MANIFESTATION
The patient may transmit the virus by the 9th-19th
day after exposure and occasionally as early as
the 7th day, before the illness can be diagnosed.
MEASLES（麻疹）
CLINICAL MANIFESTATION
2.Prodroma period
（前驱期）
about 3~5 days.
Fever,low-grade to
moderate fever
MEASLES（麻疹）
CLINICAL MANIFESTATION
URI
a dry cough,coryza,anconjunctivitis. These
symptoms nearly always precede the
appearance of Koplik spots ,the
pathognomonic sign of measles,by 2-3 days.
MEASLES（麻疹）
CLINICAL MANIFESTATION
Koplik spots
they are grayish white dots, usually as small as grains of
sand, that have slight,reddish areolae,occasionally they
are hemorrhagic（出血的）.They tend to occur opposite
the lower molars but may spread irregularly over the rest
of the buccal mucosa.Rarely they are found within the
midportion of the lower lip,on the palate,and on the
lacrimal caruncle（泪埠）.
MEASLES（麻疹）
Koplik spots appear and disappear rapidly, usually
within 12-18 hr.As they fade a red,spotty discoloration of
the mucosa may remain.
MEASLES（麻疹）
CLINICAL MANIFESTATION
Others
The conjunctival inflammation and photophobia（畏光）
may suggest measles before Koplik spots appear.In
particular,a transverse line of conjunctival inflammation,sharply demarcated（以为划界的） along the eyelid
margin,may be of diagnostic assistance in the prodromal
stage.As the entire conjunctiva becomes involved,the line
disappear.
MEASLES（麻疹）
CLINICAL MANIFESTATION
3.Rash period:
about 3~5 days.
The turn usually starts as faint macules on the upper
lateral parts of the neck,behind the ears,along the
hairline,and on the posterior parts of the cheek.The
individual lesions become increasingly maculopapular as
the rash spreads rapidly over the entire face,neck,upper
arms,and upper part of the chest within approximately
the first 24 hr.
MEASLES（麻疹）
CLINICAL MANIFESTATION
① During the succeeding 24 hr it spreads over the
back,abdomen,entire arm,and thighs.
② As it finally reaches the feet on the 2nd-3rd
day,it begins to fade on the face.The rash fades
downward in the same sequence in which it
appeared.
③ The severity of the disease is directly related to
the extent and confluence of the rash.In mild
measles the rash tends not to be confluent,and
in very mild cases there are few.
MEASLES（麻疹）
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colour and shape
The rash is often slightly hemorrhagic,in
severe cases with a confluent rash,they are
maculopapular(斑丘疹）.As the rash
fades ,branny desquamation（糠麸状脱屑）
and brownish discoloration（棕色色素沉着）
occur and then disappear within 7-10 days.
MEASLES（麻疹）
Symptoms accompany
The temperature rises abruptly as the rash
appears and often reaches 40oC(104oF) or
higher.In uncomplicated cases,as the rash
appears on the legs and feet the symptoms
subside rapidly within about 2 days usually with
an abrupt drop in temperature to normal.
MEASLES（麻疹）
① Patients up to this point may appear
desperatately ill,but within 24 hr after the
temperature drops,they appear essential well.
② Lymph nodes at the angle of the jaw and in
the posterior cervical(颈的） region are
usually enlarged.
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③ Otitis media（中耳炎),bronchopneumonia, and
gastrointestinal symptoms such as diarrhea（腹
泻） and vomitting are more common in infants
and small children than in older children.
MEASLES（麻疹）
CLINICAL MANIFESTATION
4.Recover period:
3~5 days after the onset of rashes
1) Rashes fade from face,completely gone within 6
days
2)branny desquamation, brownish
discoloration
3) Fever falls
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LABORATORY FINDINGS
1. Tolal leukocyte counts
2. Multinucleated giant cells
3. Measles IgM antibody
4. Tissue culture
5. Measles antigen
MEASLES（麻疹）
COMPLICATIONS AND SEQUELAE
（并发症和后遗症）
1.Respiratory complications
①Bacterial superinfections
②Pneumonia,bronchotitis,bronchospasm（支
气管痉挛）, croup（哮吼）
MEASLES（麻疹）
2.Cerebral complications
①Encephalitis（大脑炎）
②Subacute sclerosing panencephalitis(SSPE)（亚
急性硬化性全脑炎）
MEASLES（麻疹）
3.Other complications:
① Black measles
② Thrombocytopenia（血小板减少症）,appendicitis（阑
尾炎）,keratitis（角膜炎）, myocarditis（心肌炎）
③ Reactivation or progression of TB(tuberculosis)
④ Premature delivery or stillbirth (死产）
⑤ Mild liver function test elevation
MEASLES（麻疹）
DIAGNOSIS
1. Exposure to measles 10~14 days previously
2. Prodroma of fever,cough,conjunctivitis and
coryza（鼻炎）
3. Koplik sports
4. Maculopapular rash
5. Leukopenia
MEASLES（麻疹）
TREATMENT,PROGNOSIS
and PREVENTION
Recovery generally occurs 7~10 days after
onset of symptoms
1.Therapy:
①Eye care,cough relief,fever reduction
②Second bacterial infections:antimicrobial
③Ribavirin
④Vitamin A
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2.Active vaccination
①First time is after 8M
②Revaccination upon entrance into primary
or second school
3.Patient should be isolated 5 days from rashes
4.Exposed individuals:
①Vaccination within 72 hours
②immune globulin within 6 days
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5.Morbidity and mortality rates（致病率与死亡率）
are substantial because malnutrition（营养不良）
and secondary infections
6.Suspected cases should be diagnosed
promptly and reported to local health
department.
MEASLES（麻疹）
课后练习
1.何为麻疹早期与恢复期诊断标志
2.麻疹病人该隔离多长时间，何时传染性最强
3.麻疹的鉴别诊断
4.Koplik spot,
5.SSPE
MEASLES（麻疹）
参考文献
尼尔逊儿科学
儿科学，人民卫生出版社，薛辛东主编
Paediatrics,北京大学医学出版社
MEASLES（麻疹）
MEASLES（麻疹）